Benefits Checkup

A Service of the National Council on Aging

Helping people with limited means to remain
healthy and improve the quality of their lives...
Man With Glasses Smiling

“We helped the Martis family complete an online BenefitsCheckUp questionnaire a year ago that ultimately brought them nearly $18,000 in rent relief, an emergency call button and an aide who tends to Martis’ mother five days a week. Without the help, Martis would not have been able to help her mother stay in her home.”

-- Lehigh Valley Benefits Ambassador Program

Programs

Medicaid -- This state-run health insurance program pays for a broad range of medical services for people with low income and resources.

Basic services include doctor visits, inpatient and outpatient hospital services, lab tests, x-rays, medical transportation, family planning services, nursing facility services, home health, and nurse practitioner services. To receive benefits through Medicaid, you must go to a doctor or health service provider that participates in Medicaid. Each state runs its own Medicaid program, so eligibility and additional program benefits may vary by state.

People who have Medicare can also receive Medicaid, if they meet their state’s eligibility criteria. Medicaid can cover those services not covered by Medicare such as eyeglasses, hearing aids, dental care, or Medicare co-payments and deductibles.

Medicaid no longer covers prescription drugs for people who are enrolled in Medicare. People who have both Medicaid and Medicare will receive help paying for their prescriptions through the Medicare Prescription Drug Coverage (also called Part D). In addition, people who are enrolled in both Medicaid and Medicare will automatically qualify for the extra help for people with limited incomes and resources available through Part D.

Extra Help/Low-Income Subsidy (LIS) — The LIS helps people with limited incomes and resources pay for their Medicare prescription drug costs. People eligible for the subsidy pay either no deductible (or a lower deductible of $63 per year in 2010), significantly reduced co-payments and have no coverage gap or donut hole as it is often called. People eligible for Medicare and either Medicaid, SSI or one of the Medicare Savings Programs automatically qualify for the LIS, and do not need to apply for it. Other Medicare beneficiaries with limited incomes and resources can apply for the program through Social Security, online through BenefitsCheckUp (www.benefitscheckup.org), or through their state Medicaid office.

SSI — SSI is a federal program administered by the Social Security Administration. The goal of the program is to provide a small cash benefit to eligible aged, blind or disabled people who have very low income and resources. In most states, people who receive SSI are automatically eligible for Medicaid benefits.

Food Stamps/SNAP — As of October 1, 2008, the federal Food Stamp program is now known as the Supplemental Nutrition Assistance Program (SNAP). The program may be known under different names in states. The program provides benefits to qualified enrollees through electronic cards that enable them to buy nutritious food at participating stores. The intent of the Food Stamp program is to ensure that people with limited means are able to afford nutritious food by supplementing their incomes with food stamp benefits. Applications for the program are taken at local social services offices.

Low-Income Home Energy Assistance Program (LIHEAP) — LIHEAP is a federally funded program that provides grants to states to assist qualified individuals with their home heating and cooling costs. The program works to ensure that low-income people do not have to choose between paying their energy bills and buying food or other basic necessities. Each state has different qualifications for their program and different application processes. In addition to assistance with energy bills, some funds are available to make improvements to homes and apartments to make them more energy efficient and reduce heating bills.

Medicare Savings Programs (MSPs) — The Medicare Savings Programs are federally funded, state administered programs to help beneficiaries with their costs related to Medicare.

The Qualified Medicare Beneficiary (QMB) program, for those with incomes under 100 percent of the Federal Poverty Level, pays for Medicare Part A and B deductibles, co-payments and premiums. Both the Specified Low-Income Medicare Beneficiary (SLMB) program, for those with incomes between 100 and 120 percent of FPL, and the Qualified Individual (QI-1) program, for those with incomes between 120 and 135 percent of FPL, pay for a person’s Medicare Part B premiums.

For each of these programs, recipients must have assets below only $4,000 for singles and $6,000 for couples. However, some states may have more generous income or asset eligibility criteria. In addition, those people eligible for one of the MSPs are automatically eligible for the Medicare Part D Low-Income Subsidy.

State Pharmaceutical Assistance Programs (SPAPs) — SPAPs are state run programs that provide prescription drug assistance to low-income seniors and people with disabilities. The amount of assistance under these programs varies by state. Since Medicare Part D went into effect, SPAPs provide important “wraparound” coverage—meaning they can provide additional benefits to enrollees that they would not get under the Part D program.