Senior Health Information and Insurance Education

Need Help Paying for Medicare?

Two programs that may help you save!

If you're a Medicare beneficiary, you may qualify for programs that could save you money! Contact SHIINE to help you apply!


1. The Medicare Savings Programs

There are three different programs offered in South Dakota and the qualifications and benefits for each program vary.

What types of expenses are covered?
If you qualify, Medicare Savings Programs may cover:
  • Part A premiums
  • Part B premiums
  • Medicare co-payments
  • Medicare deductibles

How do I apply?
  • Visit your local Department of Social Services office.
  • When applying for Extra Help (Low Income Subsidy for Medicare Part D) your application will be sent to the Department of Social Services, where they will follow up with a mailing to gather more information to determine which Medicare Savings Program you qualify for.
You can have either Original Medicare (Part A and B) or a Part C (Medicare Advantage Plan).

Medicare Savings Programs to help with Medicare Parts A and B costs (Effective 2016)


Income less than: Assets* less than:
Single person $1,337 per month $7,280
$16,044 per year
Couple $1,803 per month $10,930
$21,636 per year
*The Department of Social Services (DSS) does not count $1,500 above asset limits per person if it's set aside in a specific burial fund. Call your local DSS office to see what types of accounts qualify.

2. Extra Help program for savings with Medicare Part D

What is covered?
If you qualify, Extra Help may cover:
  • Premiums
  • Deductibles
  • Some copays
  • Donut hole/coverage gap (This is a temporary coverage gap where the plan you are in reduces the amount they pay for your prescriptions and you have to pay more. This coverage gap is being phased out due to the Affordable Care Act and will no longer exist in year 2020.)
How do I apply?

Caution:
If you receive prescription coverage from an employer plan, you may not want to apply for this help. It could cause you to lose coverage through your employer health plan.


Extra Help for Part D (Effective 2016)

Income less than: Assets less than:
Single person $1,505 per month $13,640
$18,060 per year
Couple $2,023 per month $27,250
$24,276 per year
Note: People with earned income or more individuals in their household may have higher income and still qualify for Extra Help!

Limited Income NET

Medicare?s Limited Income NET provides immediate prescription drug coverage for people with Medicare who are at the pharmacy counter and qualify for Extra Help, but aren?t enrolled in a Medicare Prescription Drug Plan. Medicare?s Limited Income NET Program covers all Part D covered drugs, and there are no network pharmacy restrictions during the time period covered by this program. The person will be charged the
reduced co-payment based on the level of Extra Help they get.

Medicare?s Limited Income NET Program also covers prescriptions that eligible people filled within the last 30 days.

For more information on getting your prescriptions filled at a pharmacy using the LI NET program, click here.
 
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