Editorial: MEDICARE D EXTRA HELP ASSET LIMITS TOO LOW

For those who qualify, the Extra Help program (also called the Low Income Subsidy or LIS) under Medicare’s prescription drug benefit can be a life saver. Extra Help pays premiums, sets more affordable copayments and provides coverage through the doughnut hole—the gap in coverage that is built into Part D.

For a person with Medicare trying to afford their prescription drugs on less than $1,300 per month—the maximum allowed—Extra Help means prescriptions can be refilled on time, pills no longer have to be split and money does not have to be diverted from the grocery budget.

Unfortunately, millions of older adults and people with disabilities in or near poverty are not getting the help they need. The Extra Help program is not reaching the people it was designed to help. It needs to be fixed.

The problem is the asset test. Over half of those rejected by the Social Security Administration for Extra Help were denied simply because the value of their bank accounts, life insurance policies and retirement accounts were above the low ceilings set by law. A widow with just $7,800 saved for her retirement is ineligible for Extra Help, no matter how low her monthly income.
The problem is worse in the Medicare Savings Programs, which have maximum asset thresholds frozen at $4,000 for an individual and $6,000 for a married couple—levels established two decades ago. Only 20 percent of eligible people with Medicare are enrolled in the Medicare Savings Programs that pay the Part B premium, now nearly $100 per month.

“Medical Record” (References & Notes)

“I am a medical social worker who has discovered that many of the pharmaceutical companies’ patient assistance programs that I previously used to help my patients have now excluded those with Part D, both seniors and the disabled. Those who have low incomes but are a little over the limit for Extra Help are now prevented from getting their meds from the programs that used to provide them” (Story submitted to the Medicare Part D Monitoring Project, Medicare Rights Center, January 2007).

-Adapted from: Save More Lives, Asclepios - Your Weekly Medicare Consumer Advocacy Update, April 24, 2008 • Volume 8, Issue 17, Medicare Rights Center.

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