Low Income Assistance available in Washington State

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For plan year 2020, individuals earning below $1595 per month with less than $14610 in assets or married couples earning below $2155 per month with less than $29160 in assets MAY qualify for some of the below programs.  There are many details about these plans, as well as different levels of coverage.  Note: some individuals who enroll in the Medicare Savings Program may not receive a State of Washington Service Card (from Provider One) pictured above.  For clarification, please contact us for more details.  We do not directly administer any of these programs, but we have the most important information available to help you understand.

The key thing to remember is that we have many different options available to those who qualify for any of the below State and Federal programs.  We have some Medicare Advantage Plans specifically designed for some individuals, as well as reduced costs for an entire section of our remaining portfolio.  Individuals eligible for the programs below are also given more opportunity throughout the year to add or improve their existing insurance coverage.  We spend a large portion of the year doing exactly that for people using our knowledge related to your specific location.  We understand LOCAL issues.   Ask us, if you are unsure.

 

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Still have questions or need additional assistance:

Medicare Savings Program

The Medicare Savings Program is jointly funded by the State of Washington and the Federal Government, and is administered through DSHS.  Although it's collectively referred to as a Medicaid program, it operates with rules specific to those on Medicare and is different from "Apple Health."   If someone is eligible for Medicaid or the Medicare Savings program, we will refer to them as DUAL ELIGIBLE.

There are basically two types of eligibility. Those that are FULL Dual and those that are PARTIAL Dual.  The primary differences in qualifications are largely based on household income and assets.  In some cases, exceptions are made for certain medical conditions and level of need.

Full Dual individuals will have all of their Part B premiums paid for, along with all associated Part B and Part A co-pays, co-insurance, and deductibles.  They may still be obligated to pay costs for services not covered by Medicare.   The generally qualify for additional Medicaid benefits, even if some are required to pay a small spend-down before receiving those additional benefits.

All Full Dual individuals qualify for an additional Medicare Advantage plan that gives them even more benefits, while retaining all their original benefits associated with being Full Dual.  Additional benefits that are otherwise not include with Original Medicare may include some of the following (these are enhanced benefits in addition to any benefits included with Medicaid):

  • Enhanced priority Transportation assistance
  • Food benefits
  • Gym membership
  • Dental coverage
  • Vision coverage and eye wear allowance
  • Over the Counter medical supply allowance (which may include product catalogs and/or select in-store purchases)
  • Hearing aid allowance
  • Routine Podiatry
  • Routine chiropractic and acupuncture care
  • Nurse line
  • and more

These are Dual Special Needs Plans (DSNP) specifically designed for them.  It would be illegal for us to knowingly offer a Medicare Supplement plan to anyone who is Full Dual, but a DSNP plan is highly encouraged.   Please contact us for details, availability, and qualifications.  Some restrictions apply.

Partial Dual individuals are those that only qualify to have their Part B premiums paid for.  They are still obligated to pay for their co-pays, co-insurance, deductibles, and other associated costs not covered.  Some individuals who qualify for Partial Dual eligibility might be told they have a spend down.  That simply becomes their Out-of-Pocket Maximum.  Once they hit their spend down (often prohibitively high), their Medicaid pays the remainder of their medical expenses.  We will generally recommend a quality Medicare Advantage Plan to help reduce short term costs, to supply prescription drug coverage, and to sometimes add additional valuable benefits.  We have several options available for those who may only be "Partial Dual Eligible," which can greatly increase benefits and assist in reducing many of the costs related to healthcare.

For FREE guidance on qualifications or assistance with applying for the Medicare Savings Program with DSHS, please contact us for details.  I have met many individuals and couples who were told they make too much for Medicaid (Full Dual) but DID in fact qualify for the Medicare Savings program (Partial Dual).  Some of these people failed to enroll in the program that would have paid their Part B premiums and provided discounts for additional coverage.  Don't let that happen to you.  We can help with a free review.

Low Income Subsidy (AKA "Extra Help" or LIS)

The Low Income Subsidy (LIS) program is Federally funded and administered through the Social Security Administration (SSA).  All Full Dual and Partial Dual individuals will also qualify for the full level of "Extra Help."  There are three additional income and asset levels that still provide varying degrees of reduced costs, even if someone is told they make too much money for the Medicare Savings Program at DSHS.  We know individuals and couples that "just" miss the income and asset threshold for the Medicare Savings Program who subsequently fail to apply for the LIS program.  Even if you don't qualify at 100% assistance, you may qualify at 75%, 50%, or 25% assistance.  We have met many people not enrolled in this program who ended up in one of the four levels of assistance after knowing what to ask.  For FREE guidance on qualifications or assistance with applying with SSA, please contact us for details.

"Extra Help" is specifically designed to help reduce costs associated with Prescriptions Drug coverage.  Depending on what level of assistance someone qualifies for, the following may apply:

  1. Reduced or NO Co-pays
  2. Reduced or NO deductibles
  3. Reduced or NO Co-insurance
  4. Reduced out of pocket maximums, or the elimination of the Coverage Gap (Donut hole).
  5. Waiver of Part D's late enrollment penalty
  6. Reduced or NO Part D premiums, if enrolled only in stand-alone Prescription Drug Plan (PDP)
  7. Reduced Part C premiums.  This depends on the specific plan and is basically a reduction or elimination in the portion of the premium designated for drug coverage within the Medicare Advantage Plan.

Please contact us for more details.  These programs are complicated, but we can help simply how they will work for YOUR specific situation.  This often misunderstood benefit can be helpful for individuals to obtain more comprehensive medical coverage with more added benefits than they might otherwise choose, as a result of the reduced premiums.  We can calculate the applicable change in premiums for you and provide you several options that could improve available benefits.

Other considerations

LIS (Extra Help) and the Medicare Savings programs are the most common means for people of low income to reduce their medical and prescription drug costs associated with Medicare.

State law does provide additional assistance at various medical facilities.  The providers at effected locations are required to provide this information to you.  DSHS also administers a number of specialty programs for certain individuals with specific conditions.  Contact DSHS for more information.  You may contact us for FREE guidance or information.

I know we stated it several times earlier, but it's also important to remember that most who qualify for the State and Federal programs mentioned on this page may ALSO qualify for additional benefits or reduced costs with their added Medicare coverage.  Some might qualify for a specially designed plan, while the rest may qualify for reduced costs.  Those reduced costs often allows people to either choose a more comprehensive plan than they would otherwise wish to afford, or receive additional benefits at a reduced rate.  We now have more choices to offer than ever before

Many who qualify for the above programs are allowed to make changes, additions, or improvements throughout the year.  There are specific rules for this, but that's part of how we help.