If you’re one of an estimated 15,000 low-income seniors in Snohomish County, watch for a white government-issue envelope that could be mistaken for junk mail.
Inside that packet from the Social Security Administration is information to help low-income people 65 and older qualify for discounts in monthly premiums and the annual deductible when Medicare’s new prescription drug program takes affect early next year.
“Right now, the big emphasis is to get people to pay attention to the low-income subsidy and not toss the envelope away,” said Mike Manley, an administrator who oversees aging issues for the county’s human services department.
The mailings began in June and will continue until mid-August.
“What I’ve encountered is a certain level of anxiety,” Manley said. “People are not really sure how they should respond.”
The subsidies for low-income seniors are part of a sweeping national change in helping them pay for prescription drugs next year, replacing the current discount drug-card programs.
Seniors must sign up separately to qualify for the new program, known as Medicare Part D. Information sessions are being scheduled throughout the county to explain both programs to seniors.
For the first time, Medicare will help seniors pay for prescribed medicines outside of hospitals.
“Right now, if you go into the hospital and need drugs, Medicare pays for it,” Manley said. “The minute you leave the hospital, any prescription cost comes out of your pocket.”
That changes next year, when Medicare will pay a portion of prescription costs.
“We consider this … the biggest change to Medicare since its creation,” Manley said.
Seniors will begin seeing ads for the new prescription plans in October, with signups beginning Nov. 15.
The changes are not just in the help seniors can get in paying for prescriptions, but in what they’re required to do to qualify for them, said Tricia Neuman in Washington, D.C., who oversees Medicare issues for the Kaiser Family Foundation, which specializes in health care issues.
“It requires them to take action to get this additional coverage in a way that seniors aren’t used to doing,” she said.
As important as the changes are, surveys show that about two-thirds of all seniors don’t know much about the new benefits, Neuman said.
“Seniors nationwide are at the beginning of a steep learning curve,” she said. “For people with low incomes, a two-step process is coming their way.”
For the first time, Medicare will provide additional benefits for people with low incomes, Neuman said, but they will have to fill out forms that certify they meet the income restrictions.
To get the biggest subsidy, a single senior’s annual income cannot exceed $12,919, and a couple’s annual income can’t exceed $17,320, Manley said. There are restrictions on assets as well.
Partial discounts are available for single seniors whose annual incomes don’t exceed $14,355, or couples whose incomes don’t exceed $19,245, he said.
Seniors who are unsure whether they qualify for discounts should fill out the applications, said Jan Snyder of the Centers for Medicare and Medicaid Services.
“If in doubt, fill it out … so you don’t miss out on an opportunity,” Snyder said.
For all the paperwork hassles, the payoff can be significant.
On average, Medicare is expected to pay $4,189 of drug costs for qualifying low-income seniors, according to the Kaiser Family Foundation.
Monthly prescription drug premiums will be depend on income, ranging from no charge to $37.
Even the lowest-income seniors will still have out-of-pocket costs for prescriptions, such as $1 to $2 for generic drugs or $3 to $5 for brand-name drugs, until out-of-pocket costs reach $3,600, according to the foundation.
Generally, seniors should prepare for changes early next year in the Medicare drug plan, Neuman said. The big exception: Retirees who are included in a prescription drug plan through former employers. That coverage may be equal to or even more generous than the benefits being offered by Medicare, she said.
“Everyone would be well advised to at least think about whether they should sign up for a Medicare prescription drug plan,” she said.
Given the financial and medical impact that prescription drugs have on older people, “this is a very big deal for them to figure out so they get the benefits they deserve,” Manley said.
“This is not a welfare program,” he added. “It’s insurance, pure and simple.”
Reporter Sharon Salyer: 425-339-3486 or salyer@ heraldnet.com.
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