Medicare Assistance Programs

Title: Medicare Assistance Programs

SUMMARY
As a contractor for Medicare, Acentra Health serves as the Beneficiary and Family Centered Care Quality Improvement Organization, also referred to as a BFCC-QIO. While Acentra Health provides BFCC-QIO services in 29 states, the general information is relevant to everyone who has Medicare (including Medicare Advantage) and everyone who works with people who have Medicare. 

This episode is a conversation with our guest, Jeff Young, an Outreach and Education Specialist on the Local Engagement and Administration team at the Centers for Medicare & Medicaid Services (CMS) in Region 10, which services Alaska, Idaho, Oregon, and Washington. His role includes working closely with Congressional offices as well as conducting presentations, trainings, and community events on Medicare Programs across the region. Additionally, he works extensively on several key CMS initiatives, including Medicare Open Enrollment, Health Insurance Marketplace, and Medicaid Renewals. He joined CMS as an intern while obtaining his MPA from Seattle University. Upon completion of his MPA in 2020, he rose to the role of Outreach Specialist and has conducted numerous presentations, reached underserved populations, and prides himself in providing excellent customer service and communication.

For more information about Acentra Health BFCC-QIO, please visit https://www.acentraqio.com.

KEY TOPICS 

00:24: Overview, introduction of guest, Jeff Young
01:35: Medicare updates from the Inflation Reduction Act
05:30: New income guidelines
06:39: Getting help with your Part B premium
10:45: Summary and final thoughts

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RESOURCES

BFCC-QIO Information for stakeholders: www.acentraqio.com/partners

BFCC-QIO Information for people who have Medicare: https://www.acentraqio.com/bene/helpline

State Health Insurance Assistance Program (SHIP) and Senior Health Insurance Benefits Assistance Program (SHIBA): https://www.shiphelp.org/

Medicare: https://www.medicare.gov/

Music: Motivational Upbeat Corporate by RinkevichMusic https://soundcloud.com/rinkevichmusic
https://protunes.net/
Video Link: https://bit.ly/3NNqGTs

Transcript

Scott Fortin
Welcome to Aging Health Matters, a podcast from Acentra Health, a Beneficiary and Family Centered Care Quality Improvement Organization. We plan to cover healthcare topics for the Medicare population. Information in today’s show may help you or someone you know in their healthcare journey. Thanks for joining us. Now let’s get started. 

Nancy Jobe    
Hello everyone. I am Nancy Jobe, an Outreach Specialist for Acentra Health. Acentra Health is the Beneficiary and Family Centered Care Quality Improvement Organization providing services for Medicare beneficiaries in 29 states. We have three key services for people who have Medicare: beneficiaries have a right to appeal discharges from the hospital and skilled service terminations. Acentra Health helps beneficiaries with Immediate Advocacy to resolve medical care issues they may encounter, and beneficiaries can file a quality of care complaint. More information is available on our website at www.acentraqio.com. Today we will be learning about different parts of Medicare. We have Jeffrey Young representing the CMS Region 10 office. Jeffrey, can you tell us a bit about your background? 

Jeff Young 
Thank you for having me, Nancy. My name is Jeff Young. I work for the Centers for Medicare & Medicaid Services Region 10, and thank you for having me on today to talk a bit about some updates to the Medicare program and the Medicare Savings program. 

Nancy Jobe  
Great. Well, I know a lot of people are probably wondering what in the world are these programs that we're going to talk about today, but everybody's always interested in seeing if they could save some money and if we can help them with their healthcare costs with Medicare, then we definitely want them to know about these programs. Why don't you give us a little bit of an overview of what are some of the programs that are out there for them? 

Jeff Young
Absolutely. So what I want to start with today is some of the provisions from the Inflation Reduction Act because several of them are impacting Medicare beneficiaries and their costs. Some of these provisions made updates and changes to the program, particularly on the Medicare Part D, the drug program, and how that will impact people and their costs. So I'm going to run through those real briefly, and more information, of course, can be found on our website, cms.gov. The Inflation Reduction Act, which was passed back in 2022, had several Medicare-related provisions to it. The first one that most people may be familiar with by now is that $35 per month cap on Medicare-covered insulin. That was a really big deal when it went into effect. People most likely already noticed that impact. The other update is access to recommended adult vaccines without cost sharing, so this was a change that allowed the CDC-recommended vaccines to be received by Medicare beneficiaries with no cost sharing.

These vaccines include RSV, pneumococcal, and others. Another cost-saving update from the Inflation Reduction Act is starting next year. So starting in 2025, there will be a yearly cap of $2,000 for out-of-pocket prescription drug costs for Medicare beneficiaries. That fully closes that donut hole actually, and we'll see it come into effect in 2025. Another part which I'll go into briefly here is the low-income subsidy program also called LIS or Extra Help. This is a program that's run through Social Security that basically helps people pay for their Part D premiums and costs depending on income, and under the Inflation Reduction Act, the LIS or Extra Help program was expanded to reach 150% of the federal poverty level. And that went into effect this year.

So again, this is a Social Security-run program for lower income seniors to get help paying their Part D copays and deductibles that has been expanded as of this year. The last part I want to mention on this is the drug price negotiations. You may have heard in the news that Medicare can now negotiate drug prices directly with drug manufacturers, and they've selected some of the costliest single brand name Medicare Part B drugs to begin negotiating. The full list of what drugs will be negotiated are available on our website. And starting in 2026, those price changes you will see take into effect, and these negotiations will continue on as CMS selects further drugs to negotiate. Further updates to help lower the Part D drug costs for seniors.

Another aspect, I know I said this was the last one. One more to highlight here is starting in 2025, Medicare beneficiaries with drug coverage will have the option to pay their out-of-pocket drug costs spread out over the entire calendar year rather than upfront at the pharmacy. So say you have an out-of-pocket drug cost you have to pay. You no longer will have to pay that upfront but can spread it out throughout the full 12 months. That's the Inflation Reduction Act provisions I really wanted to highlight for everybody. 

Nancy Jobe    
I learned a lot just then Jeff. I'm going to tell you what. I like some of those savings that only take place next year. When you were talking about that LIS or low-income subsidy, that is what they consider Extra Help, correct?

Jeff Young 
Yes. We like to use different terms for the same things. I know that confuses people, but you might see it called LIS, Extra Help, low-income subsidy. It's all the same. 

 Nancy Jobe    
Well, I know CMS just did a mailing. In fact, I just received it this week for my parents, the mailing on the new income guidelines, and I was able to look it up and come to find out they will qualify with the new income guidelines. So very excited about getting that application in for them.  

Jeff Young 
Yes, I know. We sent out mailers, and I know sometimes people when you get a lot of mailers, they're easy to ignore.  

Nancy Jobe    
That's definitely a benefit because I know they were always right on the cusp of it. And I'm sure there's lots of people that are just right on that cusp. And since they increased that income guideline, a lot of people will be qualified this year for that. 

Jeff Young 
And if people miss the mailer and they're not sure, they can always go to the Social Security website to apply online or call their one 800 number, which is 1-800-772-1213 to apply. 

Nancy Jobe    
Perfect. Thank you so much. With some of the other things that Medicare helps people with because I know some people have talked about they get some help with their Part B premium, I believe there is a program for that as well. Is that correct? 

Jeff Young 
Absolutely. So this is a really important program. It's an underutilized program called the Medicare Savings Program, or you might see it abbreviated as MSP, and this is a program that it's federally funded, but it's run by each state. And basically the way this program works is it helps pay some of the out-of-pocket costs with Medicare even if you're not fully eligible for Medicaid.  

So to back up a little bit, low-income seniors may be eligible for Medicaid and Medicare, but if you're making a little too much to qualify for Medicaid, you may be eligible for the Medicare Savings Program where the state basically will help pay some of your out-of-pocket Medicare costs such as premiums, deductibles, and coinsurances. There's four levels to the Medicare Savings program, and based on income, they can cover Part A premiums, Part B premiums, Medicare coinsurance, and Medicare deductibles. 

The four levels of this program, and you can look up online or go to Medicaid.gov to find the information based on your income. You might see also called QMB. This is the qualified Medicare beneficiary program. This is one of the MSP program levels. There's also a specified low-income Medicare beneficiary called an SLMB program, which again has its monthly limits. And then what Medicare will or what the program will cover. There's also the qualifying individual program. Again, these are just levels or parts of the MSP program that will help pay these Medicare costs based on your income. The fourth one is the qualified disabled and working individual program, which is for people who potentially have a disability or lost Social Security disability benefits. 
 
So these are the kind of four main parts of the Medicare savings program, but what we really encourage people to do is to get in contact with their state Medicaid office to find out exactly what they qualify for. If you're not sure how to find that, if you go to Medicaid.gov, you can find contact information for your state's Medicaid program to find out if you qualify and apply. You may also always call one 800 Medicare, and they can help direct you to getting in touch with the state to apply for this program and see if your resources and income limits allow you to be eligible for one of these programs. 

Nancy Jobe    
There is hope for a lot of people out there that cause the 80 and 90-year-olds, they have such a lower Social Security level that I think that they're qualifying for some of these. I know that I was helping a lady not too long ago. And her Social Security income was like $800. And you take the Part B premium out of there, that's a quarter of her income. So this program was perfect for her to help her with some of her finances.  

Jeff Young 
Oh, that's great to hear. That's great to hear it. And like I mentioned at the beginning, this is an underutilized program, which means people may not be aware of it, may not be aware that they're eligible, and they're not taking advantage of what they're eligible for. So it's nice to hear that you're able to help someone out with that. 

Nancy Jobe    
Right. And the trick is having these podcasts and having as much communication as we can with people, so that they do learn that there are all kinds of programs available for them. They just have to seek them out, and I know the state health insurance programs in every state, they're trying to educate people as well and working with CMS on that. Just reach out to somebody, and somebody will be able to at least answer your questions for you. 

Jeff Young 
Absolutely. There is always assistance out there, We’re a big proponent of our SHIPs, our State Health Insurance Benefit Advisors, and our one 800 Medicare number. Assistance is out there. 

Nancy Jobe    
I really appreciate knowing a little bit more about those programs. Is there anything else you'd like to share about any of these programs? 

Jeff Young 
Yes, I can just summarize this real briefly. I think I want to highlight. The Inflation Reduction Act had a lot of provisions in it, but I want people to be aware that there are and will be cost savings for prescription drugs. There's free vaccinations for recommended vaccines for adults now covered under Part D, the $2,000 out-of-pocket cap starting next year for Part D so for your drug costs, and that the Medicare savings program is out there, run by states federally funded to help pay your Medicare costs. That's the high level I want people to take away from this, 
what's Medicare doing to lower costs and what your options are out there to help pay for some of these Medicare costs. 

Nancy Jobe    
Jeff, thank you so much because it really it is helpful to know what's going on out there because I know things change all the time in the Medicare world, and we got to get the word out there, so people understand what these changes are, and it really looks like there is a lot of changes this year and next year that are going to be taking place with the Part D for sure. 

Jeff Young 
Absolutely. I know the joke is the government moves slow, but we do make changes; we do make updates. 

Nancy Jobe    
And we like those. Alright. Well, thank you so much Jeff, for being a part of our podcast today and sharing your information with us. It's always good to have somebody that's directly from CMS to help us with the information, and we know it's correct and accurate that way. 

Jeff Young 
Thank you. 

Outro 
If you would like more information about our services for Medicare beneficiaries, please feel free to sign up for our newsletter and subscribe to our YouTube channel. Our Helpline phone number and the link to sign up for our newsletter are available on our website, which will be in the Show Notes. We also have helpful resources available on the website as well. Thank you for joining us today, and please stay tuned for our next episode of Aging Health Matters.