Medicare Part D Benefit Summary | Medicare Benefits for Low-Income Individuals
Medicare Benefits for Low-Income Individuals
Three types of enrollees are eligible to receive low-income subsidies:
- Full-benefit "Dual Eligibles" - those individuals who are eligible for both Medicare and Medicaid.
- Individuals with incomes lower than 135% of the Federal Poverty Level (FPL) and who have resources up to $6,000 (or $9,000 for a couple).
- Individuals who have incomes over 135% of the FPL but less than 150% of the FPL and who have resources up to $10,000 (or $20,000 for a couple)
Individuals who fall within the two FPL guidelines above pay no monthly premium and no deductible if they apply for extra help. Individuals who fall into the third category above have sliding-scale premiums and reduced cost sharing.
After January 1, 2006, since Medicaid will no longer pay for prescription drugs, Medicaid recipients will be covered by Part D.
Below is a table with more details about eligibility for the low-income subsidy.
Federal Poverty
Level Indicator |
<100% |
<135% |
136%-140% |
141%-145% |
146%-149% |
February 2006 Federal
Poverty Levels |
$9,570/yr for an individual;
$12,830 for a couple |
$12,919/yr-individual;
$17,320/yr-couple |
$13,015-$13,876/yr-individual;
$17,448-$17,962/yr-couple |
$13,493-$13,876/yr-individual;
$18,090-$18,604/yr-couple |
$13,972-$14,230/yr-individual;
$18,732-$19,117/yr-couple |
| Monthly Premiums |
100% subsidy |
100% subsidy |
100% subsidy |
75% premium subsidy |
50% premium subsidy |
25% premium subsidy |
| Deductible ($250) |
$0 |
$0 |
$0 |
$50 |
$50 |
$50 |
Cost-sharing, Initial
Benefit (<$2,250)
|
$0 |
$1 generic
$3 brand |
$2 generic
$5 brand |
15% coinsurance |
15% coinsurance |
15% coinsurance |
Cost-Sharing,
Coverage Gap |
$0 |
$1 generic
$3 brand |
$2 generic
$5 brand |
Cost-sharing,
Catastrophic Benefit
(> $5,100) |
$0 |
$0 |
$0 |
$2 generic
$5 brand |
$2 generic
$5 brand |
|
| Medicaid Eligible |
Full benefit
dual eligible,
insitutionalized |
Full benefit
dual eligible
QMB,SLMB |
QMB,SLMB,QI |
|
Click here for a low-income subsidy application.
This information is intended to be general and informational in nature, and is not intended to
provide you with legal, medical, tax, financial planning or other professional advice.