FREE/LOW COST BENEFITS

MEDICARE

What is Medicare?

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities and people with End-Stage Renal Disease (Permanent Kidney Failure requiring dialysis or a transplant, sometimes called ESRD).

The different parts of Medicare help cover specific services:

Medicare Part A (Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance)

Part B covers certain doctors' services, outpatient care, medical supplies, and preventative services.

Medicare Part C (Medicare Advantage Plans)

A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren't paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.

Medicare Part D (Prescription Drug Coverage)

Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

How to Apply:

Call the Social Security Administration toll-free at 1-800-772-1213 or apply online at http://www.socialsecurity.gov/medicare/.

Additional Information About Medicare

For more information regarding Medicare, use the following resources:

1-800-MEDICARE(1-800-63-4227)
WWW.MEDICARE.GOV
1-800-722-1213 (SOCIAL SECURITY ADMINISTRATION)
WWW.SOCIALSECURITY.GOV
1-800-434-0222 (HICAP)
WWW.AGING.CA.GOV/HICAP/DEFAULT.ASPX

SOCIAL SECURITY

What is Social Security

A federal income assistance program designed for people 62 or older, people with disabilities, and people with low income.

Social Security Retirement (SSR): SSR is a program for seniors funded by the federal government. Eligibility to receive SSR is based on one’s work history, while the amount of monthly benefits received reflects past earnings. Workers who are 62 or older, people with disabilities, or the spouse and children of a deceased or disabled worker who paid into the Social Security program are eligible for Social Security Retirement benefits.

Social Security Disability (SSD): SSD is another federal program based on one’s work history and earnings. It’s available to workers who, although younger than retirement age, are now disabled. A disabled person has a physical or mental impairment that is expected to last at least 12 months, or to result in death, and keeps them from performing substantial gainful activity.

Supplemental Security Income (SSI): SSI provides monthly income to people with low incomes who are blind, disabled or over the age of 65. To be eligible for SSI, a single person cannot have more than $2,000, and a couple cannot have more than $3,000, in countable assets.

How to Apply

Social Security Retirement (SSR): You can apply for Social Security Retirement benefits online at www.socialsecurity.gov/retirement or make an appointment at your local Social Security office by calling 1-800-772-1213.

Social Security Disability (SSD): You can apply for Social Security Disability benefits online at www.socialsecurity.gov/disability ssi or make an appointment at your local Social Security office by calling 1-800-772-1213.

Supplemental Security Income (SSI): The Social Security Administration does not currently offer an online application for Supplemental Security Income benefits. To apply, you can call 1-800-772-1213. If you are deaf or hard of hearing, you can call TTY 1-800-325-0778. You can also make an appointment at your local Social Security office.

Additional Information About Social Security

For more information regarding Social Security, use the following resources:

1-800-772-1213 (SOCIAL SECURITY TOLL FREE)
WWW.SOCIALSECURITY.GOV
WWW.AGING.CA.GOV

MEDI-CAL

MEDI-CAL, the Medicaid program in California, provides health coverage to people with low-income and asset levels who meet certain eligibility requirements.

What Medi-Cal Covers

Physician Visits
X-ray and laboratory tests
Hospital and nursing-home care
Home Health Care
Certain prescription drugs excluded as a Medicare Part D benefit
Prosthetic and orthopedic devices
Hearing aids
Medical equipment
Ambulance services
Hospice care

Medi-Cal will only cover these costs and services if you use providers that accept Medi-Cal. If you have both Medicare and Medi-Cal, Medicare is the primary payer (meaning Medicare will pay first for Medicare-covered benefits) and Medi-Cal is the secondary payer. If you qualify for full Medi-Cal (Medi-Cal without a share of cost (SOC)), Medi-Cal will also cover your Medicare Part A and B deductibles and co-payments, and pay your monthly Medicare Part B premium.

Prescription Drugs

If you are receiving both Medicare and Medi-Cal benefits,the Medicare Part D drug benefit will provide your prescription-drug coverage instead of Medi-Cal. You must be enrolled in a Medicare Part D drug plan or a Medicare Advantage prescription drug plan to get these benefits. (Note: if you are in Cal MediConnect, you will get your prescription drugs through your Cal MediConnect managed care plan.) Medi-Cal, however, will pay for certain categories of drugs not covered by Part D, including:

Drugs used for smoking cessation
Certain cough and cold drugs
Certain over-the-counter drugs
Vitamins and minerals

How to Qualify

To find out if you qualify for one of Medi-Cal's programs, look at your countable asset levels. You may have up to $2,000 in assets as an individual or $3,000 in assets as a couple. Some of your personal assets are not considered when determining whether you qualify for Medi-Cal coverage. For example, assets that do not count are:

Your Primary home
One Vehicle
Household goods and personal belongings
Life-Insurance policy with a face value of $1,500 per person
Prepaid burial plan (unlimited or up to $1,500 if revocable) and burial plot

Medi-Cal Programs

Supplemental Security Income (SSI)

If you qualify for Supplemental Security Income (SSI), you automatically qualify for full Medi-Cal coverage. To qualify for SSI, you must be age 65 or older, blind or disabled. Your countable monthly income may not exceed $877.40 for an individual or1,478 for a couple (higher income levels apply for individuals who are blind)

Aged & Disabled Federal Poverty Level (A&D FPL) Program

If you are aged (65+) or disabled and are not eligible for the SSI program, you may be able to get Medi-Cal through the Aged & Disabled Federal Poverty Level Program.

Federal Poverty Level (A&D FPL) program.

To qualify, you must:

Be aged (65+) or disabled (meet Social Security's definition of disability, even if your disability is blindness).
Have less than $2,000 in assets for an individual ($3,000 for a couple). Like SSI, this program does not count all of your assets.
Have less than $1,203 in countable monthly income for an individual ($1,621 for a couple).

Medi-Cal with a Share of Cost (SOC)

If your monthly income is higher than the limits to qualify for SSI or the A&D FPL program (see above), but you meet the asset-level requirements, you may still be eligible for Medi-Cal with a share of cost (SOC). An SOC functions like a deductible. You must pay this amount in any month you incur medical costs. After your SOC is paid, Medi-Cal will pay the remaining amount of your medical bills for that month.

Note: An SOC is paid only for the months you have incurred medical expenses; it is not a monthly premium. Your SOC is determined according to your monthly income, using the following formula: Medi-Cal subtracts $600 (for an individual) or $934 (for a couple) from your monthly income, and any other health-insurance premiums you may be paying.

For example, if you have an individual monthly income of $1,300, Medi-Cal subtracts $600 for an SOC of $700. This means you must pay at least $700 in covered medical expenses and/or health care premiums in a given month before Medi-Cal covers any of your health care costs for that month. For people with a high SOC, Medi-Cal is mostly a form of catastrophic coverage, meaning Medi-Cal will most likely only help them for emergencies or high-cost medical conditions.

Note: If you have Medi-Cal with a SOC, Medi-Cal will no longer pay your Medicare Part B monthly premium. This means your Part B premium will be deducted from your Social Security check each month. One exception applies if you are in a Medicare Savings Program (MSP) that pays for your Part B premium (QMB, SLMB or QI). If you are in one of these MSPs, you will not be affected.

If you meet your SOC with medical costs in any given month, Medi-Cal will retroactively pay your Part B premiums for the month(s) in which the SOC is met. Medi-Cal will send the payment to the Social Security Administration (SSA), which will refund you the amount of the premium. Any Part B premium refund received from the SSA will be counted as a resource, not income, in the month you receive it.

250% California Working Disabled (CWD) Program

The 250% California Working Disabled (CWD) program helps Californians who are working, disabled and have income too high to qualify for free Medi-Cal. Californians who qualify may be able to receive Medi-Cal by paying a small monthly premium based on their income. Premiums range from $20 to $250 per month for an individual or from $30 to $375 for a couple.

To qualify, you must:

Meet the medical requirements of Social Security's definition of disability, but you are not required to meet the agency's income and work requirements.
Be working and earning income (this can be part-time work).
Have assets worth less than $2,000 for an individual or $3,000 for a couple. Note: IRS-approved retirement funds, such as 401(k)s and IRAs, are exempt and not counted.
Have countable income less than 250% of the federal poverty level (in 2014, this equates to $2,432/mo. for individuals or $3,278/mo. for couples). Disability income does not count toward the limit, including: Social Security Disability Insurance (SSDI), Worker's Compensation, California State Disability Insurance (CSDI), Federal, State, and private disability benefits.

How to Apply

When you apply and qualify for Supplemental Security Income (SSI) at your local Social Security Administration office, you are automatically enrolled in Medi-Cal and will be sent a Benefits Identification Card (BIC). If you do not qualify for SSI, you may still qualify for Medi-Cal with or without a share of cost (SOC). Contact your Medi-Cal county office for
more information.

If you or your spouse anticipates placement in a nursinghome, contact your Department of Public Social Services (DPSS) county office to learn about the Medi-Cal rules for long-term care. These rules are very different than the rules that apply if you are not in a nursing home. Learn more about qualifying for Medi-Cal long-term care coverage.

Note: If you are hospitalized and think you may need to go into a nursing home, you may also ask the hospital's Medi-Cal specialist for assistance.

Apply for Medi-Cal as soon as possible if you think you may not be able to afford your medical expenses or nursing-home placement. Processing your application can take several weeks because Medi-Cal must first determine eligibility by verifying your income and personal assets before coverage can be approved. You may request Medi-Cal to pay retroactively for the three months prior to the month in which you apply.

Health Insurance Premium Payment (HIPP) Program

If you qualify for Medi-Cal and have private health insurance to help cover a high-cost medical condition, Medi-Cal may pay your premiums through its Health Insurance Premium Payment (Medi-Cal/HIPP) program.

To qualify, you must:

Be on Medi-Cal.
Have private insurance such as employer coverage, individual health insurance or a Medigap policy.
Have a high-cost medical condition.
Have a share of cost (SOC) less than $200. Note: Some exceptions exist that allow you to have an SOC over $200.
Have Medi-Cal determine that it is more cost-effective to pay your premiums than for you to use Medi-Cal.
Note: The Medi-Cal/HIPP program does not help pay the costs of Medicare-covered services, and is not available to members of Medicare Advantage (MA) plans.

For more information, contact HIPP through the California Department of Health Care Services
website or at 1-866-298-8443.

MEDICARE SAVINGS PROGRAM

Medicare Savings Programs (MSPs)

Medicare offers several Medicare Savings Programs (MSPs) that assist people with low income and assets: Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualified Individual (QI) and Qualified Disabled Working Individual (QDWI). California also offers the 250% California Working Disabled (CWD) program.

You must meet certain income and asset limits to qualify for these programs, which are administered by Medi-Cal (the California health program known as Medicaid in other states).

1. Qualified Medicare Beneficiary (QMB)

The Qualified Medicare Beneficiary (QMB) program helps pay for the following Medicare costs:

Medicare Part A premium. Note: Some people are required to pay a premium for Medicare Part A because they do not have enough Social Security credits. Most people do not pay a premium for Medicare Part A because they or their spouse earned enough credits by working 40 or more quarters (approx. 10 years of working full-time, four quarters per year). People who worked 30-39 quarters may buy Part A coverage and pay a monthly premium of $234 in 2014. People who worked fewer than 30 quarters may also buy Part A coverage and pay a higher monthly premium of $426 in 2014.

Medicare Part B premium ($104.90 per month in 2014)

Deductibles for both Part A ($1,216 per benefit period in 2014) and Part B ($147 annually in 2014)

Coinsurance under both Part A and Part B. For example, under Part A, QMB pays the $304 per day for hospital days 61-90, and the $608 per day for the 60 hospital lifetime reserve days in 2014. Under Part B, QMB pays the remaining 20% coinsurance after Medicare pays 80% of the covered outpatient medical services such as physician visits, as long as you see doctors and other providers who accept Medi-Cal. Note: This is because Medi-Cal administers the MSPs and will only pay providers who accept Medi-Cal.

How to Qualify

To qualify for QMB, your monthly income cannot exceed $973 if you are single ($11,670/year) or $1,311 ($15,730/year) if you are part of a couple.

Note: A $20 "disregard" is subtracted from your monthly income (earned or unearned). When you apply for QMB, your eligibility worker will automatically deduct $20 from your monthly income. For some people whose income is close to the limit, this $20 disregard allows them to qualify for the program.

In addition, your personal assets (cash, money in the bank, stocks, bonds, etc.) cannot exceed $7,160 for an individual or $10,750 for a married couple. Certain items are not calculated in your personal asset limit, including but not limited to the value of:

One home
Household goods and personal belongings
One car
Prepaid burial plan (unlimited if irrevocable or up to $1,500 if revocable) and burial plot
Retroactive Social Security or Supplemental Security Income (SSI) benefits are also excluded for 6 months after you receive them.

2. Specified Low-Income Medicare Beneficiary (SLMB)

The Specified Low-Income Medicare Beneficiary (SLMB) program helps people with low income pay their Part B premiums. This premium would ordinarily be deducted from their monthly Social Security checks.

How to Qualify

To qualify for SLMB, your monthly income cannot exceed $1,167 if you are single ($14,004/yr.) or $1,573 ($18,876/yr.) if you part of are a couple.

Note: A $20 "disregard" is subtracted from your monthly income (earned or unearned). When you apply for SLMB, your eligibility worker will automatically deduct $20 from your monthly income. For some people whose income is close to the limit, this $20 disregard allows them to qualify for the program.

In addition, your personal assets (cash, money in the bank, stocks, bonds, etc.) cannot exceed $7160 for an individual or $10,750 for a married couple. Certain items are not calculated in your personal asset limit, including but not limited to the value of:

One home
Household goods and personal belongings
One car
Prepaid burial plan (unlimited if irrevocable or up to $1,500 if revocable) and burial plot
Retroactive Social Security or Supplemental Security Income (SSI) benefits are also excluded for 6 months after you receive them.

3. Qualified Individual (QI)

The Qualified Individual (QI) program helps people with low income pay for their Part B premiums, with a higher income limit than QMB or SLMB programs.

How to Qualify

To qualify for QI, your monthly income cannot exceed $1,313 if you are single ($15,755/yr.) or $1,770 ($21,236/yr.) if you are part of a couple.

Note: A $20 "disregard" is subtracted from your monthly income (earned or unearned). When you apply for QI, your eligibility worker will automatically deduct $20 from your monthly income. For some people whose income is close to the limit, this $20 disregard allows them to qualify for the program.

One home
Household goods and personal belongings
One car
Prepaid burial plan (unlimited if irrevocable or up to $1,500 if revocable) and burial plot
Retroactive Social Security or Supplemental Security Income (SSI) benefits are also excluded for 6 months after you receive them.

4. Qualified Disabled Working Individual (QDWI)

The Qualified Disabled Working Individual (QDWI) program is available to people who had Social Security and Medicare benefits because of a disability, but lost them because they returned to work and their earnings exceeded the allowable limit. QDWI pays for the Medicare Part A premium, but it doesn't pay for Part B.

How to Qualify

To qualify for QDWI, your monthly income cannot exceed $3,975 if you are single or $5,329 if you are part of a couple.

Note: A $20 "disregard" is subtracted from your monthly income (earned or unearned). When you apply for QDWI, your eligibility worker will automatically deduct $20 from your monthly income. For some people whose income is close to the limit, this $20 disregard allows them to qualify for the program.

In addition, your personal assets (cash, money in the bank, stocks, bonds, etc.) cannot exceed $4,000 for an individual or $6,000 for a married couple. Certain items are not calculated in your personal asset limit, including but not limited to the value of:

One home
Household goods and personal belongings
One car
Prepaid burial plan (unlimited if irrevocable or up to $1,500 if revocable) and burial plot
Retroactive Social Security or Supplemental Security Income (SSI) benefits are also excluded for 6 months after you receive them.

5.250% California Working Disabled (CWD)

California offers qualifying residents the 250% California Working Disabled (CWD) program. To qualify, you must be working, disabled and have income too high to qualify for free Medi-Cal. If eligible, you may be able to receive Medi-Cal coverage by paying a small monthly premium, ranging from $20-$250 per month for an individual or from $30-$375 for a couple.

How to Qualify

To qualify for CWD, you must:

Meet the medical requirements of Social Security's definition of disability, but are not required to meet the agency's income and work requirements
Be working and earning income (this can be part-time work)
Have assets worth less than $2,000 for an individual or $3,000 for a couple
Have countable income less than 250% of the federal poverty level (in 2014, this equates to $2,432/mo. for individuals or $3,278/mo. for couples). These income calculations are different from those for the Medicare Savings Programs (MSPs). Disability income does not count toward the 250% CWD program’s income limit, including:
Social Security Disability Insurance (SSDI)
Worker's compensation
California State Disability Insurance (CSDI)
Any federal, state or private disability benefits

How to Apply

To apply for QMB, SLMB, QI or QDWI, you must also be eligible to receive Medicare Part A and Part B. If you are already enrolled in both Medicare parts, contact your California Department of Health Care Services (DHCS) county office to apply for these programs or the 250% California Working Disabled (CWD) program. Note: Having Medicare is not required to enroll in the CWD program.

If you are eligible for Medicare but not enrolled in Part A and/or Part B, you can enroll in Part B anytime through your local Social Security Administration (SSA) office (1-800-772-1213). However, you can only enroll in Part A during a specific enrollment period. This is important if you are applying for the QMB program. For instance:

If you just became eligible for Medicare and are in your Initial Enrollment Period (IEP), you may apply for QMB (through your DHCS county office), and Parts A and B (through the SSA).

If you are already enrolled in Part B, and eligible but not enrolled in Part A, you may apply for QMB (through your DHCS county office) and Part A (through the SSA) during the Medicare General Enrollment Period (GEP), which is January 1 to March 31 each year.

When applying for Part A, you may state in writing that you want "Conditional Medicare" under one of the Medicare Savings Plans (MSPs). This means you only want to receive Medicare on the condition that an MSP will pay for your Medicare premiums. Once you become eligible for Medicare, follow up with your county's DHCS office to apply for QMB, SLMB, QI or QDWI benefits, or to verify your application status. Medi-Cal recipients don't need to complete a new application.

To apply for the CWD program, contact your county’s DHCS office and specifically request an appointment with a coordinator authorized to work in the 250% CWD program.