CL This material has been created or produced by CLAIM with financial assistance, in whole or part, through a grant from the Administration for Community Living. Funding is administered through the Missouri Department of Insurance Financial Institutions and Professional Registration and service is provided by Primaris Foundation, a non-profit organization. Stretching Your Health Care Dollars CLAIM Program Missouri State Health Insurance Assistance Program (SHIP)

What is CLAIM? Community Leaders Assisting the Insured of Missouri Part of the State Health Insurance Assistance Program (SHIP), a national network A state-based program to meet local needs of the Medicare population

Why SHIPs were Created 1.To help consumers: understand Medicare make informed decisions about benefits resolve issues in navigating the Medicare program 2.To provide feedback on state and local problems to the Centers for Medicare & Medicaid Services (CMS) SHIPS were created in 1990 as part of the Medigap reform package

Funding Missouri Department of Insurance Financial Institutions & Professional Registration (DIFP) received the first federal grant in Primaris has been awarded the contract through the DIFP since Primaris Foundation is a non profit organization.

Examples of Who We Serve A Medicare beneficiary and her family A social worker helping a very sick client A 64-year-old retiring in three months Someone who just lost his benefits A professional caregiver who needs information A person who needs help enrolling in Part D Someone needing help to pay healthcare costs

Missouri RX Program Missouri’s State Pharmacy Assistance Program (SPAP): Pays 50% of the beneficiary cost sharing at all coverage levels of Part D coverage Does not pay Plan premiums Is a federally accepted plan Payments count toward Part D plan out of pocket maximums

Missouri RX Program Be enrolled in a Medicare Part D Plan Meet annual income requirements Resources are not counted Be a Missouri resident Provide a copy of: Medicare Card Social Security Card

Manufacture Assistance Programs Company Assistance Programs – discount program Income and/or resource based Will need your doctor to complete required forms Programs vary on coverage and requirements

Pharmacies Help Check out 90 day supply prices - are usually available also. Ask your pharmacy if they have discount programs such as $4 prescriptions Discount program cost do not apply to out-of-pocket cost on the Part D Plan

Low Income Subsidy (LIS) Extra Help through Social Security Administration: May qualify for zero or reduced premium for a basic Part D Drug Plan Reduced co-payments/co-insurance for medication Qualify for continuous open enrollment to change plans Eligibility and level of help determined by both income and resources Application available through Social Security or CLAIM Apply online at

Medicare Savings Programs Federal and State funding through MO HealthNet to assist with: Medicare premiums May pay deductibles and coinsurance Qualifies for extra help with Part D Three Different Levels of Assistance Enrollment - Missouri Family Support Division

Qualified Medicare Beneficiary (QMB) Qualify for a continuous open enrollment to change Part D plans (includes Advantage plans) Eligibility based on income and resources Pays Medicare Part A and Part B Premiums Pays co-insurance & deductibles Part A and B Pays premiums for Part D basic plans, reduces co- pays, eliminates deductibles and coverage gap

Specified Low-Income Medicare Beneficiary (SLMB) Pays Medicare Part B premium Pays for Medicare Part D basic plan premium, reduces co-pays, eliminates deductibles and coverage gap Qualify for a continuous open enrollment to change Part D plans (includes Advantage plans) Eligibility based on income and resources

Qualifying Individual (QI-1 or SLMB Group 2) Pays Medicare Part B premium Pays for Medicare Part D basic plan premium, reduces co-pays, eliminates deductibles and coverage gap Qualify for a continuous open enrollment to change Part D plans (includes Advantage plans) Eligibility based on Income and Resources

MO HealthNet MO HealthNet acts as a supplement to Medicare - pays co-insurance and deductibles for Part A & B Eligibility for Low Income Subsidy for Part D Reduces co-pays, eliminates deductibles and coverage gap Qualify for continuous open enrollment period to change Part D plan (includes Advantage Plans) Eligibility based on Income and Resource

ProgramMonthly IncomeResourcesWhat it pays for Missouri Rx Single $1,805 Couple $2,428 Not counted 50% of Part D cost sharing at all levels of coverage (Will not pay premiums) Extra Help from Social Security (Low-Income Subsidy) Single $1,471 Couple $1,991 Single $13,640 Couple $27,250 Reduces Part D premiums, deductibles, co-pays and eliminates the coverage gap based on income and resource level Qualifying Individual- 1 (QI-1) Single $1,345 Couple $1,813 Single $7,280 Couple $10,930 Medicare Part B premium You are auto enrolled in Part D Extra Help, which lowers the cost of premiums, deductibles, copays, coinsurance, and eliminates coverage gaps. Specified Low-Income Medicare Beneficiary (SLMB) Single $1,197 Couple $1,613 Single $7,280 Couple $10,930 Medicare Part B premium You are auto enrolled in Part D Extra Help, which lowers the cost of premiums, deductibles, copays, coinsurance, and eliminates coverage gaps. Qualified Medicare Beneficiary (QMB) Single $1,001 Couple $1,348 Single $7,280 Couple $10,930 Medicare Part A premiums if applicable Medicare Part B premiums Co-insurance and deductibles for Medicare Parts A & B Cost-sharing for Medicare Advantage You are auto enrolled in Part D Extra Help, which lowers the cost of premiums, deductibles, co-pays, coinsurance, and eliminates coverage gaps. MO HealthNet (Medicaid) Single $854 Couple $1,148 Single $ Couple $2,000 Co-insurance and deductibles for Medicare Parts A & B You are auto enrolled in Part D Extra Help, which lowers the cost of premiums, deductibles, co-pays, coinsurance, and eliminates coverage gaps. May apply for QMB

Other Considerations Always compare health care coverage Ask questions Do not sign papers if you do not understand Just say “no thank you” Always ask for information in writing Don’t be afraid to appeal or to file a grievance

Resources CLAIM Program Local Social Security Administration office Local Division of Family Support Local Area Agencies on Aging Missouri RX Program (MORX)

myMedicare.gov View claim status(excluding Part D claims) Order a duplicate Medicare Summary Notice or replacement Medicare card View eligibility, entitlement and preventive service info View or modify your drug list & pharmacy info View address of record with Medicare & Part B deductible status Access online forms, publications & messages sent to you by CMS

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