[Nfbmo] [MALWARE FREE]Re: [MALWARE FREE]Re: Medicare Part d

Fri Mar 2 04:22:21 UTC 2012

Gene I found this on the Missouri HealthNet website:

Who Is Eligible?
Any person who:

is permanently and totally disabled, or is 65 years of age or older, or
is 18 years of age or older and is determined by law to be blind (vision
less than 5/200); 
has net income less than $772 per month for an individual, or $1042 for
a couple. (If monthly income exceeds this amount, the participant may
become eligible when their incurred medical expenses reduce their
monthly income below this limit. For more information, see the section
below labeled Spenddown Coverage.) 
who lives in Missouri and intends to remain; 
who is a United States citizen or an eligible qualified non-citizen; 
if aged or disabled and if single, owns cash, securities or other total
non-exempt resources with a value of less than $1,000, or if married and
living with spouse, individually or together, $2,000 or less (Note:
Exempt resources include the home in which the participant or
participant’s spouse or dependents live, one automobile, household goods
and certain other property. If a disabled child under age 18 is living
with his parents, the non-exempt resources of the parents will be
included); 
if blind and single, does not own personal property worth more than
$2,000 or, if married and living with spouse, does not own property
worth more than $4,000 individually or together,. The following is not
considered; the home in which the blind person lives, clothes,
furniture, household equipment, personal jewelry, or any other property
used directly by the blind person in earning a living.); 
if blind, does not have a sighted spouse who can provide support 
if blind, does not publicly solicit alms; and 
is not a resident of a public, private, or endowed institution except a
public medical institution. 

Spenddown Coverage 
Spenddown refers to the amount of medical expenses that are a person’s
financial responsibility, similar to an insurance deductible. The
spenddown amount is the amount by which an individual’s or couple’s net
income exceeds the non-spenddown income limit. A person’s spenddown
obligation can be met by either: 1) submitting incurred medical expenses
to their eligibility specialist on a monthly basis; or 2) paying the
monthly spenddown amount to the MO HealthNet Division, much like an
insurance premium payment. 

If a person chooses to meet their spenddown with incurred medical
expenses, medical coverage for that month begins the date on which the
spenddown is met and ends on the last day of that month. MO HealthNet
will not pay expenses used to meet the spenddown. 

If a person chooses to pay the monthly spenddown, pay-in prior to the
first day of the month payment is due will ensure continuous coverage.
Pay-in can be by check, money order, or automatic withdrawal from a bank
account. 

Many MO HealthNet participants may also be eligible for Qualified
Medicare Beneficiary or Specified Low-Income Medicare Beneficiary
benefits. 

Qualified Medicare Beneficiary
For persons enrolled in Medicare Part A (hospital insurance), whose
income and resources are within the program guidelines, this program
will provide payment of Medicare premiums and coinsurance, and for
deductibles for Medicare-covered services. 

Who Is Eligible?
The person who:

receives Medicare Part A (hospital insurance) or enrolls in Part A on
the condition the state will pay the premium; 
has net income which does not exceed 100% of the federal poverty level
for the assistance group size; and 
if single owns resources with a value no greater than $6,940 or if
married and living with the spouse, does not own resources over $10,410

QMB Income Standards: 

Number of Persons 
QMB Income Standard 

01
$908

02
 $1226

03
$1545

*Income limits in effect on April 1 , 2011.

 http://www.dss.mo.gov/fsd/massist.htm

http://www.dss.mo.gov/fsd/qmb.htm

>>> "Gene Coulter" <escoulter at centurytel.net> 03/01/12 8:45 PM >>> 

Correction, forgot to correct oneSent: Thursday, March 01, 2012 8:17 PM 
To: NFB MO List 
Subject: [Nfbmo] Medicare Part d 

What happens if Blind persons medical coverage is eliminatede from the
state 
budget? Here is some information on Medicare Part D which would be the 
alternative for us. 
This information is not easy to find. But here are some facts about 
Medicare Part D. Feel free to share at will. 
Minimum Premium monthly $31.08 
Elective premiums can range to around $150.00 or more a month to give
more 
complete coverage including filling the “Doughnut Hole”. 
What drugs are covered: each plan has a set formulary that vary widely 
depending on the plan you select. Vaccines are covered. 
Deductible for 2012: $320.00 before medicare part D pays a dime. 
What are the coverage levels: there three coverage levels: Inital ,
Coverage 
Gap, and Catistrophic 
What are the benefits under Initial coverage: First you must meet the 
$320.00 deductible then you pay 25% of your drug costs and Part D pays
75% 
until costs reach $2930.00 
Coverage Gap: This is the so-called “doughnut hole” and medicare pays 
nothing until your cost have reached $6750.00 
The one benefit during the doughnut hole is that you only pay 86% of the

cost of generic drugs and 50% of name brand drugs provided the drugs are

covered by Medicare. 
Catistrophic coverage: Once you have bills over $6,930.00 you pay 2.60
for 
generic and $6.50 for name brand or 5% of the cost whichever is higher. 
Out of pocket costs: $4,700.00 under initial and doughnut hole before 
reaching the Catistrophic level 
Total costs excluding catistrophic using miminum premium: $5,072.96 

Example For a person getting $1,000.00 SSDi and $707.00 in BP who has 
hretail drug cost of over $6,750.00 a year here is a comparison 
Medicaid: 
Income monthly $1,707.00 
5 prescriptions at $2.00 a piece $10.00 
Net $1,697.00 
Medicare Part D: 
Income $1,707.00 
*Average drug cost $391.67 
Miminum premium $31.08 
Net income $1,284.25 
*This is the average only during the months of the “doughnut hole” the 
coverage could double or triple depending on the persons actual retail
drug 
costs. 
Here is a link to calculate these cost for specific intenses . You can 
also look at various Medicare Part D plans if you wish. 
http://www.medicare.gov/default.aspx 
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