Medicare’s Financial Assistance for Out-of-Pocket Health Care Costs

FINANCIAL HELP TO PAY FOR OUT-OF-POCKET COSTS: MEDICARE'S FINANCIAL CLIFF This graphic shows how financial assistance to pay for out-of-pocket health care costs changes when individuals move into Medicare. WHO IS ENROLLED IN MEDICARE? 41M *** SENIORS Compared to the health insurance marketplace and expanded Medicaid, Medicare's eligibility levels for receiving financial assistance to pay for out-of-pocket 9M PEOPLE WITH PERMANENT costs are more limited and should be expanded to cover more people. DISABILITIES o aaaa 010K/day NUMBER OF BABY BOOMERS BECOMING ELIGIBLE FOR MEDICARE What happens to your help with out-of-pocket costs when you move from the MARKETPLACE OR EXPANDED MEDICAID and into MEDICARE INCOME: 138 - 250% FEDERAL POVERTY LEVEL 250% YOUR INCOME AS PERCENT OF FEDERAL POVERTY LEVEL IF YOU HAVE PRIVATE INSURANCE WITH IF YOU HAVE MEDICARE: PREMIUM SUBSIDIES THROUGH THE HEALTH INSURANCE MARKETPLACE: NO HELP FOR YOUR OUT-OF-POCKET COSTS Are premiums affordable? (Premiums are sliding scale) Individuals who receive premium and copay subsidies through the health insurance Moderate help with your copay costs? marketplace (with incomes between 138 and O No asset test 250 percent of poverty) may face premium and cost-sharing increases when they transition to Medicare. INCOME: 0 - 138% FEDERAL POVERTY LEVEL 138% 135% INCOME: 100 - 135% FEDERAL POVERTY LEVEL IF YOU HAVE MEDICARE: Are your premiums affordable? IF YOU HAVE EXPANDED MEDICAID: Those who receive expanded Medicaid and have incomes No help with copay costs Has asset test between 100 and 138% of poverty may see the most severe increases in out-of-pocket costs (up to thousands of dollars annually) when they move into Medicare.** 100% INCOME: 0 - 100% FEDERAL POVERTY LEVEL IF YOU HAVE MEDICARE: Are premiums affordable? Are premiums affordable? (QMB Medicare Savings Program) No or low copay costs? Low copay costs? (QMB Medicare Savings Program) I) Has asset test O No asset test IF YOU HAVE TRADITIONAL MEDICAID:*** Can enroll in Medicaid (Pays for services that Medicare doesn't cover) A Has asset test 0% LEGEND O No asset test Very good financial assistance !G) Has asset test Good financial assistance O Modest financial assistance No financial assistance available Note: The icon used to illustrate disabilities in this graphic was used via the Creative Commons license from The Accessible Icon Project (http://www.accessibleicon.org/), a project dedicated to transforming the original Intemational Symbol of Access into a more accurate and empowering image for people with disabilities. The project partnered with Triangle, a Boston-based nonprofit that focuses on empowering people with disabilities. *This graphic illustrates financial assistance available to individuals with incomes under 250 percent of the federal poverty level before and after Medicare enrollment. It examines income eligibility and whether assets tests apply. Expanded Medicaid and subsides that help with health insurance marketplace coverage costs impose no asset limit. Medicare Savings Programs (QMB, SLMB, and Ql) for people below 135 percent of the federal poverty level have an asset limit of $7,000 per person. Traditional Medicaid has an asset limit of $2,000 per person. The infographic also does not look at assistance available to Medicare beneficiaries to help with the cost of prescription drugs, known as the Part D low-income subsidy ("Extra Help"). In this graphic, the term "copay" is used represent cost-sharing at the time of service, which includes co-insurance. ** An individual making $13,000 per year will qualify for his or her state's expanded Medicaid program prior to turning 65. Medicaid coverage will have very low cost-sharing and low, if any premiums. Even for someone who is very sick, out-of-pocket costs will be capped at $650 (5 percent of annual income) according to federal law. Upon tuming 65 and enrolling in Medicare, even though this person will be eligible to have his or her Part B premium paid, he or she will have a $147 deductible and 20 percent co-insurance for doctor visits and a $1,216 deductible for hospital care. Median out-of-pocket spending for Medicare beneficiaries in poor health is $2,825 per year, and there is no out-of-pocket cap. *** In most states, the Medicaid income threshold for people with Medicare is 75 percent of the federal poverty level or lower and includes an asset test of $2,000 per person. August 2014 FamilliesUSA.org FAMILIESUSA