LIS - Extra Help - no SS?

[sshafran]

I had an interesting call yesterday. A couple called me, both turning 65.

Husband just got enrolled in Medicare and got an award letter for extra help (and they auto-enrolled him in a pdp). His wife is eligible in a few months, and we presume that she too will qualify for extra help.

They take a few thousand dollars worth of meds monthly, so the extra help is pretty key for them.

Here's the kicker: Neither of them are receiving social security yet. Once they start receiving social security and he stops working, they'll be making more $ (approx $2,200 monthly) and may lose extra help. (Currently, the husband is the only one working and his income is just over $1k monthly).

I don't know why I never thought of this before, but I had always assumed that - before the govt would give someone extra help - they'd require them to actually collect on the income that they can get - i.e. social security benefits.

Apparently this is not the case. You can qualify for the LIS even if you aren't taking your monthly SS.

So, to afford a Med Supp - which they need - they'll probably need to start taking SS.

But, if they take SS, they'll (likely) lose their extra help and, realistically, it's about a 5-6k yearly loss for them in Rx costs (she takes one rx at $5k monthly retail).

I'm not really sure what my question is - but I hate to see them lose extra help... but are they just out of luck on that part of it? How long does it typically take the LIS program to "realize" that people are making more than when they first applied?

Just looking for an idea or two...

 

[Todd King]

Sounds like they might be partial Medicaid at this point. Don't quote me on this, but as soon as they get on Medicare they will have to qualify for it again....which doesn't sound like that's going to happen due to the increased income.

 

[sshafran]

Sounds like they might be partial Medicaid at this point. Don't quote me on this, but as soon as they get on Medicare they will have to qualify for it again....which doesn't sound like that's going to happen due to the increased income.

Seems like there should be this question on the Extra Help application:

"Are you holding off on getting other income simply so that you can get the government - i.e. taxpayers - to pay for your medication costs?"

 

[GreenSky]

Seems like there should be this question on the Extra Help application:

"Are you holding off on getting other income simply so that you can get the government - i.e. taxpayers - to pay for your medication costs?"

That's question #723 to qualify for an Obamacrap subsidy. If you are an illegal you can just leave this and all other questions blank as you auto-qualify.

Rick

 

[kgmom219]

What drug is she taking that's $5K retail????

I think that they are going to lose the extra help when taking SS. But I can barely spell LIS, much less explain it.

Can she take the spousal SS at 65, but leave him going to age 66? Will that be too much to kick them off? Or she take her SS and he take the spousal benefit?

How are they paying for the meds now? They make $1K a month, but the meds are $2K?

There's something not adding up in the story. Not sure what. But something.

 

[sshafran]

What drug is she taking that's $5K retail????

I think that they are going to lose the extra help when taking SS. But I can barely spell LIS, much less explain it.

Can she take the spousal SS at 65, but leave him going to age 66? Will that be too much to kick them off? Or she take her SS and he take the spousal benefit?

How are they paying for the meds now? They make $1K a month, but the meds are $2K?

There's something not adding up in the story. Not sure what. But something.

Enbrel INJ - medicare.gov says 4,700.... plus 18 (yes, eighteen) other Rx's - one of which is insulin.

From what I understand, for now, it's a combination of Medicaid and an obamacare plan and manufacturer assistance - this enables them to pay and/or obtain rx's.

I haven't checked into her rx's specifically on this - but I know many manufacturers end their help once one becomes eligible for Medicare.

 

[Hopes]

If he'll only be making $2200/mo, he may still qualify for Extra Help won't he? Extra Help With Medicare Prescription Drug Plan Costs, Social Security

If not, would he qualify for some financial assistance through the drug manufacturer. Enbrel® (etanercept) Financial Assistance

 

[kgmom219]

Depending on the diagnosis, tell her to switch to Humira. Or Remicaide.

Whatever drug is covered under Part B

 

[sshafran]

If he'll only be making $2200/mo, he may still qualify for Extra Help won't he? Extra Help With Medicare Prescription Drug Plan Costs, Social Security

If not, would he qualify for some financial assistance through the drug manufacturer. Enbrel® (etanercept) Financial Assistance

The limit is just over $24,000 yearly for a couple. I think you may have been looking at the assets number - which is 28k.

 

[Hopes]

The limit is just over $24,000 yearly for a couple. I think you may have been looking at the assets number - which is 28k.

Aw yes, that's exactly what I was looking at. I read that you didn't have to include your home, vehicle, etc and ran with it. (Edited to add ?) Where does the $24,000 come from? I don't see it.