Beneficiaries automatically qualify for Medicare Part D Extra Help (Low-Income Subsidy) if they meet any of these three criteria: having full Medicaid coverage, receiving Supplemental Security Income (SSI) benefits, or being enrolled in a Medicare Savings Program (MSP). These individuals are automatically enrolled without needing to apply.
To be eligible for Extra Help, your resources must be limited to $18,090 for a person or $36,100 for a married couple living together. You should contact Social Security for other resource exclusions.
If you're getting Social Security disability benefits, you'll get Medicare automatically after getting disability benefits for 24 months. If you have ALS (also called Lou Gehrig's disease) you'll get Medicare automatically as soon as you start getting disability benefits.
The extra $144 added to Social Security usually comes from the Medicare Part B Giveback benefit, offered by some Medicare Advantage (Part C) plans, which pays back some or all your Part B premium, showing up as extra money in your check if it's deducted from your Social Security. To qualify, you need Original Medicare (Parts A & B), pay your own Part B premium, live in a plan's service area, and enroll in a specific Medicare Advantage plan that offers this "rebate," with the amount varying by plan and location.
Medicare is a federal health insurance program for people age 65 or older. People younger than age 65 with certain disabilities, permanent kidney failure, or amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig's disease), may also be eligible for Medicare.
Here are some of the biggest Medicare mistakes to avoid:
Federal law forbids nursing homes from seizing patients' income and assets — such as Social Security payments and pensions — unless their accounts are in default, but it does permit nursing homes to serve as representative payees and accept Social Security and other payments directly.
To apply for Medicare Part D Extra Help, you apply through the Social Security Administration (SSA) website (ssa.gov/extrahelp), phone, or in person, providing financial details for income/resource limits to lower prescription drug costs, with free help available from SHIP counselors. Gather documents like bank statements and pay stubs; the online form is quick, and you'll get a mailed notice about approval.
You qualify for an $800 Medicare reimbursement primarily if you're a member of FEP Blue Basic (Federal Employees Program) and have both Medicare Parts A and B, paying your Part B premiums, with reimbursement for those premium costs up to $800 annually, and sometimes similar benefits exist for other federal/postal retirees through programs like GEHA, but eligibility depends on your specific health plan and enrollment in Medicare. It's not a general government program, but a benefit from specific FEHB/PSHB plans for their members.
You are entitled to free prescriptions if you or your partner receive the following benefits:
Pre-existing Condition Exclusion. A limitation or exclusion of benefits for a condition based on the fact that you had the condition before your enrollment date in the group health plan.
The four main categories of disabilities generally recognized are Physical, Sensory, Intellectual/Developmental, and Mental Health/Behavioral, encompassing challenges with mobility, senses (sight/hearing), learning/cognitive function, and emotional/thinking processes, respectively, though specific definitions can vary.
When applying for disability, avoid saying you're "fine" or "okay," exaggerating symptoms, downplaying limitations, or making vague statements; instead, be honest, specific about your functional limits (e.g., "I can't lift more than 5 lbs because it causes shooting pain"), stick to medically supported issues, and don't say you can't work "at all" or that a job doesn't pay enough, focusing on physical/mental inability to work, not just job logistics.
If you and/or your dependent are over age 65, retired, and eligible for premium-free Medicare Part A and premium-based Medicare Part B, CalPERS requires you to enroll in both Part A and Part B and then transfer into a CalPERS Medicare health benefits plan to continue CalPERS health coverage.
Starting in 2025, there is an annual limit on what you pay out-of-pocket for prescription medications through Medicare and Medicare Advantage prescription drug plans. All prescription medications, including specialty medications, covered by Part D plans are included under this cap.
You can avoid paying Medicare Part B premiums by delaying enrollment if you have creditable employer coverage (your own or spouse's job with 20+ employees) until that coverage ends (within 8 months to avoid penalties), or by qualifying for a Medicare Savings Program (MSP) to have state/federal funds pay for it due to low income. Other ways to save include using HSA funds, appealing high Income-Related Monthly Adjustment Amounts (IRMAA) for life changes, or enrolling on time during your Initial Enrollment Period.