Three Reasons You Should Apply for State Medical Benefits in 2018

If you earn a low income and have trouble paying your medical expenses, you might want to consider applying for your state’s Medicaid benefits.

Medicaid expansion has changed eligibility requirements

Medicaid expansion has changed eligibility requirements in 2018 in many states, so if you applied in years past and was denied, you might have a different outcome by applying again this year.

Each state has a different set of income requirements. I live in Michigan in a one-person household. To qualify for state medical benefits, the most I can make is $16,000—that’s 133 percent of the Federal Poverty Level. I applied in January 2018 but didn’t qualify. The $16,000 limit is still quite low considering what I earn on Social Security disability.

In 2017, I earned $14,000 from Social Security—a fairly common amount. This is the gross amount before Medicare premiums are taken out. As you can see, additional earned income would easily put me over the $16,000 limit, and it did. If I had qualified, my Medicare Part B premium of $134 would have been paid for by Medicaid. In addition, Medicaid would have acted as my secondary insurance and covered things that Medicare Part B did not cover such as copays for doctor visits, tests, and other procedures. However, my Part D drug premium and copays would not be covered. But qualifying for Medicaid would have made me eligible for another drug discount program.

The Social Security Administration has a drug discount program called Extra Help. You must have Social Security income to qualify and fall within their low-income guideline. In my case, qualifying for Medicaid would have made me automatically eligible for Extra Help. Having this program as well would have a) covered my Part D premium, and b) reduced my Tier 1 and 2 drug copays to $0.

Drug discount cards & government drug insurance

Drug discount cards won’t help much if you have government drug insurance. If you are familiar with those 30% - 75% off drug discount cards, you know they are quite a savings if you have commercial insurance such as Blue Cross, Cigna, United Health Care, et al. In that case, discounts are applied to your copay. But if you have government insurance such as Medicare and Medicaid, those discount cards can only be applied to the full retail price of the drug. Even with the discount the price is too high, keeping the drug unaffordable and out of reach.

You can’t get copay assistance from private charities

It happens to a lot of multiple sclerosis patients every January. They had copay assistance for their disease-modifying drugs the previous year and then lost it in the new benefit year because the fund ran out before they could re-enroll.  It’s been first-come-first-served for years. Needless to say, it ain’t fair.

But if you qualify for Extra Help, those expensive Tier 5 MS drugs will carry a copay of only $3.70.

The scenarios above are based on a one-person household in the State of Michigan with an income below $16,000. Bear in mind that if you have dependents under age 18 or older adults living with you, those circumstances will be major determining factors in your eligibility.

To find out where and how to apply, visit your state’s Department of Health and Human Services website.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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