Group 1:
Who: People enrolled in Medicare and Medi-Cal who have $10,400 or less in yearly countable income (The Federal Poverty Level for 2007). The countable income limit for a couple is $14,000.
How to Enroll: You will automatically get the Low Income Subsidy. If you are on the Medically Needy Medi-Cal (also known as Share of Cost Medi-Cal) program, see Group 2 below.
The Subsidy:
- You will not have to pay any premiums to be enrolled in benchmark plans.
- You will not have to pay a deductible before you get help paying for drugs.
- There will not be any gap where Medicare will not help you pay for drugs.
- You will have to pay $1 for every generic drug prescription and $3.10 for every brand-name prescription you purchase.
Group 2:
Who:
- People on Medicare and Medi-Cal who have more than $10,400 a year in countable income
- People eligible or enrolled in a Medicare Savings Program (QMB, SLMB, QI)
- People enrolled in Medically Needy Medi-Cal who have met their share of cost
- People who have yearly countable incomes between $10,400 and $13,783.50 and assets less than $6,120. Couples can have yearly countable income between $14,000 and $18,481.50 and assets below $9,190.
How to Enroll:
- If you are on most forms of Medi-Cal, you will automatically receive the help.
- If you are on Medically Needy Medi-Cal Program (also known as Share of Cost Medi-Cal), once you have met your share of cost, you will automatically be eligible for the subsidy. It begins in the month after the month you meet your share of cost and lasts for the rest of that year (or through the following year if you meet your share of cost after a certain point in the year).
- If you are on a Medicare Savings Program, you will automatically receive the help.
- If you are not on Medi-Cal, but meet the income requirements, you need to apply through Social Security or apply at your county Medi-Cal office
.
The Subsidy:
- You will not have to pay any premiums if you enroll in a benchmark plan.
- You will not have to pay a deductible before you get help paying for drugs.
- There will not be any gap where Medicare will not help you pay for drugs.
- You will have to pay $2.15 for every generic drug prescription and $5.35 for every brand-name prescription you purchase.
Group 3:
Who: People on Medicare who have between $13,783.50 and $15,315 in yearly countable income and have assets less than $10,400. If you are a couple, the income limits are between $18,481.50 and $20,535 and the asset limit is $20,410.
How to Enroll:
The Subsidy:
- You will pay a monthly premium to be enrolled in your Prescription Drug plan:
- If you have between $13,783.51 and $14,294 in yearly countable income, you will pay 25% of the premium. (Those figures are $18,481.51 and $19,166 for a couple).
- If you have between $14,294.01 and $14,804.50 in yearly countable income, you will pay 50% of the premium. (Those figures are $19,166.01 and $19,850.50 for a couple).
- If you have between $14,804.51 and $15,315 in yearly income, you will pay 75% of the premium. (Those figures are $19,850.51 and $20,535 for a couple).
- You will have to pay a $53 deductible before you get help paying for drugs.
- You will have to pay 15% of your drug costs until you have spent $3,850 on prescription drugs covered by your plan.
- You will have to pay $2.15 for every generic drug prescription and $5.35 for every brand-name prescription you purchase after you’ve spent $3,850 on prescription drugs covered by your plan.
We told you it was complex and confusing.
