Low income people with who have heart disease often have difficulty getting health insurance, accessing quality medical care or paying for prescription medicines. Older people and people with disabilities can have even greater challenges receiving the care they need. There are several government programs designed to provide assistance. The following information provides an overview of these programs. For further information, go to the web sites listed below.

Low Income Programs

*$20 may be subtracted from the individual's or couple's gross income for some programs. If the $20 subtraction reduces the income to the number listed on the chart, then the individual or couple probably qualifies for the benefit.

**Available on a first come/first serve basis.

Medicare

Medicare is a health insurance program for:

• People age 65 or older
• People under age 65 with certain disabilities
• People of all ages with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant)

Medicare has:

Part A Hospital Insurance - Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

Part B Medical Insurance - Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Prescription Drug Coverage - Most people will pay a monthly premium for this coverage. Starting January 1, 2006, Medicare prescription drug coverage became available to all Medicare beneficiaries. Everyone with Medicare can get this coverage that may help lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.

Qualified Medicare Beneficiary Program (QMB or "Quimby")

This program will pay the premiums, deductibles and co-insurance payments of the Medicare Program for older and disabled individuals who are financially eligible.  The current QMB eligibility caps for 2008 are: $867/month income and $4,000 in assets for an individual; and $1,167/ month income and $6,000 in assets for a couple.  QMB-eligible beneficiaries must go to medical care providers who participate in the Medical Assistance Program.  In addition to the income and assets stated, an individual or couple may have a house, car, and a burial plan (with a value not to exceed $1,500) and still be eligible for the QMB Program. 

Applications are made for the QMB Program through the local Department of Social Services, using the standard Medical Assistance form. QMB recipients receive a gray card as evidence of their eligibility.

Special Low Income Medicare Beneficiary Program (SLMB or “Slimby”)

This program will pay the Medicare Part B premium ($96.40 per month in 2008) for people whose incomes are slightly more than the QMB criteria.  The 2008 SLMB I eligibility guidelines are: $868 - $1,040 monthly income and $4,000 in assets for an individual, and $1,168 - $1,400 income and $6,000 in assets for a couple.  As with the QMB Program, an individual or couple may hold certain assets (house, car, burial fund, etc.) that may be exempt from consideration.

Applications are made for SLMB Program through the local Departments of Social Services, using the standard Medical Assistance form.

Medicaid

Medicaid is a jointly run and funded Federal-State health insurance program for certain low-income and disabled persons. Medicaid eligibility is determined by the State.  To qualify for Medicaid in 2006, an individual must have no more than $350/month in income and $2,500 in assets.  A couple must have no more than $392/month income and $3,000 in assets.

Qualifying for Extra Help to Pay for Your Prescriptions

Low Income Subsidy (LIS) from the Federal Government

You may automatically qualify for extra help with Medicare Part D expenses if:

• You are enrolled in both Medicare and Medicaid
• You are enrolled in a Medicare Savings Program that helps pay your medical bills or pays your Medicare Premiums (QMB, SLMB)
• You receive Supplemental Security Income (SSI)

If you do not automatically qualify for help with Medicare Part D expenses but you have limited income and assets, you may be eligible for some extra help:

• If your income is no more than $15,315 a year ($1,276 per month) for individuals and $20,535 a year ($1,711 per month) for couples and you have limited assets of no more than $11,700 (individuals) and $23,410 (couples), you may qualify for help. Assets include savings, stocks, bonds, CDs, but not your home or car.  Income may be higher if some of the income is earned income.
• If you qualify, you will get help paying for your drug plan’s monthly premium, deductable and for some of the co-pays of your prescriptions.  The type of extra help will be based on income and assets.

Source: "Low Income Programs." Senior Health Insurance Assistance Program of Montgomery County, Maryland.  Last revised November 5, 2008.

 "Medicare Program - General Information." Centers for Medicare & Medicaid Services. Last revised December 14, 2005.