Medicare Administration

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Medicare Administration FAQ’s

Part D and VA drug coverage

Veterans Affairs (VA) benefits offer creditable drug coverage. This means that if you are enrolled in VA drug coverage, you can delay Medicare Part D enrollment without incurring a late enrollment penalty (LEP). Be sure to compare the costs and benefits of...

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Medicare & Workers’ Compensation

Workers’ compensation is a state-administered program that pays for health care and other claims for job-related injuries. If you have Medicare and file for workers’ compensation, workers’ compensation pays primary for any care related to your accident or...

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The Basics of Qualified Health Plan (QHP)

Qualified Health Plans (QHPs) are health insurance policies that meet protections and requirements set by the Affordable Care Act (ACA). They are typically not for people with Medicare. QHPs must:Follow federally established cost-sharing limitsProvide...

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Part B enrollment decisions with QHP coverage

If you have a Qualified Health Plan (QHP), deciding what to do as you approach Medicare eligibility depends on your circumstances. In most cases, you should enroll in Medicare and disenroll from your QHP, but there are two exceptions:You have End-Stage...

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(SHOP) Small Business Health Options Program

Insurance plans offered through the Small Business Health Options Program (SHOP) are job-based insurance plans purchased through the Marketplace. SHOP allows businesses with fewer than 50 employees and their employees to search for and buy health coverage....

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How EPIC Works With Medicare Low-Income Programs

EPIC (Elderly Pharmaceutical Insurance Coverage) is the New York State Pharmaceutical Assistance Program (SPAP). EPIC is available to New York State residents who are 65 or older and have annual incomes below $75,000 if single and $100,000 if married. EPIC...

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Questions to Ask When Considering an SPAP

If you are thinking about joining a State Pharmaceutical Assistance Program (SPAP), here are some questions to ask to find out if you are eligible and how your state’s program works with other drug coverage you may have.SPAP eligibilityDoes my state have...

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State Pharmaceutical Assistance Programs (SPAPs) Basics

Many states offer State Pharmaceutical Assistance Programs (SPAPs) to help residents pay for prescription drugs. Each program works differently.States may coordinate their drug assistance programs with Medicare’s prescription drug benefit (Part D). Some...

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Part D When you Have Medicare and Extra Help

If you have Extra Help and do not choose a Part D plan, Medicare will automatically enroll you in a benchmark Part D plan. Benchmark Part D plans have a premium below the specified amount for your state, which means that Extra Help will pay the full cost...

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Drug Costs Under Extra Help

If you have Extra Help, throughout the year you will pay either the Extra Help copayment or your plan’s copay for your prescription drugs. You always pay the lower cost between the two. Note that plan copays for prescriptions may change during the year,...

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How to Keep Extra Help From Year to Year

To keep your Extra Help benefits from year to year, you must continue to meet the eligibility requirements. Depending on your state and how you initially qualified for Extra Help, this process may be automatic or require that you submit information to...

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How to Apply for Extra Help

If you do not have Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), you can apply for the Extra Help program through the Social Security Administration (SSA) using either the agency’s print or online application. (If you...

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Extra Help Basics

Extra Help eligibilityIf your monthly income is up to $1,615 in 2020 ($2,175 for couples) and your assets are below specified limits, you may be eligible for Extra Help (see the Extra Help income and asset limit chart for details). These limits include a...

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