The US government funds the Pennsylvania Medicare insurance program which is designed to provide health insurance coverage to qualified individuals. The state government of Pennsylvania helps Medicare beneficiaries through various assistance programs.
From Medicare, beneficiaries can obtain Medicare Part A and Part B which make up what’s known as Original Medicare. Part A covers hospital insurance, and this includes coverage for inpatient care. Part B covers medical insurance, and it pays for the cost of medically necessary treatments, durable supplies, and screenings for diseases.
Beneficiaries do not normally pay for Part A premiums, although premiums for Part B are commonly required. This isn’t too expensive at $134 a month for those whose income is less than $85,000 a year, and it is much more affordable than the average cost of Pennsylvania insurance premiums at $490 a month. Both Part A and Part B will also require beneficiaries to pay for deductibles, copays, and coinsurance costs.
From the perspective of some beneficiaries, the coverage of the Original Medicare has some gaps that must be filled. These can be compensated with additional supplemental plans known as Medigap policies that can be purchased from Medicare-approved private insurance carriers. However, these plans will require an additional premium as well.
The extra expense may be worth it, as these plans can provide coverage for Medicare prescription drugs. Such plans are known as Medicare Part D. Other types of supplemental plans can provide coverage for extra healthcare services that Part A and Part B do not cover. It may even cover the expense of deductibles, and other out-of-pocket expenses involved with Original Medicare.
The addition of supplemental coverage to Original Medicare may be combined in a single Medicare Advantage Plan, which is also called Medicare Part C. These plans at the very least provide the same coverage as Part A and Part B, and it may add Part D as well. Other Medicare Advantage plans may also provide coverage for additional medical and hospital services.
These plans are available from some carriers in Pennsylvania. These carriers must first be approved by Medicare before they can offer these plans.
Pennsylvania offers several Medicare Savings Programs (MSP) for certain beneficiaries to help them cover the costs of Medicare coverage. The level of assistance they receive will depend on their income and resource level.
For the Qualified Medicare Beneficiary (QMB) program, the individual’s monthly income must be less than $1,032 a month. An applicant living with a spouse has a combined monthly income limit of $1,392. Qualified beneficiaries will have the QMB program pay for virtually all their Medicare expenses. The program pays for the premiums of Part A and Part B, as well as the deductibles, coinsurance, and copays.
The next MSP is the program for Specified Low-Income Medicare Beneficiaries (SLMB). This only pays for Part B premiums, which still saves Pennsylvania residents at least $1,608 a year. An individual can qualify with a monthly income of less than $1,234 while married couples have an income limit of $1,666.
The program for Qualified Individuals (QI) also only pays for Part B premiums, and it has more limited funding. This may keep late applicants from receiving this benefit. To qualify, an individual cannot earn more than $1,386 a month while the combined monthly income of a married couple cannot exceed $1,872.
All these three programs have a resource limit for applicants, and this limit does not factor in the value of the house and the car. An individual’s asset worth cannot be more than $7,560 while the resource limit for a married couple is $11,340.
Another program is for Qualified Disabled and Working Individuals (QDWI), and this pays for the premium of Medicare Part A. An individual must earn less than $4,132 a month and have assets worth less than $4,000. For married couples, the income limit is $5,572 with a resource limit of $6,000
All these limits are “rough” guidelines, and those whose incomes and assets are slightly higher than the limits should apply as well. Some types of income and resources may not be counted as part of the limit.
Pennsylvania has the Apprise Health Insurance Counseling Program that offers free and objective counselling and answers for Medicare beneficiaries in the state. These beneficiaries can contact Apprise at 800-783-7067.
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