How to Choose the Best Health Insurance for You

The Erie County Department of Senior Services staff

Photo courtesy of the Erie County Department of Senior Services


Are you uncertain about how to choose the health insurance option that best meets your needs?
Too much insurance, too little coverage, claims that are never submitted, and lack of awareness of regulation and procedures can waste your time and money!

Today, health insurance is one of the greatest concerns for Americans of all ages. For people with Medicare in particular, health insurance can be very confusing. They must investigate, choose, and make sense of a wide array of health insurance options. These include Medicare, Medicare Advantage, Medicaid, the Medicare Savings Program, employee and retiree health plans, New York’s Elderly Pharmaceutical Insurance Coverage (EPIC), Medicare Supplement Long-term care insurance, and hospital and accident indemnity insurance policies.
Erie County Department of Senior Services’ Health Insurance Information Counseling and Assistance Program (HIICAP) provides free accurate and objective information to senior and disabled people with Medicare, their representatives, or person’s soon-to-be eligible for Medicare who have questions and concerns about other health insurance. Call 858-7883 for help!

Many older adults and people with disabilities have low incomes, but many do not have incomes and assets low enough to qualify for Medicaid. Medicare Savings Programs (MSPs) provide relief for lower income seniors and individuals with disabilities by offsetting the costs associated with Medicare.


Medicare Savings Programs
Medicare Savings Programs (MSP), also known as Medicare Buy-In programs or Medicare Premium Payment Programs, help people with Medicare (who do not qualify for Medicaid) pay for some of the costs of Medicare B.
To qualify for MSP, you must be eligible for or have Medicare Part A, receive Social Security benefits, and meet income guidelines.

There are three Medicare Savings Programs:
QMB: Qualified Medicare Beneficiary pays for Medicare’s Part A and Part B premiums, deductibles and coinsurance.
SLMB and QI-I: Specified Low-income Medicare Beneficiary and Qualifying Individual-I pays for Medicare’s Part B premium.


Income Guidelines for Medicare Savings Program

Program Federal Monthly Income Net Income Asset Limits
  Individual    Couple Individual/Couple
QMB $1032    $1392 No Asset Test
SLMB $1234    $1666 No Asset Test
QI-1 $1386    $1872 No Asset Test


QDWI: Qualified Disabled and Working Individual pays for Medicare Part A premium only for disabled worker under the age of 65 who lost Part A benefits because of return to work.


QDWI Income Below Resources Below
Single $4132 $4,000
Couple $5572 $6,000


You may be eligible for the Medicare Saving Program (MSP) that will pay the Medicare Part B premium. This program also automatically makes you eligible for “Extra Help,” the Low Income Subsidy (LIS) that will help with Part D premiums, lower co-pays and elimination of the gap in coverage. Please call 858-8526 for help.

Many people who qualify for an MSP may otherwise not qualify for “Full” Extra Help (LIS). This is because individuals who apply directly for Extra Help (LIS) must meet both an income eligibility limit and an asset eligibility limit.

“Extra Help” Low Income Subsidy (LIS) helps to reduce or eliminate the beneficiary’s Part D premium and significantly lower their cost sharing requirements: Full Extra Help (LIS) recipients will pay no monthly premium for a basic Part D plan whose monthly premium is at or below New York State’s subsidy amount ($38.98 in 2018). Co-payments for prescription medications will be reduced to $3.35-$8.35 (in 2018) for Full Extra Help; Partial Extra Help maybe available based on the beneficiary’s limited income and resources.

MSPs can enroll an individual into Medicare Part B: If a person has Part A of Medicare but does not have Part B, she/he may utilize an MSP to enroll into Part B outside of an enrollment period.

MSPs automatically eliminate Late Enrollment Penalties for Part B and cover the Part B premium: When an individual delays timely enrollment in Part B and does not qualify for the Part B Special Enrollment Period, that individual may be assessed a Late Enrollment Penalty (LEP). A person with an LEP would typically have to pay the LEP for as long as they have Part B. Enrollment in an MSP automatically eliminates the LEP, even if the beneficiary has the MSP, later.  

Medicare Part B (Medical Insurance) helps cover many preventive services. You pay nothing for most covered preventive services if you get the services from a doctor or other qualified health care provider who accepts Medicare. However, for some preventive services, you may have to pay a deductible, coinsurance, or both. These costs may also apply if you get a preventive service in the same visit as a non-preventive service.

Medicare has preventive services that are paid in full (no co-payment) for the following: Annual Wellness Exam; “Welcome to Medicare” Preventive Visit; Alcohol Misuse Screening and Counseling; Abdominal Aortic Aneurysm Screening; Bone Mass Measurement; Cardiovascular Disease Behavioral Therapy; Cardiovascular Disease Screening; Cervical Cancer Screening (Pap Smear and Pelvic Exam); Colorectal Cancer Screening; Depression Screening; Diabetes Self-Management Training; Flu Shot; Hepatitis B Shot; Hepatitis C Screening; HIV Screening; Lung Cancer Screening; Mammogram Screening; Medical Nutrition Therapy; Obesity Screening and Counseling; Pneumococcal Shot; Prostate Cancer Screening; Smoking and Tobacco Cessation; Sexually Transmitted Infection (STI) Screening/ Counseling. Medicare pays 80 percent for Glaucoma Screening; Diabetes Screening (20 percent co-payment).


For more information, call Erie County Senior Services health insurance at 858-7883.


Medicare Savings Program Eligibility Worksheet

Enter:     Gross Income    
    SSA (Including Medicare Part B Premium)  
    Other Income*                                              
    *(except for bank interest)                 Total:   

Subtract:    Medical Premium(s)
    Supplemental Premium or Medicare Advantage Premium  
    EPIC Premium                            
    Long Term Care Insurance        
    Dental Premium                          
                                  Minus Total:  

                             Net Income Total:

If your NET Income is below:     Single: $1,386/mo or less       Married couple: $1,872/mo or less

Apply for benefits!
Call 716-858-8526




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