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Life Health > Health Insurance > Medicare Planning

FAQ: Waiving Part D Costs

By staff Writer

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An agent from Winter Springs, FL asks…

Q: One of my clients is on Part D but is experiencing some financial difficulty. Can I get any of Medicare Part D’s costs waived?

A: Low-income Medicare beneficiaries may qualify for a subsidy to help pay costs associated with Part D plans. Also, under certain circumstances, the copayment for prescriptions may be waived or reduced.

You may qualify for a low-income Part D subsidy (about $2,100 of assistance) if:

  • your income is no more than 135%-149% of the federal poverty level (see “2006 HHS Poverty Guidelines” at U.S. Department of Health and Human Services at http://aspe.hhs.gov/poverty/index.shtml), and
  • your assets, not including your own home, are less than $11,500 ($23,000 for a married couple).

You can learn more about eligibility requirements and apply for a subsidy at the Social Security Administration office online at www.ssa.gov.

In addition to low-income subsidies, circumstances exist in which a Part D plan enrollee may not have to pay the normal copayment for a covered drug. These include:

  • People who live in a long-term care nursing facility, and who are enrolled in both Medicare Part D and Medicaid, have no copayments.
  • Some plans waive or reduce copayments for certain drugs, particularly generic versions, to coax people to join that particular plan. But the plan can change this copayment waiver at any time.
  • Pharmacies may waive copayments for any enrollee with a low-income subsidy, for any drug. But the waiver is not automatic; you have to ask for it.

If you would like to be considered for our Medicare FAQ expert panel to answer frequently asked questions, email associate editor Heather Trese.

Do you have a Medicare question that you would like answered? Email us and let us know! Please put “Medicare FAQ” in the subject line.

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