ST. PETERSBURG — When it comes to health care and prescription drugs, Margaret Cross, 86, has been pretty lucky. She is bright-eyed, energetic and worked until age 80. She still volunteers at the Sunshine Senior Center answering telephones.
Her four generic drugs don't cost her a dime because her Medicare Advantage plan currently covers generics.
But with Medicare's annual open enrollment window beginning today, her insurance agent is helping her add a new layer of protection for 2014.
Called "Extra Help,'' it's an oft-ignored part of Medicare that covers drug premiums, deductibles and copayments for people of modest means.
Margaret Cross may need only the four generics today, but "God forbid something catastrophic happens and she needs something extensive,'' said David McDaniel, agent for her Physicians United Plan. "She could face hundreds of dollars in bills, or even thousands.''
About 10 million Americans and 650,000 Floridians received this Extra Help benefit in 2010, according to a study financed by the Kaiser Family Foundation. But that left about 1.6 million Americans and 87,000 Floridians who probably qualified but did not sign up.
"A lot of people aren't aware of the benefit and don't know how to apply,'' said Casey Schwarz, client services counsel for the Medicare Rights Center, a national advocacy group based in New York. "This can save people a tremendous amount of money. It lowers the monthly out-of-pocket cost."
Medicare's dreaded "doughnut hole,'' the period when drug costs shift from insurance plans to consumers, is being phased out by the Affordable Care Act. But it is eliminated altogether for people in the Extra Help program.
Some people know about Extra Help, "but are too proud to take it,'' said McDaniel, the Physicians United agent. "I tell them, they have earned this by contributing to society and to Social Security."
People may qualify in 2014 if their annual income falls below $17,235 for a single person and $23,265 for a married couple living together. Liquid assets — like stocks and savings — cannot exceed $13,300 for a single person and $26,580 for a married couple. A house, a car and a few other things are exempt from the asset count.
Experts advise people to apply even if their income and assets fall a little above these levels, because of nuances in the law.
"It's a no-brainer,'' said McDaniel. "You go on (the website) SSA.gov and it takes only a few minutes'' to apply.
Another federal initiative, called a Medicare Savings Program, can actually put cash in people's pockets, by paying Medicare's Part B premium, projected to remain at about $104.90 in 2014.
These programs, administered through the states, have lower income and asset thresholds than the Extra Help program, with $15,756 being the highest qualifying income level for an individual. The lower the income, the greater the benefit.
About 370,000 Floridians benefit from a Medicare Savings Program, state officials said. But, as with Extra Help, experts say more could be eligible.
Some people on Medicare with very low incomes cannot, for various reasons, qualify for additional assistance from the Medicaid program. They might have to pick an inexpensive Medicare Advantage HMO for their health care, because they simply cannot afford anything else.
But in some circumstances, a Medicare Savings Program might pay their Part A and B copayments and deductibles, along with their Part B premium. That aid allows them to stay on traditional Medicare and not be restricted to the providers in an HMO network.
The application for a Medicare Savings Program is more detailed than the one for Extra Help, and that frustrates some people, said Charles Franckle, Pinellas County coordinator for the SHINE program, which helps consumers sort through Medicare issues.
For Extra Help, "we can go onto the Social Security website and help people sign up over the phone,'' Franckle said. "With a Medicare Savings Program, we have to print out the application and mail it to them.''
Margaret Cross is delighted that her insurance agent is helping her sign up for Extra Help. She receives $1,014 a month in Social Security and lives in federally subsidized housing. The notion of a serious illness and large drug bills "is horrible to imagine,'' she said.
"I couldn't afford them. I would have to go without them. There is no money for that. You can't just not eat.''
Contact Stephen Nohlgren at [email protected]