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New Poverty Guidelines Announced: Do Your Clients Qualify for Medicare Help?

Posted by Jean A. Lentsch on 4/28/21 3:21 PM

Medicare help

Many seniors struggle with the high cost of healthcare. Recent research published in Health Affairs finds that Medicare enrollees near the poverty line may forgo essential healthcare because of the cost. However, for many seniors, there may be a better option. Financial assistance is available for qualifying beneficiaries. The 2021 limits have been announced, so this is a good time to make sure your clients are getting the aid they deserve.

2021 Poverty Guidelines

Every year, the Department of Health and Human Services must update the poverty guidelines. The calculations are based on changes in the Consumer Price Index for All Urban Consumers, or the CPI-U. The increase for 2021 reflects the 1.2% price increase that occurred between 2019 and 2020.

The 2021 poverty guidelines for the 48 contiguous states and the District of Columbia are as follows:

  • $12,880 a year for a family of one
  • $17,420 a year for a family of two
  • $21,960 a year for a family of three
  • $26,500 a year for a family of four
  • $31,040 a year for a family of five
  • $35,580 a year for a family of six
  • $40,120 a year for a family of seven
  • $44,660 a year for a family of eight

Limits are higher in Alaska and Hawaii. For larger families, $4,540 can be added for each additional person.

Poverty Guidelines and Medicare Programs

The poverty guidelines are used along with resource limits to determine eligibility for certain Medicare programs. When calculating resources, money in checking or savings accounts, stocks and bonds should be included. Certain other resources, including the enrollee’s house, furniture, household items, personal items, one car, a burial plot and up to $1,500 set aside for burial expenses, should not be included.

Below you’ll find a quick recap of the 2021 Resource Limits charts from CMS and or you can click to view the 2021-LIS-Resource-Limits-Memo.

Resource Limits for Determining LIS Eligibility

LIS
Level1

Marital
Status
2020 LIS
Resource Limit
2020 LIS
Resource Limit
with Burial Expenses
2021 LIS
Resource Limit
2021 LIS
Resource Limit with Burial Expenses
Full
Subsidy
Single $7,860 $9,360 $7,970 $9,470
Full
Subsidy
Married $11,800 $14,800 $11,960 $14,960
Partial
LIS
Single $13,110 $14,610 $13,290 $14,790
Partial
LIS
Married $26,160 $29,160 $26,520 $29,520


2021 Maximum LIS Beneficiary Cost-Sharing Table

Low-Income Subsidy Category Deductible Copayment up to Out-of-Pocket Threshold2 Copayment above Out-of-Pocket Threshold2
Institutionalized Full-Benefit Dual Eligible; or Beneficiaries Receiving Home and Community-Based Services $0 $0 $0
Full-Benefit Dual Eligible ≤ 100% FPL $0 $1.30 generic,
$4.00 brand
$0
Full-Benefit Dual Eligible > 100% FPL $0 $3.70 generic,
$9.20 brand
$0

1 Per section 1860D-14(a)(3)(B) of the Act, in the case of an individual whose spouse dies during the effective period for a determination or redetermination, such effective period shall be extended through the date that is one year after the date on which the determination or redetermination would otherwise cease to be effective.

2 The out-of-pocket threshold is $6,550 for 2021.

Low-Income Subsidy Category Deductible

Copayment up to
Out-of-Pocket
Threshold2

Copayment above
Out-of-Pocket
Threshold2

Medicare Saving Program Participant (QMB-only, SLMB-only, or QI); or

Supplemental Security Income (but not Medicaid) Recipient; or

 

Applicant < 135% FPL with resources ≤ $9,470 ($14,960 if married)3

     

Applicant < 150% FPL with resources between $9,470 -

$14,790 ($14,960 - $29,520 if married)3
$92 15% $3.70 generic,
$9.20 brand

2 The out-of-pocket threshold is $6,550 for 2021.
3 The resource limits displayed include $1,500 per person for burial expenses. For beneficiaries that did not notify SSA that they expect to use some of their resources for burial expenses, the applicable resource limit is $7,970 ($11,960 if married) for the full low-income subsidy and $13,290 for the partial subsidy ($26,520 if married).

How to Get Help

Medicare enrollees who think they might qualify should apply for coverage, even if they aren’t sure.

  • To apply for the QMB, SLMB or QI programs, Medicare enrollees should contact their state’s Medicaid program. See this Medicaid directory to find contact information in each state.
  • To receive Extra Help, Medicare enrollees should apply through the Social Security Administration.

Topics: Medicare help

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