Medicare Changes and Social Security

The Patient Protection and Affordable Care Act (also known as “the Affordable Care Act,” P.L. 111-148) makes important changes to Medicare Part A and Part B.

First, the Affordable Care Act provides free Medicare Part A, along with eligibility for Part B and D, to individuals exposed to certain health hazards within areas federally determined to represent an environmentally-based public health emergency.  Currently the only area under such a declaration is Libby, Montana, with Medicare eligibility applicable to individuals suffering from certain asbestos-related ailments.  To be eligible, these individuals must have been present in Lincoln County, Montana for a total of at least six months during a period ending 10 years or more before the diagnosis.   For more information, please visit our Libby, Montana Outreach Site.  

Second, the Affordable Care Act changes the Medicare Part B enrollment period for TRICARE beneficiaries. This change will allow for Part B enrollment without increased premiums.

The Medicare Improvements for Patients and Providers Act (P.L. 110-275) changed existing Medicare law to further assist low-income beneficiaries:

Social Security is now working with the States to increase participation in Medicare Savings Programs. For information on our expanded role, see our fact sheet.

Effective January 1, 2006, a new Medicare Prescription Drug Program, also referred to as Medicare Part D, was launched. In addition to the prescription drug insurance the program makes available to all Medicare beneficiaries, the program also provides subsidies – or “extra help”-- for those Medicare beneficiaries who have limited income and resources. These subsidies reduce out of pocket costs paid by those Prescription Drug Program (PDP) enrollees who have limited income (below 150% of the poverty line applicable to the size of the family involved) and resources (up to $12,677 in assets for an individual or $25,260 for a married couple in 2011) by providing reduced monthly premiums and other cost-sharing assistance.

Social Security provides additional outreach resources for individuals and organizations working to assist the public with the prescription drug “extra help” program (also known as the Medicare Part D Subsidy). This link contains an online tool that can be used to assess an individual’s potential eligibility for a subsidy, as well as copies of outreach posters, and additional training materials.

During May and June 2011, SSA mailed about 3.6 million outreach letters to Medicare beneficiaries who are potentially eligible for Medicare Savings Programs (MSPs) or the Part D Low-Income Subsidy (Extra Help). This annual outreach, stipulated under Section 1144 of the Social Security Act, requires SSA to notify low-income Medicare beneficiaries each year about specific programs available to assist them with their medical and prescription drug expenses. The Centers for Medicare and Medicaid Services (CMS) joins SSA in this effort, with both SSA and CMS letterhead appearing on all notices.

The following links show two versions of the 2011 outreach letters:

* SSA-L447 –Mailed to beneficiaries with countable income that appears to be less than 135% of the Federal Poverty Level; the beneficiaries have Extra Help but do not have a Medicare Savings Program.

* SSA-L448 –Mailed to beneficiaries with countable income that appears to qualify them for Extra Help and the Medicare Savings Programs but the beneficiaries have neither.

Medicare beneficiaries who have higher incomes may be required to pay an income-related adjustment amount (IRMAA) in addition to their standard premiums.  This fact sheet provides more detail.