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toward the nursing home bill. A $30 personal needs
allowance (and an additional $90 if receiving VA aid and
attendance benefits) and any health insurance premiums
are allowable deductions. Your spouse may choose to
keep his or her entire income or claim an additional
deduction from your income to bring his or her income
up to $2155 per month (July 2020). The spousal limit
may increase in July 2021 and each year thereafter.
Paying for Prescription Drugs
Upon your admission to a nursing home, you should
determine if your prescriptions will change. Confirm if
your current plan covers the new drugs and if the nursing
home’s pharmacy accepts your current Medicare Part D
or other coverage. You may need to change your Part D
or other drug plan. After admission to the nursing home,
you may change Part C or Part D plans even outside the
normal open enrollment periods.
To determine which plan saves the most money, visit www.
medicare.gov. Complete the questionnaire including the
drugs taken, dosages, milligrams, etc. Upon completion,
the computer will show which plans will save the most. It
will also list the drugs covered and not covered, the cost of
each premium, any deductibles, and if coverage is available
for the coverage gap. Choose the plan requiring the lowest
out-of-pocket expense that the pharmacy will accept.
Those eligible for Medicaid, QMB, SLMB or QI
are entitled to a Part D drug card with no premium,
deductible or coverage gap. All Medicaid nursing home
residents and Medicaid waiver beneficiaries who also have
Medicare pay no co-payments. For those ineligible for
nursing home Medicaid, but eligible for QMB, SLMB or
QI, co-payments will be small. Persons qualifying for the
Low Income Subsidy (LIS) through the Social Security
Administration will either pay a small or no premium
and deductible, small co-payments, and no coverage gap.
Income limits for these programs are described in the
Medicare article in this publication.
Married persons who are admitted to a nursing home
or assisted living facility or who have to live apart in
some other setting should reevaluate their eligibility for
QMB, SLMB, QI, or LIS because they can now apply
as single persons under the more generous income limits
that apply to single persons. For example, a couple each
of whom has a monthly income of $1075 would only
qualify a 25% extra help drug plan subsidy in 2020 while
they reside together because their combined income of
$2150 is just under the highest LIS limit for a two-person
household, but when one of them moves to a nursing
home or assisted living facility, then each of them would
qualify for QMB!
SARCOA’s State Health Insurance Program (SHIP)
provides help with applying for QMB, SLMB, QI, and
LIS and with determining which Medicare health and
prescription drug plan will save you the most money.
For further assistance call 334-671-3990.
/www.medicare.gov
/www.medicare.gov
/www.sarcoa.org