Federal health programs for the poorest elderly

from Newsday

Saul Friedman

Gray Matters

There is this disturbing fact, obscured during last month's congressional effort to put together a stimulus package to soften the fall of the economy for hard-pressed American families:

Millions of older Americans, our brothers and sisters, are truly and desperately poor.

It is true that the poverty rate for persons older than 65, at less than 9 percent, is a lot lower than it is for the rest of the population, now at about 12.3 percent. That's mostly because of Social Security and Medicare. But many still need extra help because of the higher costs for Medicare, and in this column we'll explore some special programs for the lowest-income beneficiaries.

In 2006, more than 3.4 million people over age 65 struggled in poverty. Indeed, the median annual income for all 36 million Americans over 65 was $16,890, which meant that half - 18 million - lived on even less. Many fell below the poverty line, which was then $9,669 for a single person.

As a result, according to the Congressional Research Service, an estimated 1.1 million Americans over 65 had to get public assistance to survive because they were ill or disabled and their Social Security checks were not enough to live on. Mostly, this assistance came from Supplemental Security Income (SSI).

What is even sadder is that the poverty rate among older women, at 12 percent, was much higher than that for men (7 percent). The problem of old-age poverty in the United States is disproportionately a problem facing women. That's especially true among women over 85, who make up more than 70 percent of Americans over 85. Most are widows.

The National Academy of Social Insurance estimates that the poverty rate among older Americans would double without Social Security. (More on this next week.) But for many people, Social Security is most, if not all, of their income. And they were left out of the House's stimulus bill.

That's why AARP and leading Senate Democrats successfully sought to include among those getting rebates persons 65 or older, more than 20 million seniors who rely primarily on Social Security. This was not counted as eligible income in the House-passed proposal.

That was foolish, as well as unfair, because people on fixed incomes tend to spend such windfalls. Last year 90 percent of men and women over 65, or nearly 50 million older Americans, received more than $585 billion in Social Security, and most of it was pumped into the economy.

Still, the average monthly benefit - $1,050 - barely keeps up with the new 2008 official poverty levels, $10,400 for a person living alone and $14,000 for a couple. But it's important that you know these guidelines, for older Americans who live at or below the poverty levels or slightly above may be able to take advantage of a number of federal health programs.

Here, courtesy of the nonprofit, nonpartisan Center for Medicare Advocacy (medicareadvocacy.org), are some of the programs and their eligibility levels:

Full Medicaid, which pays for medicines and medical care for the aged and disabled whose income is up to 100 percent of the Federal Poverty Level (FPL), $866.67 a month for an individual and $1,166.67 for a couple.

In some states, including New York, Medicaid is available for home care. It's also available for people entering nursing homes, although the applicant may be required to "spend down" to the eligibility level. The spouse who remains at home is permitted a monthly income of at least $2,610, and he/she may retain half the couple's assets up to $104,400.

Qualified Medicare Beneficiaries (QMBs). The states must be responsible for all Medicare cost-sharing fees, premiums, co-pays, coinsurance and deductibles. Eligibility: 100 percent of the FPL.

Specified Low-income Medicare Beneficiaries (SLMBs), which pays the Part B premium. Eligibility: 100 to 120 percent of FPL, or $12,480 a year ($1,040/month) for an individual and $16,800 a couple ($1,400/month).

Qualified Individual (QI), will pay for Medicare Part B premiums for beneficiaries with income between 120 and 135 percent of the FPL and limited assets. That means individuals with incomes of $14,040 ($1,170/month) and couples earning $18,900 ($1,575/month).

Full Part D low-income subsidy: Provides a full drug subsidy with low co-payments to Medicare beneficiaries with incomes up to 135 percent of the FPL, or $14,040 for individuals ($1,170/month) and $18,900 for couples ($1,575/month).

Partial Part D Subsidy: Provides a partial subsidy on premiums, deductibles and co-pays for beneficiaries with incomes up to 150 percent of the FPL, or $15,600 ($1,300/month) for an individual and $21,000 for a couple ($1,750).

The Center for Medicare Advocacy reminds us that you may "add $20 to each of the monthly amounts to determine actual eligibility limits since applicants are allowed a $20 disregard from any income before their income is measured against the poverty levels. Couples only get one $20 disregard per month."

A related note: As President George W. Bush continued his efforts to kill Medicare by proposing to slash its budget by $6 billion next year and $178 billion over five years, the Journal of the American Medical Association reported on a study of 5,000 previously uninsured adults. Their health improved significantly after they acquired Medicare.

Bush's cuts, which would also slash billions from Medicaid, are not expected to pass in the Democratic-led Congress. But as my former colleague Marie Cocco pointed out in a recent column, we'd better keep an eye on the president for the next 10 months.