Finding Medicare Assistance

For many people, enrolling in Original Medicare (Parts A and B) is really only the beginning of the experience. Often, people find they need more coverage than what comes with it, and more to the point, they may not be able to afford all the coverage they need, especially when prescription costs and other issues come to the forefront. It's important to know that regardless of your situation, there is help available for you, whether it's an advisor to give you the information you need to make your best healthcare decisions, or additional financial aid through Medicare assistance programs. 

NJ PAAD and Senior Gold

NJ PAAD and Senior Gold are both prominently discussed when people in New Jersey look for Medicare assistance programs that focus on prescription drug costs. Medicare Part D is an insurance policy you obtain through private insurance companies in addition to your regular Medicare, and each of these programs help to alleviate costs from that. Other than the need to enroll in a Medicare Part D policy, they both have specific benefits and qualification requirements.

NJ PAAD helps to pay the cost of premiums and for medically necessary prescription drugs with a simple, low copay of $5 for generic drugs and $7 for name-brand, covering all costs above that, provided the drugs are approved by their Medicare Part D plan. If they are not, the patient must switch to an approved medication, or their physician must request an exception based on medical need.

To qualify, recipients must: 

  • Be a New Jersey resident that is 65 or older, or 18 or older receiving Social Security Title II Disability benefits.
  • Have an income (in 2020) that's less than $28,399 if single or less than $34,817 if married. 

Senior Gold is a similar program that targets the income bracket just above NJ PAAD. You're doing better in terms of income, but may still need some assistance. In this program, you pay your monthly premium, plus a standard $15 copay for your medication, plus 50 percent of the remaining cost, until you reach a yearly out-of-pocket expense of $2,000 if single and $3,000 if married, and then it is just $15. 

To qualify, recipients must: 

  • Be a New Jersey resident that is 65 or older, or 18 or older receiving Social Security Title II Disability benefits.
  • Have an income (in 2020) that's between $23,399 and $38,399 if single, or between $34,817 and $44,817 if married. 

Other Medicare Assistance for Low-Income Recipients

Both a Medicare Savings Program (MSP) or Low Income Subsidy (LIS) through the state department could save you thousands of dollars in healthcare costs if you happen to be a low-income resident. 

The State of New Jersey may pay your Part B premium if:

  • Your 2019 annual income did not go over $16,872 if single and $22,836 if married,
  • Your assets (excluding home and car) are not more than $7,730 for a single person or $28,720 for a married couple.

Another aid for you if you are enrolled in a Medicare Part D prescription drug plan is a low-income subsidy. If you qualify for this, you can have late enrollment fees waived, your premium paid, and lower your co-pay amount—no donut hole included or necessary. 

To qualify, you must: 

  • Not have an annual income for 2019 that goes over $18,735 if single or $25,365 if married
  • Not have assets, excluding home and car, totalling more than $14,390 if single or $28,720 if married.

You can explore all of these and more by speaking with an agent at New Jersey Medicare Brokers. Contact an agent to discuss your options with an unbiased, informed expert. 

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