Berkshire Senior Online

Margie Ware, former Regional SHINE Coordinator, Elder Services

When an elder hears a term like "public benefits," his or her first inclination is to flinch. The generation that survived the Depression and World War II prides itself on being self-sufficient, and a sense of pride is affected if a well-meaning counselor suggests some form of assistance.

The reality is we all have paid taxes for many years. In some years, when our children are going to school, we use more public services than we’re paying for. In other years, we pay taxes so that our next door neighbors’ children can be educated after ours are grown. It is the same with income assistance and health insurance supplement programs. When we are in our peak earning years, we contribute to assist others. After we retire, it’s our turn to avail ourselves of help when we need it.

Public benefits programs like MassHealth (Medicaid), and lesser known terms like "QMB" and "SLMB" (often pronounced "Quimby" and "Slimby!") are all programs that look at both the incomes and assets of individuals over 65 to determine whether they are eligible for assistance with health insurance coverage or Medicare premiums. For those who qualify, they fill an important need. What is frustrating for those of us who counsel elders are the situations where an individual’s income or assets are just slightly over the limit; there are no "sliding scales" for these programs and too often very deserving individuals are unable to access help, just because their income barely exceeds the assistance level.

Individuals and couples whose incomes are at or below 100% of the federally-established poverty level qualify for health insurance through MassHealth. Their Medicare Part B premiums are not deducted from their Social Security checks and they do not pay any copays or deductibles under the Medicare system. They must visit physicians and dentists who accept patients under the MassHealth program, but for those who qualify, the security of knowing that all doctors’ visits, hospitalizations and prescription drugs are being covered is greatly reassuring. The income level for this program is $736 monthly for an individual and $988 for a couple. Each individual must have no more than $4000 in assets (not including one’s home and first car) or $6000 for a couple. The MassHealth applications are not always easy to complete. Caseworkers from the Division of Medical Assistance are available at Hillcrest Hospital at appointed times to help with applications, and Elder Services’ case mangers and SHINE counselors can also be of assistance.

For individuals with incomes from $819 - $1,181/month, the SLMB or Qualifying Individual programs will allow persons to have their Medicare Part B premiums paid (the limit for couples is $987 - $1,327/month). Because this premium is $50/month, an individual finding that they qualify for this benefit saves over $600 per year. Again, individuals must have assets of less than $4,000 and individuals are limited to $6,000.

It is important for both elders and their family members to investigate the possibility that they might qualify for one of these programs. Because inflation changes the value of retirement income over time, elders often don’t realize that they may be eligible for a public benefit. A retirement check which seemed adequate in 1985 may not have the same buying power in 2000. It is important that seniors who qualify for these programs avail themselves of the benefits. Every dollar saved is a dollar that can be applied to other household expenses. For additional information on all public benefit programs, please feel free to call your local Council on Aging or the SHINE program at 499-0524 or 1 800-957-3557.