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Medicare drug benefit’s ‘donut hole’ is going away – Sara Duris – Nov. 9, 2024

November 12, 2024

Q. Is there some sort of Social Security for someone who never really worked at a steady job during their life?

A. Supplemental Security Income (SSI) is a monthly Social Security benefit for people with low incomes, limited resources and who are blind, disabled or 65 and older. Unlike Social Security Retirement benefits, and Social Security Disability Insurance (SSDI) benefits, SSI has no work-related requirements to qualify. Children who are blind or have disabilities might also qualify for SSI.

The 2024 monthly maximum SSI benefit is $943 for individuals and $1,415 for couples. In 2025, this will rise to $967 for individuals and $1,450 for couples.

The Social Security Administration recently announced a large step in a multi-year effort to simplify processes for people who are applying for SSI by starting to offer an online, streamlined application for some applicants starting in December. This initial step – known as iClaim expansion – aims to establish a fully online, simplified iClaim application that will reduce the time spent applying as well as the processing time for initial claim decisions.

According to the Social Security Administration news release, the rollout of the iClaim expansion will generally be available to first-time applicants between 18 and almost 65, who never married, and are concurrently applying for Social Security benefits and SSI. A goal of the second phase – currently targeted for late 2025 – is to expand this to all applicants.

Q. Is it true there’s no more drug coverage gap or “going into the donut hole” for Medicare drug plans now?

A. Yes, this is true, and it is great news for people on Medicare! Through 2024, most Medicare drug plans have had a coverage gap, also called the “donut hole.” This means there’s been a limit on what the drug plan will cover for drugs. Under the standard drug benefit, once you and your drug plan have spent $5,030 on covered drugs in 2024, you’re in the coverage gap. You won’t exit the coverage gap and get catastrophic coverage unless your out-of-pocket spending reaches $8,000. Because of the prescription drug law, the coverage gap ends on December 31, 2024.

Starting in 2025, all Medicare plans will include a $2,000 cap on what you pay out-of-pocket for prescription drugs covered by your plan. If your out-of-pocket spending on covered drugs reaches $2,000 (including certain payments made on your behalf, like through the Extra Help program), you’ll automatically get “catastrophic coverage.” That means you won’t have to pay out-of-pocket for covered Part D drugs for the rest of the calendar year.

There is still time to check your Medicare drug coverage during Open Enrollment!

Now is the time individuals on original Medicare with a Part D drug plan, and those on Medicare Advantage plans, can make changes to their coverage. Open Enrollment goes until December 7, 2024.

Area Agency on Aging (AAA) and the Michigan Medicare Assistance Program (MMAP) are here to help offering free and confidential assistance comparing Medicare Advantage plans and Part D drug plan options. MMAP counselors are available throughout our service area of Berrien, Cass, and Van

Buren counties. AAA is offering appointments now through the beginning of December, as well as walk-in clinics. Keep updated on our website at www.AreaAgencyonAging.org/medicare-medicaid or call our Info Line for Aging and Disability at 800-654-2810.

Sara Duris is community information liaison of Region IV Area Agency on Aging in Southwest Michigan. Questions on age or independence services? Call the Info-Line for Aging & Disability at 800-654-2810 or visit areaagencyonaging.org. The Generations column appears each weekend in The Herald-Palladium.

Filed Under: Generations Columns

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Area Agency on Aging Region IV

2900 Lakeview Avenue, St. Joseph, MI 49085

(800) 654-2810 Info Line

(800) 442-2803 Admin Office

(616) 816-2580 Spanish Line

info@areaagencyonaging.org

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