Pennsylvania Medicare Beneficiaries Settle Claims Against Commonwealth to Pay Medicare Premiums

PHILADELPHIA – Lawyers in Philadelphia announced today the settlement of a lawsuit that will lower the cost of Medicare insurance and increase access to Medicare services and benefits for low-income senior citizens and people with disabilities in Pennsylvania.

"The Pennsylvania Department of Public Welfare is making wonderful improvements to its systems so that Pennsylvanians struggling to afford premiums and costs associated with Medicare will get the help they need more quickly and efficiently," said Pam Walz, an attorney with Community Legal Services, which sued the Pennsylvania Department of Public Welfare on behalf of two low-income Medicare beneficiaries and two advocacy organizations. The Center for Medicare Advocacy, a national organization that represents Medicare beneficiaries, joined Community Legal Services in filing the lawsuit, Narcisa Garcia, et al. v. Kathleen Sibelius, et al.

Most senior citizens and people who get Social Security disability benefits depend on Medicare insurance to meet their health care needs. However, Medicare requires beneficiaries to pay premiums, copayments and deductibles which can add up quickly. The premium for Medicare Part B, which pays for doctor's visits, is nearly $100 per month.

Fortunately, low-income beneficiaries can receive help from the Medicare Savings Program, which was created by Congress to improve access to Medicare insurance. Eligible single people must have an income below $1,218/month and savings of less than $6,600. Married couples must have a combined monthly income below $1,639 and savings of less than $9,910. Thorny computer data-sharing problems and misunderstandings about how the program works, however, kept many eligible people from getting into the program.

Prior to the lawsuit, Narcisa Garcia was barely getting by on her monthly disability income of $695. Although she was found eligible for the Medicare Savings Program to pay her monthly Medicare premium in November 2008, she was not actually enrolled into the program for another six months because of computer difficulties. Ms. Garcia's income dropped by nearly $100 during each of those months because, in the absence of enrollment in the Medicare Savings Program, the Medicare premium was deducted from her Social Security check. "It has been much easier to pay my bills and buy food since I got into the Medicare Savings Program," said Ms. Garcia.

The changes which the Department of Public Welfare will make include new processes, developed in consultation with the plaintiffs and the federal government, to enroll people into the program, and to resolve data discrepancies more quickly. There will be more training for staff to increase understanding of the program and facilitate more efficient enrollment. Additionally, the Department identified a large group of Pennsylvania residents who were entitled to benefits but were not receiving them, and is currently taking action to enroll these individuals.

"We are very pleased that DPW is making these changes benefitting thousands of Medicare beneficiaries," said Diane Menio, Executive Director of the Center for Advocacy for the Rights and Interests of the Elderly (CARIE), one of the plaintiff organizations. Steve Suroviec, Executive Director of The Arc of PA, which provides advocacy and resources to citizens with intellectual and developmental disabilities and is also a plaintiff organization, emphasized the importance of Medicare Savings Program benefits. "This program is literally a lifesaver for people with developmental disabilities whose fixed incomes are already stretched to the max. Without this program, Medicare premiums and copayments would swallow a large part of the same disability check that has to pay for other costs of living, such as housing, utilities, transportation, and food."

Anyone in Pennsylvania who has Medicare, or will soon become eligible for it, and who meets the income and savings requirements above should contact the Department of Public Welfare to apply for the Medicare Savings Program. Applications are also available on the Department's website at www.dpw.state.pa.us. 

For more information, including a copy of the settlement agreement, contact Pam Walz at PWalz @ clsphila.org or 215-227-2400, ext. 2431.