December 30, 2004 Terry Berthelot
(860) 456-7790

Transitional assistance is a $600 per year credit available to help low-income Medicare beneficiaries pay for their prescription medications.  It is available to individuals whose income is not more than 135% of the federal poverty level applicable to the individual’s family size.

However, because the Medicare regulations state, “Family size means one for individuals who are single, and two for individuals who are married,” many beneficiaries who should be eligible for Transitional Assistance will be excluded because they have a larger family unit, and therefore should have a higher poverty level applied than an individual or married couple.

According to Attorney Terry Berthelot of the Center for Medicare Advocacy, “not all Medicare beneficiaries live alone or with a spouse, and many beneficiaries who qualify for Medicare because of disability are young and have children.”  The regulations also fail to recognize the growing number of grandparents who have legal custody of their grandchildren.  “In other words,” says Ms. Berthelot, “the Medicare regulations simply ignore the fact that Medicare beneficiaries often care for children.”

This gross oversight must be addressed.  Medicare is a universal program that should not discriminate against people because they have children or custody of their grandchildren. Fortunately, because the oversight exists only in the regulations, and not in the statute, Congressional action is not required to address it.  All that is required is that the Centers for Medicare & Medicaid Services, the agency which crafted these broken regulations, change them so that family size reflects real family size.  With this change, Medicare beneficiaries caring for children in 2005 will not be denied assistance with their prescription drug costs.

© Copyright, Center for Medicare Advocacy, Inc. 09/04/2013