Senior fights to alter barrier to Medicare payments
Thirty-seven cents is preventing Elmer Gardiner, 79, from receiving a $104.90 reimbursement from Medicare Part B benefits. As someone known in Warwick and Cranston as an advocate for seniors, he’s upset he’s missing out, coupled with the fact that more elderly people are also experiencing this frustration.
“I’m not only representing myself; you’ve got other seniors that qualify,” said Gardiner, a Warwick resident who formerly lived in Cranston. He estimates at least 5,900 seniors are dealing with this issue statewide.
Maureen Maigret, consultant for the older women’s policy group of the Senior Agenda Coalition, said the amount of seniors is a guesstimate, but a pretty good one. She added that there is no way of knowing how many people who would apply for the benefit and become eligible.
Still, Gardiner said the well-being of many seniors is at stake. He isn’t happy with Rhode Island Human Services.
“Human Services has been negligent in the sense that they don’t notify you about whether you qualify for a benefit or if you don’t,” he said. “I sent in an application to Human Services so they would know and it took them three weeks to reply.”
In response, Rhode Island Human Services sent him a letter stating he is not eligible for the Medicare Premium Payment Program because as of June 4, 2013, his monthly income of $1,293 exceeds the qualified standard of $1,292.63.
“It’s less than a half a dollar,” said Gardiner. “It’s kind of ridiculous. I know they have to draw a line in the sand somewhere, but the state says it’s $1,292 and the federal government says another thing. I should qualify.”
Larry Grimaldi, chief of information and public relations for the Rhode Island Division of Elderly Affairs, said he has spoken to Gardiner about the situation several times. While he is sympathetic, he said it’s out of their hands.
“By all means we are trying to help,” Grimaldi said, noting that the state of Rhode Island has the option of setting the income limit, while the Department of Human Services administers a Medicare Premium Payment Program.
“I understand his dilemma, but we don’t really have any control over what those resource limits are. No matter where that bar is set, somebody is obviously going to fall on the other side of it,” Grimaldi said.
Gardiner is nevertheless contesting the issue, and recently spoke to an attorney from Rhode Island Legal Services, who he says aims to argue his case based on rounding down the figure. He also hopes to schedule a hearing relative to the matter with the General Assembly, as bills were introduced in the Senate and House earlier this year.
He’s less than thrilled that the fiscal budget for 2014 was recently approved without legislation regarding the issue even being discussed. The fiscal note on the bill was $3.1 million.
“The state legislature did not deal with it at all,” Gardiner said. “If you don’t want to address a problem, it doesn’t go away – it gets bigger. I had the backing of the AARP and the Senior Agenda System, but it’s dead at this point. When we went to the Financial House Committee [on May 7], no one opposed it.”
What also gets under his skin is the fact that the budget includes a $3.16 million purchase of eight parcels of land near the State House in Providence from real estate developer Patrick T. Conley, former Senate Majority Leader John Hawkins, along with his real-estate partner Salvatore Butera. Others were also included in the deal.
“They bought property next to the State House for the same amount of money that our bill would have been,” Gardiner said. “It’s kind of unethical. They could have helped people, but instead bought the property. The property around the State House is not that great. They couldn’t find the money for seniors, but they found it for a real estate deal.”
But this fact isn’t stopping his crusade, and he plans to get his hearing. His objective is to increase the standard figure of $1,292.63 to at least $1,830, the amount he said is associated with Maine. While most states set the premium at $1,292, nearby states are higher.
“In Connecticut, you can earn as much as $2,200 and still get Part B paid for,” he said. “In Washington, D.C., you can earn $2,700 and get Part B. What does this mean? This means that the states that don’t increase that limit of $1,292 are losing money because the federal government pays 52 percent of the premium. That’s a good deal. For every 52 cents, you’re making 4 cents, which can be used for other things.”
Gardiner further argues that seniors spend additional money – approximately $5,600 annually – on non-prescription items they need that people under 50 don’t need. Hygiene products, he said, are often pricey.
“I’m paying this Part B premium and I could use that $104.90 for those products,” he said. “I’m better off than other people because of help I get from my family, but there are a lot of seniors out there having trouble paying their prescriptions. If they would reduce the sales tax from 7 percent to 5 percent on some items, it would make us more competitive with other states.”
However, as a veteran of the U.S. Navy, he said he’s pleased he qualifies for prescription reimbursement. He pays $64 per month for eight medications. Still, he realizes other seniors are not as fortunate.
“You’re an economic prisoner when you’re on low-income,” Gardiner said. “You’ve got just enough money to pay your rent, buy food and general products you need on a monthly basis. You don’t have any kind of so-called spending money. This $104 would be big for them because they could go out to lunch a couple of times with their friends or take a joy ride.”
One of the main reasons Gardiner feels so strong about the Plan B issue, he said, is because his generation has backed Social Security and Medicare since their respective inceptions. Social Security was introduced in the 1940s, while Medicare came forward during the 1960s.
“We paid into these things with good faith,” he said. “What generation should you be thankful for? My generation fought in three wars; World War II, the Korean Conflict, which I was in; and Vietnam. These people built this country and fought for the things that we hold dear. Help the vets and the people that built this country.”
According to Maigret, all is not lost. Just because the bill wasn’t approved this year doesn’t mean there isn’t hope for the future of the legislation.
“It didn’t pass this year, but we can continue to pursue it,” she said. “I think it’s important to keep the issue out there.”