Navigating the maze of government assistance for an adult child

Dear Liz: I have a daughter who is 21 and a single mother with a 1-year-old. She has been diagnosed with borderline personality disorder and major depressive disorder. She hasn’t worked since high school and can’t hold a job. She is no longer a dependent as of this year. My question is what assistance is she eligible to apply for? She already is with WIC and getting benefits for the baby. She’s a mess and I’m having difficulty understanding what she can apply for, and what is realistic in terms of Supplemental Security Income, disability, housing assistance and so on.

Answer: Government benefits can be a nightmarish maze to navigate, but you and your daughter may be able to find your first guide in the WIC program. WIC — which is formally the Special Supplemental Nutrition Program for Women, Infants, and Children — provides low-income women and children with supplemental food and nutrition counseling. WIC also provides screening and referral to other benefit programs that could help your daughter and grandchild.

Another resource is the benefits finder tool at USAGov, the official site of the federal government. Start at https://www.usa.gov/benefit-finder.

You didn’t mention health insurance, but making sure your daughter and her child have coverage is crucial. With medication and counseling, your daughter could stabilize enough to become employable and start to build her young life. Under the Affordable Care Act, she can continue on your health insurance until age 26 even if she’s not a dependent for tax purposes. Otherwise, check the health exchanges at https://www.healthcare.gov/. Please act quickly, as open enrollment ends Dec. 15.

Dear Liz: In the past, you’ve discussed the pros and cons of Medicare Advantage plans versus original Medicare. There is one more point I think you need to tell readers, and that is the high cost of Part D prescription drug coverage for people who choose original Medicare. For example, if you need just a few expensive drugs that are Tier 3 or higher, coupled with the monthly premium, you can easily pay $3,000 a year or more. I am not saying original Medicare is bad. On the contrary, it gives you great freedom of health choice. However, Part D is expensive.

Answer: Let’s start with the news that in 2025, Medicare Part D will have a $2,000 out-of-pocket maximum. The cap applies to Part D plans purchased by people on original Medicare as well as to Medicare Advantage plans that have prescription drug coverage. Once you hit the limit, you won’t have to pay more for covered drugs for the rest of the year.

Note the phrase “covered drugs.” Prescription drug coverage is provided by private insurers, and their lists of covered prescriptions can change every year. An insurance plan that covers a drug this year may not cover it next year, so every year during Medicare’s open enrollment — which ends Dec. 7 — you should be shopping to make sure your plan provides the coverage you need. If you don’t comparison-shop during the annual open enrollment period, you can wind up paying substantially more than you expected.

As background, Medicare Advantage plans are provided by private insurers as an alternative to original Medicare. Whereas original Medicare allows you to choose any doctor who accepts Medicare — and the vast majority do — Medicare Advantage has provider networks and may not cover care outside those networks, or may charge more. Also, Medicare Advantage networks and benefits can change from year to year.

Fortunately, Medicare offers a comparison tool to help you sort through your options. Entering the drugs you take and your preferred pharmacy can help you select the best plan for your circumstances. Now’s the time to compare and switch plans if necessary.

Liz Weston, Certified Financial Planner, is a personal finance columnist. Questions may be sent to her at 3940 Laurel Canyon, No. 238, Studio City, CA 91604, or by using the “Contact” form at asklizweston.com.