Projects - Center Launches Monthly Column

CENTER FOR MEDICARE ADVOCACY
MEDICARE COLUMN

The Center for Medicare Advocacy has, in the past, published a monthly column in The Chronicle, the Center's hometown newspaper. The column dealt with current issues in Medicare, particularly those which are of interest to Medicare beneficiaries and those who work with them. The first column appeared February 17, 2004, and dealt with the changes to Medicare wrought by the Medicare Act of 2003, with particular emphasis placed on trying to explain some of the convoluted aspects of the new prescription drug benefit. To read the articles which have appeared thus far, please click the links below.

Although the Chronicle Column has been discontinued, the Center continues to run a monthly Podcast and will continue to write occasional pieces for publication in the "Resources" section of www.fairmedicare.org.

Articles with a ".pdf" notation require an Adobe® reader. Click HERE to download

March, 2006 - Doctor Is Critical In getting Medicare Part D Cover A Drug that's Been Denied (.pdf)

December, 2005 - New Law Protects Those On ConnPACE And Title 19

October, 2005 - Part D Enrollment To Begin In November

September, 2005 - Medicare Beneficiaries Face 13.2% Increase In Monthly Part B Premium For 2006 (.pdf)

August, 2005 - Upcoming Changes To Medigap Insurance (.pdf)

July, 2005 - Access To Life Saving Treatment Limited For Medicare Beneficiaries (.pdf)

June, 2005 - Medicare Part D Low-Income Subsidy Info On Its Way (.pdf)

(Note: there was a two-month hiatus in May and June)

April, 2005 - Medicare Coverage Of Ambulance Transportation (.pdf)

March, 2005 - General Enrollment Period For Part B Ends March 31st (.pdf)

February, 2005 - Medicare Part D: What Every Advocate Should Know (.pdf)

January, 2005 - Emergency Ambulance Services (.pdf)

December, 2004 - What Medicare Beneficiaries Can Expect In 2005

November, 2004 - Medicare Auto-Enrolls Some Beneficiaries Into Discount Cards

September, 2004 (printed in October by the Chronicle) - 2005 Medicare Premiums Increase Significantly

August, 2004 - Medicare Act Enhances Hospice Care

July, 2004 - The Medicare Act of 2003: More Than Just Prescription Drugs

June, 2004 - ConnPACE Asset Test And Estate Recovery Repealed

May, 2004 - Choosing A Medicare Prescription Drug Discount Card

April, 2004 - ConnPACE And Medicare Prescription Drug Discount Cards

March, 2004 - Medicare Prescription Drug Discount Card: Making Informed Choice Might Be Difficult

February, 2004 - Prescription Drug Coverage In The New Medicare Law: Is Real Help On The Way?

PRESCRIPTION DRUG COVERAGE IN THE NEW MEDICARE LAW: IS REAL HELP ON THE WAY?

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003, referred to as the "Medicare Act of 2003," was signed into law by President Bush on December 8, 2003. The enactment of this legislation raises many questions about the future of health care coverage for seniors and people with disabilities. The Medicare Act of 2003 makes several changes to the existing Medicare program, but the prescription drug benefit is predominant in the minds of seniors, disabled persons, and those caring for them.

"Medicare Part D, " the name given to the new prescription benefit, will provide persons eligible for Medicare Part A or Part B with assistance in paying the cost of prescription medications beginning January 1, 2006. To participate, beneficiaries will need to enroll in a drug plan offered by a private insurance company, either as a separate prescription drug insurance plan or through a Medicare managed care plan. Current beneficiaries will be able to enroll from November 15, 2005 through May 15, 2006. Beneficiaries eligible after May 2006 will be able to enroll when they enroll in Part B. Once in a plan, a beneficiary will be required to remain in that plan until the next annual enrollment period, November 15 though December 31 of each year. In addition, failure to enroll in a drug plan when a beneficiary is first eligible will subject the beneficiary to significant monetary penalties if he or she later enrolls.

To receive coverage under Part D beneficiaries will be required to pay a premium estimated at $35 per month. This premium may be higher for some as the amount was not set in the new law. Beneficiaries will also have to meet a $250 deductible before prescription drug coverage will begin. Once the deductible is met, the plan will pay 25% of the cost of prescriptions listed on the plan’s "formulary, " or list of covered medications, not for other drugs. This coverage will be available from $251-$2250 in expenses for drugs on the formulary. If a drug needed by a beneficiary is not listed on the plan’s formulary, or is removed, which the plan may do at any time, the beneficiary will have to pay the full price of that prescription.

Once a beneficiary has reached the $2250 threshold, coverage will stop. Coverage will not begin again until the beneficiary has incurred a total of $3600 in out-of-pocket expenses in addition to the premium. This gap is what has been referred to as the "doughnut hole." Once again, the calculation of out-of-pocket expenses only includes those medications on the plan’s formulary. Therefore, if the drug is not on the formulary, it does not count toward the calculation of the beneficiary’s out-of-pocket expenses. A beneficiary will continue to be required to pay the monthly premium even after reaching the doughnut hole. If a beneficiary meets the $3600 out-of-pocket limit, "catastrophic coverage" begins, and the beneficiary is only responsible for a 5% co-insurance amount for covered medications from that point until the beginning of the next year.

The fine points of how "Medicare Part D" will be implemented are yet to be worked out by the Medicare Administration. However, one thing is certain: individuals who need the coverage the most, and who therefore surpass the $2250 threshold because of chronic or catastrophic illnesses, will be left without adequate coverage. At that point, these individuals will be in the position they were in before the Medicare Act of 2003, choosing between medications and other basic essentials.

MEDICARE PRESCRIPTION DRUG DISCOUNT CARD:
MAKING INFORMED CHOICE MAY BE DIFFICULT

Beginning this June prescription drug discount cards will be available to Medicare beneficiaries. The discount cards are a result of the Medicare Act of 2003, the new Medicare law passed in December, 2003. The cards are an interim measure, intended to provide some assistance until the new Medicare prescription drug program begins in January 2006.

Individuals getting Medicare Part A or B are eligible for the discount card program. To participate they will be required to pay an annual enrollment fee of no more than $30 and will then have access to a card which will provide a discount for each of the prescription drugs on the discount card’s list of covered drugs, known as the "formulary". While beneficiaries will only be allowed to have one Medicare-certified discount card, they can continue to participate in other non-Medicare discount drug card programs.

Individuals with low incomes who are eligible for both Medicare and Medicaid will continue to receive prescription drug coverage through Medicaid until the full Medicare prescription drug program begins in 2006. They will not have access to the discount card benefit.

In addition to the discount, individuals whose yearly incomes are at or below 135% of poverty level (currently $12,123 for a single person and $16,362 for a couple) and who do not have prescription drug coverage through another insurance plan will be eligible for "transitional assistance." Adjusted gross income levels will be verified by the Internal Revenue Service. There is no asset test or limitation. Individuals eligible for transitional assistance will receive a $600 yearly credit towards the costs of the prescription drugs covered by their chosen prescription drug card. These individuals will not be charged an enrollment fee. Any amount remaining of the $600 credit at the end of 2004 will be carried over to be used in 2005.

Enrollment in the discount card program is planned for this May and the program will go into effect in June. Beneficiaries will have little time to choose which card best suits their needs since marketing for the available cards is not expected to begin until May and beneficiaries will need to sign up that same month.

Beneficiaries will have a variety of discount cards to choose from. They will need to decide which card is best for them based on a comparison of the benefits offered by each, namely which prescriptions are covered and the discounts available. Unfortunately, comparative information on the drugs covered and the discounts offered by each card will not be sent to beneficiaries. Instead, beneficiaries themselves will need to contact each plan to obtain this information. In addition, beneficiaries should be aware that discount drug card sponsors are allowed to change the drugs that they cover and the discount that they offer at any time. Even though, beneficiaries signing up for the discount cards in May are locked into the card they choose until the annual enrollment period for choosing the card for 2005. This could leave some beneficiaries with a discount card that may provide little or no benefit if the card sponsor decides to change its formulary or the individual develops a need for a drug not on their card’s formulary.

It is important for beneficiaries to remember that the Medicare prescription drug discount card will offer negotiated discount prices, not full prescription drug coverage. Only those individuals who are eligible for transitional assistance will receive actual coverage, of up to $600 for covered prescription drugs. Prior to enrolling with a prescription drug card, beneficiaries should assess their needs and determine which plan best meets their situation. For assistance in choosing a card individuals in eastern Connecticut can contact the CHOICES program administered by the Area Agency on Aging, Senior Resources, at (860)887-3561 or (800)809-6485. Information is also available at the Center for Medicare Advocacy, 456-7790 and on the organization’s website, www.medicareadvocacy.org.