BIG CHANGES IN MEDICARE

Alabama Nurse, Jun-Aug 2005

Medicare Part D or Medicare Part D Education Planned

The Alabama Department of Senior Services (ADSS) and Alabama's Aging Network are facing a busy year, the least of which involves educating people and providers about the new Medicare drug benefit (also known as Medicare Part D). Alabama has approximately 800,000 Medicare beneficiaries who will need to understand this new benefit. Additionally, anyone who helps people with Medicare also needs to learn about Medicare Part D. The process will be complicated and experience shows that people will turn to their physicians and pharmacists for guidance.

Over the next several months, the Alabama Department of Senior Services and area agencies on aging are conducting a Medicare education campaign targeting community opinion leaders, health care providers and social service organizations. If our experience with the discount card program is any evidence, this will be an overwhelming task for everyone involved. For this reason, ADSS has convened a steering committee to organize education and outreach efforts at the state level.

"The whole issue will be very confusing for people and we don't want clients to think they can put off this decision without consequences. We are dependent on the community providers to help us reach out to these folks. We all have to work together to make sure people get the right information from a credible source," said Tara Shaver, State Health Insurance assistance Program (SHIP) state director.

According to Shaver, it is especially crucial that providers work with the SHIP program because Alabama has its own loophole when it comes to applying for the subsidy. Not knowing the right direction could cause someone to be asset-tested out of their eligibility, while going the right way could save the client over $900 in annual Part B premiums.

Through SHIP and the Alabama SenioRx Program, trained Medicare counselors are available to train professionals as well as educate beneficiaries. If you are interested in coordinating a training session, educational meeting, or if you have questions about Medicare Part D, call your local SHIP counselor at 1-800-AGE-LINE (243-5463) for more information.

The ABCs of Medicare Part D

A-APPLY FOR THE SUBSIDY-If you have Medicare and your income is less than $1,097 per month and you are not enrolled in Medicaid or a Medicare Savings Program (QMB/SLMB/QI-1), contact the Social Security Administration at 1-800-772-1213 or www.ssa.gov to apply for the subsidy.

B-BE SMART!-Each drug plan will be different. Prices and coverage will vary. Know your needs. Know your choices. This is NOT the same as the Medicare-approved prescription drug discount card and some people will pay a higher premium if they wait to enroll.

C-CHOOSE A PL AN-Plan information will be available October 15, 2005 from 1-800-MEDICARE (633-4227) or www.MEDICARE.gov. For local help call the Medicare counseling program (SHIP) at 1-800-AGE-LINE (243-5463).

Participation in Medicare Part D is voluntary, but every Medicare beneficiary needs to make a decision about the Part D Prescription Drug Benefit-even if the decision is not to enroll. Some people will pay a higher premium if they wait to enroll in a Medicare prescription drug plan.

Beginning this month, the Social Security Administration will begin promoting a low-income subsidy available to Medicare beneficiaries with incomes below $1,196 per month for individuals or $1,603 per month for couples. People who receive help in paying for their Part B premiums (QMB/SLMB/QI-1 or full-Medicaid) will automatically be eligible for the extra help paying for medications. Medicare will send letters to qualified individuals telling them they will automatically receive the extra help.

Certain low-income beneficiaries (specifically those who currently receive their medications through the Medicaid program), will be automatically assigned to a prescription drug plan if they do not make a decision to ensure that there are no gaps in their prescription drug coverage. They will receive information on how to enroll in a different plan if the one assigned to them does not meet their needs.

While information and applications for the low-income subsidies will be available in May, specific plan information will not be available until October 15. Drug plan sponsors will begin marketing their programs in October. Open enrollment begins November 15, 2005 and ends May 15,2006. Drug plan benefits will begin as early as January 1, 2006.

Shaver explains, "As with the drug discount cards, this program places a great deal of responsibility on the consumer. It is very important for beneficiaries to read and understand the information that is sent to them from Medicare (CMS) and Social Security in the coming months. This information may be confusing, but help is available."

Assistance is available from the SHIP program by calling 1-800-AGE-LINE as well as from Medicare (1-800-MEDICARE or www.medicare .gov). Social Security will only provide assistance in applying for the low-income subsidy. The Alabama Medicaid Agency will not help with or handle applications for Part D.