The Med Diva

An insider's guide to Medicare Part D and more

Archive for the category “LIS and Extra Help”

Seniors are losing billions of dollars buried in unused benefits from Medicare and other agencies

Money doesn't grow on trees, but billions of dollars are buried in unused benefits.

According to a report released by the National Council on Aging (NCOA) and National Association of Area Agencies on Aging (n4a), millions of low-income older adults are missing out on over $20 billion in free and low-cost support that could help pay for health care, prescriptions, food, and utilities. The main reason why seniors are not taking advantage of these resources? They simply don’t know the money is there for them.

In response to this disconnect, the NCOA and n4a have launched a campaign, “You Gave, Now Save,” to help connect available funding to those who need it the most.

“It is no secret that millions and millions of Americans are struggling right now, but help is just a phone call away,” said Sandy Markwood, CEO of n4a, in a news release. “The aging network is coming together to do everything we can to communicate with older adults and caregivers who demand these services, and let them know that support is available. This campaign is about connecting those in need with the support that is right at their fingertips.”

Medicare Part D Extra Help counts for $6.8 billion in unused benefits

According to the NCOA, the $20 billion is based on estimates of the collective population eligible for benefits but not receiving them. One of these benefits is Part D Extra Help, which helps Medicare beneficiaries pay for their prescription drug costs. According to data from the Centers for Medicare & Medicaid Services (CMS), 1.7 million eligible people are not taking advantage of Extra Help, which has an annual average value of $4,000.

For more information about Extra Help, please see my October 8, 2011 post. You can also click here, contact your local Social Security office, or call Social Security at 1-800-772-1213. (TTY: 1-800-325-0778). 

You Gave, Now Save connects seniors with benefits

The You Gave, Now Save campaign directs seniors to two great resources that can help you connect with potential support:

• NCOA’s BenefitsCheckUp is a free online screening tool that has more than 2,000 public and private programs for low-income people with Medicare.

The Eldercare Locator (1-800-677-1116), a public service of the U.S. Administration on Aging, connects older adults and their families to local agencies and organizations that can assist them with applying for support from a variety of programs. Some of these programs include home heating and cooling assistance as well as free or discounted services from state and local governments and the private sector that provide tax breaks, legal assistance, and in-home assistance. You can go online or reach them at 1-800-677-1116, Monday through Friday, 9 a.m. to 8 p.m. EST.


The Countdown to Medicare Part D Open Enrollment Is Over

Open Enrollment for 2012 begins today, October 15, and ends on Wednesday, December 7, 2011.

The 3 eligibility windows for joining or switching Part D plans

Since today is the start of the Annual Coordinated Election Period (or Open Enrollment), I thought I’d give a quick review of the 3 eligibility windows for joining or switching prescription drug plans.

1. Initial Enrollment Period
2. Open Enrollment Period
3. Special Enrollment Period

1. Initial Enrollment Period

If you are turning 65 and newly eligible for Medicare, you have 7 months to enroll in a Medicare Part D plan:

  • Up to 3 full months before you turn 65
  • During the month of your 65th birthday
  • Up to 3 full months after you turn 65

If you join during the 3 months before you turn 65, your coverage will start on the first day of your birthday month. If you join during or after your birthday month, your coverage will begin on the first day of the next month.

For example, let’s say Patricia is going to turn 65 on May 10, 2012. Her eligibility window will be from February 1 to August 31, 2012.  If she enrolls in a plan any time in February, March, or April, her coverage will begin on May 1. If she waits to join on her birthday, her coverage will begin the following month, on June 1.

If you get Medicare due to a disability, you can enroll in a Medicare Part D plan:

  • Up to 3 months before the 25th month of your disability
  • Up to 3 months after your 25th month of disability
  • During your Initial Enrollment Period when you turn 65

2. Open Enrollment Period

If you are already in a Medicare prescription drug plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD), you can switch to a new Medicare Part D plan during the Open Enrollment Period from October 15 through December 7.

3. Special Enrollment Period

Outside these two windows above, you may only switch plans if you qualify for a Special Enrollment Period (SEP). For example, you may qualify for an SEP for the following reasons:

  • You lose creditable coverage (coverage as good as or better than standard Medicare) through no fault of your own
  • You move to a new permanent address that is not in your current plan’s service area
  • Your current plan no longer offers prescription drug coverage
  • You receive Medicaid or get Extra Help with Part D costs
  • You are enrolled in a State Pharmaceutical Assistance Program (SPAP)

How to avoid a late-enrollment penalty

I talked a lot about the late-enrollment penalty yesterday, but I want to remind you again that if you choose not to enroll in a Part D plan when you first become eligible, Medicare will impose a monthly penalty if you join later. To avoid paying a late-enrollment penalty:

  • Make sure you join a Part D plan during your Initial Enrollment Period.
  • Be sure to enroll in a plan within 63 days of not having a Part D plan or other creditable coverage, such as coverage from:
    • A current or former employer or union
    • Department of Veterans Affairs
  • Let your new prescription drug plan know within 63 days if you had other creditable coverage (your former plan must send you a letter called “Notice of Creditable Coverage,” which you can use as proof of coverage when you join a new plan).

Countdown to Medicare Part D Open Enrollment: Day 8

Open Enrollment for 2012 begins on Saturday, October 15, and ends on Wednesday, December 7, 2011.

Day 8: Getting Extra Help with your prescription drug costs

 In a recent poll conducted for the National Council on Aging (NCOA), more than half of the Medicare beneficiaries surveyed (53 percent) said they were not aware of Extra Help from Medicare, which helps pay for some or all prescription drug costs for those with low incomes. If you or a loved one that you care for takes medication on a regular basis and has a limited income and investments, it’s important to be aware of this benefit.

To qualify for Extra Help, you must:

  • Have Medicare Part A (hospital insurance) and/or Medicare
    Part B (medical insurance); and
  • Live in one of the 50 states or Washington DC; and
  • Have combined savings, investments, and investment real estate worth no more than $25,260 (if you are married and living with your spouse) or $12,640 (if you are not currently married or not living with your spouse.)

When considering your total worth, do not include the home you live in, your cars or other vehicles, personal possessions, burial plots, or back payments from Social Security or Supplemental Security Income (SSI). Also, if you have Medicare and SSI or you have Medicare and Medicaid, you are automatically getting Extra Help for your prescription drugs so you do not have to do anything else.

 For more information about Extra Help, click here, contact your local Social Security office, or call Social Security at 1-800-772-1213. (TTY: 1-800-325-0778).  You will need to complete and submit an application, which will be reviewed by Social Security to determine if you qualify. Social Security will notify by letter if you qualify or not.

State Pharmaceutical Assistance Programs (SPAPs)

Many states and the U.S. Virgin Islands offer help paying drug plan premiums and/or other prescription drug costs. Each state has its own set of eligibility requirements; for example, in New York your income must not be more than $50,000 if married, while in New Jersey a married couple cannot have an income higher than $39, 956. Click here to find out if your state has a SPAP.

In tomorrow’s countdown, I’ll review the Coverage Gap Discount Program, which was enacted under health care reform legislation and is already helping thousands of seniors substantially lower their drug costs.

Countdown to Medicare Part D Open Enrollment: Day 12

Open Enrollment for 2012 begins on Saturday, October 15, and ends on Wednesday, December 7, 2011.

 Day 12: Tips for caregivers–Helping someone choose a Part D plan

If your parent or someone you care for is joining a Medicare Part D plan for the first time or looking to switch plans, it’s important that you first understand the person’s prescription drug coverage needs. Here are some questions to ask and take note of before visiting Medicare’s Plan Finder website or calling the enrollment centers for specific plans:

  • What kind of health and prescription drug benefits does the person have now?
  • Does the person currently have Medicare coverage?
    • If so, what type of coverage is it (for example, Part A, Part B, Part C, a Medigap policy)?
  • What medications does the person take now?
    • What will the drugs cost under each plan?
    • Are the medications covered under the plan’s formulary (drug list)?
  • Does the person receive financial help?
    • If not, is it possible that he or she would qualify for Extra Help from Medicare?
  • Would the person be able to continue to use his or her local pharmacy?
    • Is the person interested in saving time and money by getting prescriptions by mail?
  • What specific questions does the Medicare-eligible person or you have?

Determine current coverage and prescription drug needs

One of the most important things you must do when helping someone enroll in a Medicare Part D plan is make sure the person doesn’t already have prescription drug coverage through a former employer or other health insurance plan. If your loved one has coverage as good as the standard Medicare benefit (called “creditable coverage”), he or she may forfeit that coverage by enrolling in a Part D plan.  Creditable coverage could include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, the Department of Veterans Affairs, or other health insurance coverage that includes prescription drug coverage.

 Plans must tell their Medicare-eligible members each year if their drug coverage is creditable coverage. This information may be sent to members in a letter (called a “Notice of Creditable Coverage”) or included in a newsletter from the plan. Make sure your loved one keeps this information, because he or she may need it if he or she joins a Medicare drug plan after the Initial Enrollment Period when first becoming eligible for Medicare.

 Another important step for caregivers is to compile a list of the person’s drugs, including the strengths, so you can find out if they are covered under the plan’s formulary (drug list). Most plans offer online tools that allow you to confirm which drugs are on the plan’s formulary and what they will cost. You can also call the plan directly and ask the customer service representative to tell you whether the drugs are covered or not.

Additional information you should know:

  • Find out if the person you’re helping receives financial help or would qualify for Extra Help with Part D costs.
  • When comparing plans, make sure the person will be able to continue to use his or her local retail pharmacy.
  • In addition, check to see if the plan has a mail-service pharmacy for savings on long-term medications (such as those used to treat high blood pressure or high cholesterol).

For answers to other questions about Medicare Part D, you can call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. (TTY/TDD:  1-877-486-2048).

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