PRESCRIPTION ADVANTAGE OPEN ENROLLMENT 3/15 - 4/28

The state has announced an open enrollment period for a redesigned Prescription Advantage program. Open enrollment is March 15 to April 28. Starting this year, for those with Medicare, the program will no longer be the primary source of aid for medications. Instead, Prescription Advantage will work with the federal government's new Medicare Part D drug plan. Prescription Advantage will also provide primary coverage that is comparable to Medicare Part D plans for those who are not eligible for Medicare.

''It is important for people who were not eligible for Prescription Advantage before, or who did not consider the program, to understand how much Prescription Advantage can help them now," Elder Affairs Secretary Jennifer Davis Carey said in a statement. ''I encourage people to consider joining Prescription Advantage in order to reduce their out-of-pocket costs for their prescription medications."

Prescription Advantage will supplement the federal plan and fill in coverage gaps such as the infamous doughnut hole -- the range of annual spending from $2,250 to $5,100 in prescription drug costs that is not covered under basic Medicare plans. The state plan will also pay monthly premiums for Medicare drug plans and cover some of the copayments.

The state program is aimed at several types of beneficiaries:

• Those over 65 who have annual income of not more than five times the federal poverty level ($49,000 for a single person and $66,000 for married couples). To receive the added state assistance, they must enroll in a Medicare Part D program.
• Those under 65 who meet state disability requirements and have annual income just under two times the federal poverty level ($18,424 for a single person and $24,816 for married couples).
• Those who have drug coverage through their former employers or unions that qualifies as ''creditable coverage" -- which means a federal plan equivalent to a basic Medicare drug plan.

''There is no monthly premium for people who join Prescription Advantage to receive help paying for their prescriptions," Carey said.

Despite the expected enrollment increase, the cost of providing Prescription Advantage is likely to decline because the state will no longer be the primary source of drug-spending assistance for most participants. State spending on Prescription Advantage dropped from $115 million in fiscal 2005 to $92 million in the current fiscal year. It is expected to drop to $60 million next year.

Those Low Income Prescription Advantage members with incomes below 188% of the Federal Poverty Level (FPL) ($17,993 single; $24,121 married couple) who are Medicare-eligible, are required to submit an application to Social Security for Extra Help. Those in this category were sent a letter in December 2005 informing them that their Prescription Advantage benefits would be terminated as of March 1, 2006 if they failed to apply for the Extra Help.

An additional “Subsidy Application Notice of Termination” was mailed in mid-February as a final attempt to reach members who have not responded with their application status. Included also was a copy of the letter sent in December. For a copy of the termination notice click here.

For more information see the Prescription Advantage Website.

Also see fact sheet here.

-Adapted from “State pushes supplemental drug program” By Jeffrey Krasner, The Boston Globe February 14, 2006, Prescription Advantage Bulletin (Open Enrollment) 2/21/06 and Prescription Advantage Bulletin (LIS Application – Failure to Apply) 2/10/06, retrieved at above website on 2/21/06.

02/06