PRESCRIPTION ADVANTAGE: ONGOING OPEN ENROLLMENT

Somehow this one got by us, as of August 15, 2007 Prescription Advantage, the Commonwealth’s pharmacy assistance program, opened enrollment to allow enrollment at anytime throughout the year. In previous years, Massachusetts residents age 66 or older had to wait for a scheduled open enrollment period.

Prescription Advantage lowers drug costs for many seniors and individuals with disabilities by wrapping around their Medicare Part D prescription drug coverage. The program helps pay for co-payments, premiums and the coverage gaps associated with Part D plans.

In addition to providing coverage during the donut-hole, other benefits of joining Prescription Advantage include:

• No monthly premium;
• It supplements Medicare prescription benefits by helping to pay co-payments and deductibles;
• It limits the amount of money spent on prescriptions; and
• Individuals with limited income may also be eligible to receive help paying for their Medicare Part D plan premiums.

Seniors not eligible for Medicare and those who do not have Medicare Part D, but have prescription drug coverage through an employer or union, can also apply for Prescription Advantage benefits. Becoming a Prescription Advantage member will allow those who are eligible for Part D, but have not yet joined a Part D plan to join one without having to wait for Medicare’s open enrollment in November.

To obtain a Prescription Advantage enrollment form, visit the Elder Affairs website at www.mass.gov/elders or call toll-free 1-800-AGE-INFO (1-800-243-4636), TTY for the deaf and hard of hearing at 1-877-610-0241, to speak with Prescription Advantage Customer Service or to access a SHINE (Serving the Health Information Needs of Elders) counselor for free health insurance counseling and application support. MassMedLine staff is also available to help with decisions about prescription drug coverage at 1-866-633-1617.

PRESCRIPTION ADVANTAGE FACT SHEET

Who Can Join Prescription Advantage?
Prescription Advantage is available to those who are:

• 65 years of age or older who do not have a gross annual income that exceeds 500 percent or more of the Federal Poverty Level (single $51,050, married $68,450);
• Under age 65, work no more than 40 hours per month, meet MassHealth’s CommonHealth disability requirements, and have a gross annual household income at or below 188 percent of the Federal Poverty Level (single $19,195, married $25,737).

How Will Prescription Advantage Work for Those Eligible for Medicare?

• If you are Medicare eligible, you must join a Medicare Part D drug plan or have prescription drug coverage that Medicare classifies as creditable in order to be eligible for Prescription Advantage benefits;
• Limited-income applicants (those at or below 188 percent of the Federal Poverty Level - single $19,195, married $25,737) must apply for “Extra Help” also known as “Low Income Subsidy” administered by the Social Security Administration to be eligible for Prescription Advantage benefits.
• Medicare Part D will be the primary drug insurance Prescription Advantage will be the secondary payer supplementing the Medicare coverage during coverage gaps and will provide protection from catastrophic drug costs.
• Prescription Advantage will cover the portions of co-payments that exceed Prescription Advantage detremined limits. Co-payment limits are on a sliding scale according to the member’s income.
• There will be no monthly premium for Prescription Advantage members with incomes below 300 percent of the Federal Poverty Level (single $30,630, married $41,070). There will be a $200 annual enrollment fee for those between 300 and 500 percent of the Federal Poverty Level (single $30,631 - $51,050, married $41,071 - $68,450).
• Prescription Advantage may also pay all or part of the member’s Medicare Part D premium.

How Does Prescription Advantage Work for Those with Coverage that is “Creditable” or Comparable to Medicare Part D through a Union or Employer?
Prescription Advantage will provide secondary coverage to members who are not in a Medicare Part D plan, but have “creditable coverage,” meaning that Medicare has determined that the prescription drug coverage is as good as Medicare Part D coverage. Creditable coverage is typically provided through an employer or union.

How Does Prescription Advantage Work for Those Not Eligible for Medicare?

• For members not eligible for Medicare, Prescription Advantage will continue to provide primary prescription drug coverage.
• There will be no monthly premium for this coverage; however, members will pay a quarterly deductible and co-payments until an annual out-of-pocket spending limit is reached. At that time, Prescription Advantage will pay the full cost of the member’s covered prescription drugs through the end of the plan year.

-Adapted from Commonwealth of Massachusetts press release dated August 15, 2007: “Lieutenant Governor Murray Announces Prescription Advantage On-Going Open Enrollment”, retrieved at: http://www.mass.gov/?pageID=pressreleases&agId=Eeohhs2&prModName=eohhspressrelease&prFile=070815_prescription_adv.xml

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