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www.medicarerights.org | e-newsletters ![]()
Volume 4, Issue 45: Week of November 7, 2005
Welcome to Dear Marci, a free, weekly newsletter designed to keep you in the loop about health care benefits, rights and options for older Americans and people with disabilities.
Dear Marci is a service of the Medicare Rights Center (MRC) (www.medicarerights.org), the nation's largest independent source of health care information for people with Medicare. A national nonprofit founded in 1989, MRC helps older adults and people with disabilities get good, affordable health care.
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Topic of the Month: Medicare Prescription Drug Coverage
Marci's Mailbox
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Dear Marci,
My father lives in a nursing home and gets his drugs paid for by Medicaid. Will this new Medicare prescription drug benefit affect him? If he has to join a Medicare drug plan, will he have to pay for this new drug coverage?
–Hannah (Saint Paul, MN)
Dear Hannah,Yes, the new Medicare drug benefit will affect your father’s current coverage because all Medicaid prescription drug coverage for people with Medicare will end on December 31, 2005. Beginning January 1, 2006, Medicare will provide prescription drug coverage to your father. As someone who receives Medicaid, your father will be enrolled in the new benefit and will automatically qualify for Extra Help, a federal program that will pay for his Medicare drug plan costs—he does not have to apply for it.
He should, however, still take action. To ensure that he enrolls in a plan that meets his needs, help him choose and sign up for a Medicare prescription drug plan that both works with the pharmacy that the nursing home coordinates with and which covers the drugs he takes.
- Start by calling his nursing home facility and asking which pharmacy it gets its residents’ medications from.
- Then help him explore his plan options online using the Medicare Prescription Drug Plan Finder. (No Internet access? Call 800-Medicare and an operator will look up plans in your area.) See Resources below for an important note about this tool!
- Help him compare his Medicare private drug plan options to find a plan that works at the right pharmacy and covers the drugs he needs . Also, find out if the plan requires that your father obtain special permission before it will cover any of the drugs he needs.
- Make sure all of the plan’s premium will be paid for by Extra Help (see note below).
If you find a plan for your father that meets these criteria, he will not have any out-of-pocket costs for his Medicare prescription drug coverage as long as he is a resident of a nursing home. (If he were not living in a nursing home, he would have a copayment for each prescription he fills: $1 for generics and $3 for brand-name drugs.) He will have to pay the full cost of any medications not covered by the plan or that he buys at a pharmacy outside the plan’s network. Medicaid will continue to pay for his doctor and hospital deductibes and coinsurance. In addition, Medicaid programs in a few states will help pay for drugs that are excluded from Medicare coverage. Call your Medicaid office for more information.
Note: To make sure that Extra Help will pay for his entire Medicare drug plan premium, he must pick a drug plan that has a premium at or below the Extra Help premium amount for his state and only offers basic coverage—coverage that is as good as but not better than the drug benefit outlined in the Medicare law. If he chooses to enroll in a plan that has a monthly premium above his state’s Extra Help premium amount and/or one that offers enhanced coverage (coverage better than what is outlined in the law), he will have to pay the difference. Keep in mind that it may be worth paying a higher premium for a plan that covers the drugs he needs or that covers them at a lower copayment. To find out his state’s Extra Help premium amount, see the link in the Resources section below.
If your father does not choose and enroll in a plan on his own before December 31, 2005, he will be randomly assigned to a plan that may not work at the right pharmacy or cover his drugs. He should receive a letter by the end of November explaining which plan he will be auto-enrolled in. However, because he has Medicaid, he will be able to change his Medicare drug plan once a month, should he find that his plan isn’t working out.
Stay tuned next week to learn what dates you need to circle on your calendar when we cover Medicare enrollment periods!–Marci
Due to high email volume, we are not currently able to accept your questions to Marci. Please direct your questions to your local State Health Insurance Assistance Program (SHIP).
Spotlight on Resources
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Want more information about how the new Medicare drug benefit will work for nursing home residents or people with Medicaid? Both populations will receive special consideration and assistance regarding the new benefit. For a complete overview of these populations’ concerns, read the following materials published by the Medicare Rights Center:
- “Medicare Drug Coverage: What You Need to Know If You Live in a Nursing Home” (PDF)
- “What Happens to My Medicaid Drug Coverage When the Medicare Drug Benefit Begins?”(PDF)
- “Medicare Drug Coverage 101” (PDF)
UPDATE! To make sure that Extra Help will pay for your entire Medicare drug coverage premium, you must pick a drug plan that has a premium at or below the Extra Help premium amount for your state and only offers basic coverage. Find your state’s Extra Help premium amount online at the Medicare Rights Center.
At present, the Medicare Prescription Drug Plan Finder cannot tell you how much you will actually pay for your prescriptions in each of the plans available in your area. In addition, plans have until November 15, 2005, to update their information. Marci does not recommend that you use the tool to make any decisions about what plan to enroll in until it is complete and accurate.
Call your State Health Insurance Assistance Program for more information on Medicare benefits, rights and options. Call Social Security (800-772-1213) for questions about enrolling in Medicare.
Health Tip of the Week* * * * * * * * * * * *
Have you recently experienced abdominal or back pain, decreased appetite, unexplained weight loss or fatigue? Although comprising a vague assortment of symptoms, they may indicate pancreatic cancer when experienced concurrently.
As designated by Congress last month, November is Pancreatic Cancer Awareness Month. The fourth most common cause of cancer-related deaths in America, pancreatic cancer is difficult to diagnose at an early stage and is, for most, fatal—making patient education and early detection critical. Smokers and those suffering from long-term diabetes, chronic pancreatitis or various hereditary conditions (such as hereditary pancreatitis, Lynch or von Hippel-Lindau syndromes) should all be aware of their increased risk for this disease. For a schedule of awareness events this month, visit pancan.org. For more information about pancreatic cancer, visit visit the National Cancer Institute’s web site.
Survey Says . . .
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Did you know that more than half of Medicare patients fail to get routine preventative care? According to a study conducted by researchers at the Center for Studying Health System Change (HSC) and Memorial Sloan-Kettering Cancer Center, patients are much more likely to get such care— including cancer screenings—if they are cared for by board-certified doctors in larger practices treating fewer poor patients.
Another key variable that appeared to affect or indicate a greater likelihood that a patient would receive preventative care is whether or not the practice employs information technology to automate preventative care reminders or access treatment guidelines.
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