Berkshire Senior Online

By Margie Ware

Many individuals have called our office, visited local Councils on Aging and Elder Services seeking help with the Prescription Advantage application.

It’s understandable why so many people are seeking help. Even though the application is fairly straightforward, it looks daunting! The former pharmacy application was a one page form on two sides; the present application is 10 pages long. The "dirty little secret" that only the SHINE volunteers know is that actually, the two applications ask almost the same information! The old application was very compact, had small print, and no instructions. The new application has larger print, lots of instructions and bigger blocks to fill in your information. But all those "improvements" took up space, and the result is that the application appears more complicated than it really is.

So let’s start on Page 3, and "walk through" the Prescription Advantage application. These generic directions may help; if you’re still unsure of some answers, feel free to call the SHINE Program at 499-0524/800 957-3557 or call your local Council on Aging.

The first question "Who is applying" gives you one clue. The choices are "you" or "you and your spouse." So this means two individuals can apply on the same form, and even if only one person in a couple is applying, financial and demographic information about the spouse needs to be included. This is a change from the former Pharmacy Program.

The second question asks if you live with a spouse or any dependent children, and the third asks if you are presently enrolled in the old Pharmacy Program. Check the appropriate boxes. Then it says "Tell Us About Yourself." Remember if you have a P.O. Box, that address needs to be listed under "Mailing Address." The primary address must have your actual street address so that they can verify that you are a resident of Massachusetts. Under "Tell Us About Your Spouse" you must include your spouse’s name, Social Security number, date of birth and gender, whether or not your spouse is applying for Prescription Advantage.

Authorized representative: If a child, attorney or other individual is handling all your paperwork, you may want to list that person in this space so that mail can be sent to them. Please note they will receive all mail; you will not receive any. They will receive notices of acceptance, premium notices, enrollment forms, etc. Only use this section if someone else handles all your paperwork and billing.

"Please answer these questions about you and your spouse." Notice that you must answer these questions about your spouse even if the spouse is not enrolling.

1. Are you a resident? You must be a resident of Massachusetts to qualify for this program. That means your legal residence must be in Massachusetts.

2. Are you under age 65 and disabled? There are income limits to this program for disabled Medicare beneficiaries under age 65. Please call SHINE if you fall into this category.

3. Are you a MassHealth (Medicaid) or Commonhealth member? If you are, you do not qualify for Prescription Advantage.

4. Are you enrolled in Medicare? Remember to put your Medicare number, which may or may not be similar to your Social Security number.

5. Are you enrolled in a Medicare HMO? Check no. We do not have these in Berkshire County.

6. If you have a "Medigap"/Medicare supplemental policy, please check yes.

7. Do you have any other prescription drug coverage? Prescription Advantage is always the payer of last resort so you are required to disclose other coverage. If you are in the process of cancelling your old coverage please indicate that fact on Page 5.

Do not worry about getting the address of your insurance company. Fill out the name of the company, the name of the policyholder, the policy number and whether the plan covers prescription drugs. Remember to check the box "who is covered?" Fill out for both persons if you have a spouse with insurance.

At the top of page 6, most people want to check the second box "I am age 65 and I wish to be considered for premium assistance." If you check the top box, you do NOT have to include income information; you will, however, have to pay the highest monthly premium and annual deductible.

After checking the box, you need to provide some version of income verification. If you filed a federal income tax return in the past two years, you need to include a copy of your 1040 including the signature page. In addition to your tax return, you will need to include a copy of your Social Security award letter or your 1099 from last year. If you do not have copies of this information, you will need to call Social Security to get a copy. Bank statements are no longer acceptable, nor are copies of Social Security checks. If you have included a tax return and your Social Security letters, you do NOT have to fill out the boxes in the chart on Page 6. If your tax return last year shows nonrecurring income (a job that you no longer have, or an IRA which you have exhausted), please include a separate letter explaining that fact. Make a note on the signature page under your signature that additional information is included.

If you have not filed income tax returns in the last two years, please check the box in the middle of Page 7. In addition, you need to provide the Social Security verification mentioned above, and any verification through 1099's of pension and/or dividend income. Put the ANNUAL amounts of Social Security, pension income and dividends/interest in the appropriate blocks for BOTH husband and wife even if only one person is applying. The monthly premium and deductible are calculated on gross household income.

We’re almost through. Only those on disability need to complete Page 8. Everyone needs to sign page nine, both the applicant and, if applicable, the spouse even if only one person is applying.

If the Prescription Advantage Program has your application in hand in their office by the 15^th of the month, our understanding is that your application will be able to be approved in time for the first of the following month. Applications received after the 15^th may be approved for the month following. Ten days to two weeks after sending the application to Prescription Advantage, you may want to call the program at 1-800-243-4636. Press "1" when the recording begins, press "1" a second time, and then ask for Member Services when an operator answers. When Member Services answers, give them your Social Security number and ask to be informed of the status of your application.

The week before your membership is effective, you should receive a welcome packet and membership card in the mail. If no card is available on the 1^st of the month, use your welcome letter as proof of your membership – it includes your name and membership number which the pharmacist can use. Always use your card, even during your deductible period. That is the only way that your out of pocket expenses can be included in the computer.

Applications should be mailed to: Prescription Advantage, P.O. Box 15153, Worcester MA 01615-0153. Please call SHINE if you have any questions concerning these instructions.