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Are you a member of Prescription Advantage?
By Margie Ware
Are you a member of the Prescription Advantage (PA) program? Do you know your membership number? Can you find your card? If the answer to any of these questions is “no,” then you need to read on. The Massachusetts Prescription Advantage Program is one of the best State Prescription Assistance Programs (SPAP) in the country. But because the program has changed its benefit structure over time, many people who are members may not be aware that they still belong, and what benefits they are entitled to.
For the vast majority of members, Prescription Advantage is a free program. Plus, what makes it a very accessible public benefit is the fact that individuals and couples can belong regardless of their asset levels. The only requirement for the free membership is an annual income below 300% of the Federal Poverty Level, which at this time is $32,670 for an individual and$44,130 for a married couple. Individuals and couples with higher income levels (up to $54,450/73,500)may join for a $200 annual fee, but in most cases, the limited benefits provided do not justify this fee.
What are the current benefits of belonging to Prescription Advantage? At the moment, the primary benefit is for those who purchase more than $2,840 worth of medications annually and end up in the coverage gap, aka “doughnut hole” with Medicare Part D. If you are one of these people, you would know it, because at some point in the year, your medication co-pays rise dramatically. At that point, you either need to call Prescription Advantage to activate your benefits, or get an application for membership. During the coverage gap period in Medicare D, PA members pay no more than $12 for a generic medication and $30 for a brand name. People with lower incomes, who fall under PA's "S-2"Category, pay $7 or $18.
In addition to help with the coverage gap, some PA members get assistance with paying for benzodiazepines, which are medications for anxiety that are not covered by Medicare D. Other PA members who qualify for “partial help” with Medicare D get co-payment assistance during their small deductible period at the beginning of the year.
One of the least well-known, but potentially very valuable benefits of PA membership is the ability to have what is called a Special Election Period or SEP for the Medicare D plan. Individuals access this benefit in two different ways. If someone does not have a Medicare D plan, that person can join a Part D plan outside of the October15 – December 7 annual election period if they are a member of a State Prescription Assistance Program. In other cases, current PA members may want to change plans outside of the annual election period if they discover that their plan is too expensive or does not cover a drug that they need to have.
Elder Services' SHINE program can help you with all these questions. In addition, PA has an outstanding customer service department that can be accessed by calling 1-800-AGE- INFO (1-800 243 4636) and pressing “2” to connect directly. Their new system asks you to enter your member ID number. So if you don’t know your number, or lost your card, or don’t remember if you still belong, this is a good time to clarify your membership status before the beginning of the annual election period for Part D, which begins October 15, 2011. October? Yes, that’s right. Open enrollment for Part D is beginning a month earlier from now on, so mark that date on your calendar – it’s just around the corner!
Margie Ware is Elder Services’ SHINE Coordinator.