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prescription drug benefit
What caregivers need to know
By Margie Ware, Elder Services Regional SHINE Director & Bea Cowlin, Elder Services Caregiver Liaison
One of the traditional roles of family caregivers, often early on in the process, is to become the counselor or surrogate for family members when it comes to investigating health insurance choices and making decisions about insurance policies, prescription drug coverage and billing issues.
The Federal government is calling for a “National Day of Conversation” around Thanksgiving to make sure that family members help Medicare beneficiaries make the choice of which new prescription drug program to join. Fortunately for caregivers in Berkshire County, Elder Services Family Caregiver Support Program and Elder Services SHINE (Serving the Health Information Needs of Elders) programs are closely aligned. Bea Cowlin, the Elder Services’ Family Caregiver Liaison is a SHINE counselor and Elder Services’ Regional SHINE Director Margie Ware is also the Regional Caregiver Coordinator. So it is a special goal of Elder Services of Berkshire County to facilitate caregivers’ knowledge and understanding of the requirements of the new Medicare Part D prescription drug benefit.
If you don’t know the answers to the following questions about your loved one, read the enclosed supplement and either ask or call SHINE to find out the best way of addressing your care recipient’s situation.
• Is your loved one a Medicare Beneficiary? Do they have Part A, Part B or both? (Most people have oth, but new immigrants and other individuals may have only Part B or no Medicare coverage at all.)
• How does your loved one currently pay for prescription medications?
• If they are on MassHealth, they will be assigned to a new Medicare prescription drug program this fall. Make sure that their currently prescribed medications are covered under the assigned plan. We can help you choose a new plan if necessary.
• If they are on Prescription Advantage, they need to sign up for the new Medicare Part D prescription program by no later than December 31
st. Please contact SHINE or your local Council on Aging to make sure this work is completed by that date. If they do not currently pay a premium to Prescription Advantage, make sure an application for “extra financial help” has been filled out with the Social Security Administration even if you know the individual will not qualify (usually because of assets over the limit indicated.)• If they now receive prescription coverage through a former employer, make sure that the employer sends them a notice by November 1st indicating that the coverage will continue and is “creditable” – i.e. as good as or better than Medicare D coverage.
• If they currently have no coverage for prescription medications, please take time to review what medications they take and whether the new Medicare benefit would be appropriate for them.
NOTE – there is a penalty if individuals do not join when initially eligible (between November 15, 2005 and May 15, 2006) so be aware that there is a consequence to not electing to join the program.
Although we would like the process to go smoothly, the reality is given the complexity many will experience downright frustration. We often tell people in our public presentations that it takes seven repetitions before the information starts to sink in! We are here to help you.