Homepage
-- Programs and Services -- Contact Information "How do you pay for prescription drugs?"
Elder Services of Berkshire County’s Information and Referral (I & R) Department receives many calls each month from elders with problems or issues they are unable to solve on their own. Below are recent questions focusing on prescription medications.
Q. My mother’s bill for prescription medications is over $600 a month. Is there any help for her?
Q. My doctor prescribed a new medication, which is going to cost me $137 a month. I don’t have the money to pay out of pocket. What can I do? I really need to have this prescription filled monthly.
Q. I have just moved to Massachusetts from another state where I was enrolled in a prescription drug plan. Is there a similar prescription program in Massachusetts?
A. The answer to the above questions is the Prescription Advantage Plan, a prescription drug insurance plan administered by the Commonwealth of Massachusetts Executive Office of Elder Affairs. Prescription Advantage is available to all Massachusetts residents age 65 or older, as well as younger individuals with disabilities who meet income and employment guidelines.
Prescription Advantage members pay premiums, deductibles and co-payments based on their gross annual household income. The Rate Schedule Guide is listed below. It lists premiums, deductibles, and co-payment rates for Prescription Advantage.
Prescription Advantage will conduct an annual Open Enrollment period September 1 to September 30, 2004. The effective date of coverage will be November 1, 2004. It is important to note that applications must be received no later than September 30. Individuals are eligible to sign up for Prescription Advantage if they are Massachusetts residents who are not receiving prescription drug benefits under Medicaid and are: age 65 or older or under age 65, work 40 or fewer hours per month, meet MassHealth’s CommonHealth disability requirements and have gross annual household incomes at or below 188% of the Federal Poverty Level. (Single $17,503, Married $23,481)
Prescription Advantage applications can be obtained through local Councils on Aging, Elder Services of Berkshire County’s SHINE Program (413-499-0524), www.800ageinfo.com, or by contacting Prescription Advantage directly at 1-800-243-4636.
SINGLE OR MARRIED WITH ONE SPOUSE IN THE PLAN
PREMIUMS DEDUCTIBLES AND CO-PAYMENTS
Category
If you are single and your income is
OR
If you are married, with one spouse in the plan, and your income is
Your individual monthly premium is
Your individual quarterly deductible is
Your retail (up to a 30-day supply) co-payments are
Level 1 Level 2 Level 3
Your mail service (up to a 90-day supply) co-payments are
Level 1 Level 2 Level 3
1
$0 - $12,569
$0 - $16,863
$0
$0
$9 $23 $45
$18 $46 $80
2
$12,570 -$17,503
$16,864 - $23,481
$0
$0
$9 $23 $45
$18 $46 $80
3
$17,504 -$20,948
$23,482 - $28,103
$15
$25
$12 $30 $50
$24 $60 $100
4
$20,949 -$27,930
$28,104 - $37,470
$25
$50
12 $30 $50
$24 $60 $100
5
$27,931-$46,550
$37,471 - $62,450
$50
$100
$12 $30 $50
$24 $60 $100
6
$46,551-and over
$62,451 - and over
$99
$125
$12 $30 $50
$24 $60 $100
MARRIED WITH BOTH SPOUSES IN THE PLAN
PREMIUMS DEDUCTIBLES AND CO-PAYMENTS
Category
If you are married, with both spouses in the plan, and your income is
Your individual monthly premium is
Your individual quarterly deductible is
Your retail (up to a 30-day supply) co-payments are
Level 1 Level 2 Level 3
Your mail service (up to a 90-day supply) co-payments are
Level 1 Level 2 Level 3
1
$0 - $16,863
$0
$0
$9 $23 $45
$18 $46 $80
2
$16,864-$23,481
$0
$0
$9 $23 $45
$18 $46 $80
3
$23,482 - $28,103
$12
$25
$12 $30 $50
$24 $60 $100
4
$28,104 - $37,470
$20
$50
$12 $30 $50
$24 $60 $100
5
$37,471 - $62,450
$40
$100
$ 12 $30 $50
$24 $60 $100
6
$62,451 - and over
$74
$125
$12 $30 $50
$24 $60 $100