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Elder Services Announces Open Enrollment for Prescription Advantage Plan
Prescription Advantage, the state prescription drug insurance plan administered by the Executive Office of Elder Affairs, will conduct an annual Open Enrollment period September 1 - 30, 2004. The effective date of coverage will be November 1, 2004.
Massachusetts residents who are not receiving prescription drug benefits under Medicaid and are age 65 or older, or under 65 who meet income, disability and employment guidelines, are eligible to sign up for Prescription Advantage, which is a state-funded insurance plan which enables elders and disabled persons to afford to purchase their prescription medications. The Plan utilizes a formulary that categorizes prescription drugs into three categories: generic drugs, brand-name drugs, and additional brand-name drugs. Generic drugs have the lowest co-payment, while additional brand-name drugs have the highest co-payment. The Plan’s formulary covers most outpatient oral prescription drugs, including insulin and disposable insulin syringes with needles.
The plan is available to elders age 65 or older regardless of income. Elders with lower incomes pay lower premiums, deductibles, and co-payments. For example, a single elder whose annual income is $16,883 or less, or a married couple whose income is $22,786 or less will pay no premiums or deductibles, and will have the lowest co-payments - $9 for a 30-day supply of level one Generic Drugs, $23 for level 2 Brand-Name Drugs, and $45 for level 3 Additional Brand Name Drugs.
(These numbers are based on the rate schedule guide in effect for fiscal year 2004). The Plan year runs from July 1 through June 30 of each year. For members who reach their annual out-of-pocket spending limit, the Plan pays the full cost of their covered prescription drugs through the end of every plan year.
Individuals age 65 or younger can join at any time during the year. Those age 66 and older can only join during an open enrollment period. During the last open enrollment period in September 2003, more than 11,000 individuals applied for enrollment into the plan. Although Berkshire County represents only 2% of the Commonwealth’s overall population, almost 7% of those applying for enrollment resided in the Berkshires.
Revised Prescription Advantage applications will be available by mid-July. It is important to note that applications must be received no later than September 30. Old applications should not be used, as additional information is requested on the new forms. Those who are interested in applying for, or who have any questions about the Prescription Advantage Plan, should call Elder Services SHINE (Serving the Health Information Needs of Elders) Department at (413) 499-0524 or 1-800-544-5242. Applications can also be obtained through one’s local Council on Aging, or from Ecu-Health Care in North Adams, at (413) 663-8711