Nebraska Department of Insurance
THE NEBRASKA HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE (NICA) PROGRAM
MARCH 2004 NICA NEWS
TRAINER NOTES
Seniors need our help!
According to a study released February 26th by the Kaiser Family Foundation, seniors are confused by the new prescription drug law...are you surprised? I know I'm not, because everyone I talk to is confused about the new drug law - agency staff, volunteers, CMS workers, and me included! However, it is our responsibility to understand the new changes the best we can and share that information with beneficiaries. Truly, sixty-eight percent of the seniors surveyed by Kaiser did not even know the new law was passed. Sixty-eight percent! While explaining the new law does seem daunting, there are small pieces of the law going into effect soon that can potentially bring big benefits to seniors - but they have to know about them first!The Update trainings for volunteers this spring were focused mostly on the new Medicare-Approved Drug Discount Cards that are available to beneficiaries beginning in May 2004. This drug discount cards can potentially save all beneficiaries between 10 and 25% on individual prescription drug costs-but even more important is that low-income beneficiaries can receive up to $1,200 by filling out one simple form! Medicare beneficiaries below a certain income level who do not have drug coverage through any other insurance plan can receive $600 in 2004 and $600 in 2005 to help pay for prescription drugs. It is important to note that, unlike Medicaid, there are no asset guidelines for this program. It is crucial that we make sure that beneficiaries who are eligible for the $600 credit sign up for a card! Beneficiaries also need to be made aware of the potential fraud schemes that are surfacing in the country and in Nebraska regarding these cards.
Volunteers will continue to receive updated information on the drug cards and on the Medicare Modernization Act through mailings and future trainings. If any volunteers have any questions, or would like specific materials for doing outreach and counseling, please contact the SHIIP program office or your regional representative.
Take care - and have fun!
Update Trainings
February 26-Kearney |
Initial Trainings
March 16-17-North Platte |
QUICK FACTS about the Medicare-Approved Drug Discount Cards
The Medicare-Approved Drug Discount Cards, created by the Medicare Prescription Drug, Improvement and Modernization Act (MMA), will be available in June 2004. Medicare will contract with private companies to offer the new cards. This is a temporary benefit that is being offered until the Medicare prescription benefit starts in 2006. The cards could save beneficiaries between 10-25% on prescription drugs, and low-income beneficiaries may be eligible for up to $1,200 ($600 per year) in assistance to help pay for prescriptions.Eligibility & Enrollment:
- Card plan sponsors will be announced, and marketing will begin in April 2004
- Beneficiary enrollment can begin in May 2004
- Card is effective beginning June 1, 2004 and ending December 31, 2005
- Annual enrollment fee of up to $30
- All beneficiaries with Medicare Part A and/or B are eligible unless they have drug coverage through Medicaid
- Beneficiaries may only have one Medicare-approved drug card at a time
- Can change plan, if desired, between November 15 and December 31, 2004, receive special election period for changing under certain circumstances
- Beneficiaries will receive discounts only at participating pharmacies
- Drug cards approved by CMS will carry a Medicare-approved seal
- Simple enrollment form, sent to drug card sponsor
Special $600 Credit for LowIncome Beneficiaries:
- $600 credit in 2004 and 2005 for incomes below 135% of Federal Poverty Level (FPL) In 2004 - $12,569 or less if single; $16,862 or less if married
- No asset test for the discount drug card or for the $600 credit
- Persons with drug coverage through Medicaid, TRICARE for Life, or an employer group health plan cannot qualify for the credit
- The $600 can carry-over to the following year if not fully used
- 5% coinsurance for individuals with incomes below 100% FPL
- 10% coinsurance for individuals with incomes below 135% FPL
- Beneficiaries with the $600 credit will not have to pay the annual enrollment fee
Drug Cards:
- Must provide convenient access to pharmacies; cannot require mail
- order only
- Drug card discounts can be limited to a formulary-meaning not all drugs will be covered by all cards - but formulary must include one discounted drug in each of 209 classes commonly used by elderly
- Card may offer discounts on over-the-counter drugs (OTC), but $600 credit cannot be used to purchase OTC
- Required to offer price comparisons on a website and a grievance policy
- Potential fraudulent activities with the drug card should be reported to CMS by calling the Medicare Fraud Hotline at 1-800-447-8477
How to choose a card:
- Information comparing cards available in Nebraska on www.medicare.gov or by calling 1-800-MEDICARE after April 29, 2004. The SHIIP program office will send information to SHIIP Volunteers
- Beneficiaries should compare cards for drugs covered, the dollar amount discounted, which pharmacies will accept the card, and the card enrollment fee