prescription plan

Getting Medicare? Do You Qualify for Help Paying for Prescriptions?

Extra Help? Part D? Low-Income Subsidy? Prescriptions?

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Medicare prescription coverage is called Part D and if you are enrolling in Medicare, you have to enroll in Part D to get prescription coverage. Medicare can help you pay for some or all of your out of pocket prescription costs through a program called Extra Help or the Part D Low-Income Subsidy.

What is Extra Help?

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Extra Help provides a Low-Income Subsidy to help pay for out of pocket costs for Part D prescription plans. Extra Help will help pay for monthly premiums, annual deductibles and prescription co-payments. Extra Help can save you up to $4900 a year depending on your medications and on your income and assets. If you have low assets and are working, you may qualify even if your income is over the limit below. If you are struggling to pay for prescriptions, apply.

To qualify for Extra Help, your income and assets must be below:

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How do I get Extra Help?

You must apply for Extra Help, it is not usually automatic. Social Security will need information about your income and assets. Assets include your savings, investments and real estate (other than your home). If you are married, you will need information for yourself and your spouse.

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You may have received an Extra Help application in the mail when you first received information about starting Medicare. If you filled it out and mailed it back, you have already applied. If not, you can apply online at SocialSecurity.gov.

Some people automatically qualify for Extra Help and will receive a notice from Medicare. The notice will be purple, yellow or green or possibly orange. The purple notice says you qualify for Medicaid and Medicare and will receive the maximum Extra Help benefit. The yellow notice indicates you qualify for Extra Help and have been auto-enrolled unless you are already enrolled in a Part D plan. The orange notice states your Extra Help amount is changing for the coming year.

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How do I know if I already have Extra Help?

You can call Medicare at 1-800-633-4227 or log in to your account at medicare.gov.

In addition to Extra Help with Part D, you may also be eligible for help paying your Part B premium or be eligible for Medicaid with your Medicare.

At the WHP office, we help people who have Medicare apply for Medicaid. We can help you get an appointment with a Medicare Medicaid Assistance Program (MMAP) counselor to choose your Part D prescription plan. If you have questions, call us at 734-544-3030.


Resources:

Medicare 1-800-MEDICARE (1-800-633-4227)

Social Security Administration 1-800-772-1213

Find your Level of Extra Help (Part D) from Medicare.gov.

Understanding the Extra Help With Your Medicare Prescription Drug Plan from Social Security.

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How to Reduce the High Cost of Prescriptions

By J. Troha via Wikimedia commons

By J. Troha via Wikimedia commons

$4 copays. $20 copays. 10% coinsurance. If you are on many medications, the costs of those prescriptions--even if each one doesn't cost a lot--can really add up! Whether you have employer insurance, a Marketplace plan, Medicare or Medicaid, you might be interested in some of these ideas. 

1. Understand how your insurance works and what the costs are for medications. There are a few ways to do this, but a good place to start is by calling customer service for your insurance. Generally, the customer service number can be found on your insurance card. The customer service staff should be able to explain to you how your insurance works, and what the costs will be for different medications, based on the insurance company's formulary.

2. A formulary is, at its essence, a list of medications that are covered by an insurance company, categorized by level or tier. Here's an example. The three lowest-cost Marketplace plans in Washtenaw County all use the Blue Care Network formulary. To find the formulary, I typed into Google, "Blue Care Network Select Silver formulary." I found their Custom Drug List

[Starting January 1 all Michigan Medicaid plans will use the same formulary. It has a convenient way to search for medications, and you can find it here.]

Now let's say that I take a couple of asthma/allergy drugs, and I want to know what their "Tier" is, because that will tell me the copay amounts. I use "control F" and type into the search box the name of the medications I am looking for. Let's say I take Singulair and Xopenex HFA. I type those names into the search box.

Singulair has a generic name as well, montelukast sodium (search by either one!) and is marked as a Tier 1B medication. (That is generic, but not the least expensive generics--in the BCN terminology those are Tier 1A.)

Xopenex HFA is a Tier 3 medication. That one is going to be expensive! But the formulary also suggests some generic alternatives: Albuterol(g), Proair HFA, Respiclick; Ventolin HFA, Xopenex(g) 

3. The formulary or your local pharmacist may be able to suggest some alternatives to an expensive medication, but to find out if that will work for you, you need to talk to your doctor's office! Pharmacists can be very helpful, but they are generally not familiar with your specific situation--it's more that they understand the general medication alternatives. Doctors do not automatically know what your insurance is or what it covers, and they won't know that the cost matters to you unless you tell them! (Be prepared, also, to be told in some cases that there is no good alternative.)

4. In some cases, you may want to search through goodrx.com to compare medication costs.

A screenshot from goodrx.com. 

A screenshot from goodrx.com. 

Note that, next to Kroger, it suggests that the estimated cash price would be $80, but the price is discounted with a free coupon.

5. In some cases, filling a 90-day supply of a medication you use regularly may save money. 

6. Last, but not least, in some cases there are Prescription Assistance Programs, or PAPs, available to you. You can find a good list at needymeds.org. Criteria to qualify for a PAP vary widely. In the case of the Xopenex HFA, there is a PAP, but you would need to a) have insurance and b) be under 500% of the poverty level ($58,850 for a single person) in order to qualify. If you qualify, the PAP could save you hundreds of dollars. So this may be a good route to go if you have a high-deductible insurance plan. If you think a PAP is necessary for you, generally the doctor's office will have to fill out part of the form. They are used to doing those, so don't be afraid to ask!

 

--R. Kraut

 

 

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2015 Medicare Open Enrollment - October 15 through December 7 - Get Help

MedicareCard

It's time to review your Medicare Plan!  

October 15, 2015 to December 7, 2015, is the annual Medicare Open Enrollment Period. During Open Enrollment you may:

  • Change from original Medicare to a Medicare Advantage Plan
  • Change from a Medicare Advantage Plan back to original Medicare
  • Switch Medicare Advantage plans
  • Join a Medicare Part D Prescription Drug Plan
  • Switch Medicare Part D Prescription Drug Plans

It is important to review your Part D coverage every year!

Premiums, co-pays and the drugs covered can change from year-to-year, even within the same plan.  Your current plan should send you an "Annual Notice of Change" before Open Enrollment that outlines any changes for the next year.  Medicare Part D plans are sold and managed by private companies and vary greatly in terms of monthly premiums, annual deductibles, drugs covered and prescription prices.  

The Medicare Savings Program may help you pay your Medicare premium, or you may qualify for Medicaid and Medicare which together will cover all your health care costs. To qualify for the Medicare Savings Program you must be low-income and not have many assets.  For married couples, your combined income must be less than $1770/month and you must have less than $10,930 in assets.  For single people, your income must be less than $1313 and you must have less than $7280 in assets.  If you think you qualify, talk to a MMAP (Medicare/Medicaid Assistance Program) counselor.  

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There is help available from a MMAP counselor.* 

MMAP offers information and assistance with plan comparisons and enrollment throughout the election period.  You can get help from a MMAP counselor by calling the MMAP assistance line at the Area Agency on Aging 1-B (800-803-7174).  

*MMAP Counselors are background checked, trained and certified by the State MMAP office and provide confidential unbiased information; they are not connected with any insurance company.  MMAP is the State Health Insurance assistance Program (SHIP) for Michigan. 

Scheduled Events for Washtenaw County:

  • Milan Senior Center  Thursday October 29,  9:30am - 3pm    

Call 734-508-6229 to reserve a spot. 

  • Washtenaw ISD Computer Lab - Ann Arbor     Wednesday November 11 OR Wednesday December 2,  10am - 7pm  

Call 800-852-7795 to reserve a spot.

  • Salem-South Lyon District Library Monday November 16, 10am - 2pm  

Call 800-852-7795 to reserve a spot.

If you can't make one of the above sessions, you can make an appointment at a partner site. Appointments are scheduled either by the host agency or by calling the Area Agency on Aging 1-B.  

Partner Sites where appointments are available in Washtenaw County:

  • Catholic Social Services - Ann Arbor  734-712-0523
  • Chelsea Senior Center - Chelsea  734-475-9242
  • Dexter Senior Center - Dexter  734-426-7737
  • Hope Clinic - Ypsilanti  800-852-7795
  • Jewish Family Services - Ann Arbor  800-852-7795
  • Salem- South Lyon District Library - South Lyon  800-852-7795
  • Saline Senior Center - Saline  734-429-9274
  • Turner Senior Wellness Program - Ann Arbor  734-764-2556
  • Washtenaw Health Plan - Ypsilanti  800-852-7795

It is confusing but there is help!  To get help, contact an agency or call MMAP directly.   Remember, most people can only change plans during Open Enrollment, October 15, 2015 to December 7, 2015.

And Wish Medicare a Happy Birthday!  

Medicare and Medicaid: keeping us healthy for 50 years

On July 30, 1965, President Lyndon B. Johnson signed into law legislation that established the Medicare and Medicaid programs. For 50 years, these 2 programs have been protecting the health and well-being of millions of American families, saving lives, and improving the economic security of our nation.

President Lyndon B. Johnson signs the Medicare bill at the Harry S. Truman library in 1965.       Source:  Truman Library

President Lyndon B. Johnson signs the Medicare bill at the Harry S. Truman library in 1965.       Source: Truman Library

Happy Autumn-  

M. Buhalis

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