NEWS RELEASE
Pearl W. Stanley
Extension Agent
Family and Consumer Sciences, CFCS
Bolivia, NC 28422
March 2004
You read about it in the news. You see it on television. People are talking about it, but how much do you know? The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) has caused quite a stir among Medicare beneficiaries. This spring, companies can begin offering the new Medicare prescription drug discount cards. You may be wondering if you need a Medicare prescription drug discount card or if you can keep your Medicare the way it is now. Below is a list of questions and answers to help familiarize you with these upcoming Medicare prescription drug discount cards.
Q. How much will the cards cost?
A. The cards will cost $30 or less each year. They are free if your income is less than $12,123 a year or $16,362 for couples. The income limits will change annually.
Q. How much will the cards save me?
A. If your medication is discounted, you may save between 10 and 15 percent off the retail price; however, the final cost for each prescription filled will depend on where you live and what pharmacy you use. Also, the discount offered can change at any time.
There are other ways to save on prescription drug costs, including mail-order pharmacies, drug manufacturer assistance programs and state drug assistance programs.
Q. Will the cards cover the prescription drugs I need?
A. Different cards will cover different prescription drugs. If you take two or more prescription drugs, you may not be able to find a card that gives discounts on all of them. Certain prescription drugs — such as high-cost drugs in limited supply and those needing special administration — will not be covered by any card.
Q. Can anyone get one of these cards?
A. Anyone entitled to Medicare Part A and/or enrolled in Part B is eligible to buy a prescription drug discount
card, unless they already have Medicaid prescription drug coverage. Enrollment in a card program is voluntary.
Q. Is there any assistance for people with low incomes?
A. Yes. If your annual income is less than $12,123 ($16,362 for couples) and you sign up for a Medicare
prescription drug discount card, the government will pay the card’s annual fee and 90 to 95 percent of your drug costs, up to a maximum of $600 in both 2004 and 2005. These income limits will change annually.
You cannot get this extra assistance if you have prescription drug coverage from a current or former employer (including uniformed services). You can still get the assistance if you have drug coverage from a state drug assistance program (other than Medicaid).
Q. How do I get this low-income assistance?
A. If you are enrolled in a state drug assistance program, that program may offer its own card that gives you the $600
worth of drug assistance. Otherwise, once you have chosen the prescription drug discount card you want, tell the company sponsoring the card that you wish to join the low-income assistance program. You will need to state your income, family size and any other prescription drug coverage you might have, but you will not have to show proof of your income. If you do not receive assistance and you think you should, you can appeal to Medicare.
Q. Who will offer these cards?
A. Pharmacies, pharmaceutical benefit management companies, insurers, Medicare private plans (HMOs, PPOs or
PFFSs) and other private organizations may offer a Medicare prescription drug discount card. Medicare will post a list of these cards and the discounts they offer on its Web site at www.medicare.gov.
Q. How do I enroll?
A. You can join any prescription drug discount card program offered in your state between spring 2004 and the end of December 2005. Before you choose a card, you will want to compare the cost of your medications using different cards and different pharmacies.
If your Medicare private plan (HMO, PPO or PFFS) offers a discount card, you may only be able to join that plan's discount card program. If you choose not to join it, you may not be able to join any other Medicare prescription drug discount card program. However, you can still use any of the non-Medicare sponsored discount drug cards available.
Q. Can I have more than one Medicare prescription drug discount card at a time?
A. No. You can only have one Medicare prescription drug discount card at a time. But, you can have as many
of the non-Medicare sponsored drug discount cards available as you want. You cannot get discounts from more than one card on any one purchase.
Q. Can I use the Medicare prescription drug discount card at any pharmacy?
A. No. Not every pharmacy will honor every Medicare prescription drug discount card. Find out whether you can
use the card you buy at your pharmacy. Keep in mind that some pharmacies will offer lower prices than others even with the discount card.
Q. If I move, can I still use my Medicare prescription drug discount card in my new location?
A. Maybe. If you relocate to another part of the same state, you can still use your card, since cards must work
throughout the state in which they are offered. Some cards will only work in a certain state (or states) while others will work throughout the U.S. (but not in its territories).
Q. Can I switch to another Medicare prescription drug discount card if I decide it could help
me more?
A. You can switch Medicare prescription drug discount cards between Nov. 15 and Dec. 31, 2004.
You are also allowed to enroll in another card during a special enrollment period if you move outside the card’s service area, if you move to or from a long-term care facility or if you enroll or withdraw from a Medicare private plan (HMO, PPO or PFFS). If you switch cards, you will not get a refund of your annual fee.
The Seniors' Health Insurance Information Program (SHIIP) continues to learn more about the bill and educates staff and volunteers with information regarding the benefits of the new bill. SHIIP’s Toll Free Consumer Line (1-800-443-9354) is available Monday through Friday from 8 a.m. to 5 p.m. You can visit the Web site at www.ncshiip.com to answer Medicare beneficiaries’ questions or e-mail shiip@ncdoi.net to get your questions answered online. SHIIP also has trained volunteers in all 100 counties of North Carolina for one-on-one counseling sessions. To reach a SHIIP volunteer counselor in your area, contact Pearl W. Stanley, Family Consumer Education Agent:
SHIIP is a division of the North Carolina Department of Insurance and offers free, objective information about Medicare, Medicare supplements, Medicare managed care, Medicare fraud and abuse and long-term care insurance. There is absolutely no selling involved, as the program is a state-operated service.
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Date Created 3/7/2004