Join Your TownHealth 
Open enrollment for pharmacy asistance under way for eligible seniors
Tue Nov 20, 2007, 02:32 PM EST
The Prescription Advantage, the Commonwealth's pharmacy assistance program, is opening enrollment to allow seniors to enroll at any time throughout the year, according to Senator Scott Brown's office.
Prescription Advantage lowers drug costs for many seniors and individuals with disabilities by wrapping around their Medicare Part D prescription drug coverage. The program helps pay for co-payments, premiums, and other coverage gaps associated with Part D plans.
Who Can Join Prescription Advantage?
Prescription Advantage is available to those who are:
65 years of age or older who do not have a gross annual income that exceeds 500 percent or more of the Federal Poverty Level (single $51,050, married $68,450);
Under age 65, work no more than 40 hours per month, meet MassHealth's CommonHealth disability requirements, and have a gross annual household income at or below 188 percent of the Federal Poverty Level (single $19,195, married $25,737).
How Will Prescription Advantage Work for Those Eligible for Medicare?
If you are Medicare eligible, you must join a Medicare Part D drug plan or have prescription drug coverage that Medicare classifies as creditable in order to be eligible for Prescription Advantage benefits;
Limited-income applicants (those at or below 188 percent of the Federal Poverty Level - single $19,195, married $25,737) must apply for "Extra Help" also known as "Low Income Subsidy" administered by the Social Security Administration to be eligible for Prescription Advantage benefits.
Medicare Part D will be the primary drug insurance Prescription Advantage will be the secondary payer supplementing the Medicare coverage during coverage gaps and will provide protection from catastrophic drug costs.
Prescription Advantage will cover the portions of co-payments that exceed Prescription Advantage limits. Co-payment limits are on a sliding scale according to the member's income.
There will be no monthly premium for Prescription Advantage members with incomes below 300 percent of the Federal Poverty Level (single $30,630, married $41,070). There will be a $200 annual enrollment fee for those between 300 and 500 percent of the Federal Poverty Level (single $30,631 - $51,050, married $41,071 - $68,450).
Prescription Advantage may also pay all or part of the member's Medicare Part D premium.
How Does Prescription Advantage Work for Those with Coverage that is "Creditable" or Comparable to Medicare Part D through a Union or Employer?
Prescription Advantage will provide secondary coverage to members who are not in a Medicare Part D plan, but have "creditable coverage," meaning that Medicare has determined that the prescription drug coverage is as good as Medicare Part D coverage. Creditable coverage is typically provided through an employer or union.
How Does Prescription Advantage Work for Those Not Eligible for Medicare?
For members not eligible for Medicare, Prescription Advantage will continue to provide primary prescription drug coverage.
There will be no monthly premium for this coverage; however, members will pay a quarterly deductible and co-payments until an annual out-of-pocket spending limit is reached.
At that time, Prescription Advantage will pay the full cost of the member's covered prescription drugs through the end of the plan year.
Resources for Prescription Advantage Members and Other Medicare
Beneficiaries
Prescription Advantage Customer Service: 1-800-243-4636, press 1;
TTY: 1-800-610-0241
www.800ageinfo.com
SHINE - Serving Health Information Needs of Elders: 1 -800-243-4636, press 2
TTY: 1-800-872-0166
www.medicareoutreach.org
MassMedLine: 1-866-633-1617; TTY/TDD users should ask the operator to call the MassMedLine toll-free number
www.massmedline.com
Medicare: 1-800-MEDICARE (1-800-633-4227) TTY: 1-877-486-2048
TTY: 1-877-486-2048
www.medicare.gov
