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Friday, February 28, 2020  

Low Income Seniors Get Help on Medicare Part D CostsPublished 9/19/2005

 

Starting January 1, 2006, Medicare beneficiaries can enroll in Medicare Part D, or better known as the prescription drug benefit. For many years, seniors have faced ever increasing costs of prescription drugs.

Enrollment for the prescription drug benefit begins November 15, 2005 and will continue until May 15, 2006. Individuals will select a) a Medicare Advantage – Prescription Drug Plan or b) a stand-alone Prescription Drug Plan. The average monthly cost of the plan will be $37 per month.

Each plan will offer a formulary that is approved by Medicare. The standard benefit will include one generic and one name brand drug in each class of drugs. Changes can be made to the formulary by providing a 60-day notice to Medicare, the provider network and beneficiaries.

The plans will cover prescription drugs, biologicals, insulin, and medical supplies associated with the injection of insulin. Benzodiazepines, barbiturates, over-the-counter drugs, fertility drugs, and cosmetic drugs are not a covered benefit.

In addition, to the monthly premium of approximately $37, each person will be responsible for a $250 annual deductible, 25% of the costs from $251 to $2250; 100% of the costs from $2251 to $5100 and 5% for all costs over $5101.

Low income beneficiaries can receive assistance through Medicare to assist with the monthly premiums, deductibles, and co-insurances if they meet the income and asset requirements for Groups 1, 2 or 3.

Group 1 beneficiaries are individuals whose monthly income is less than $798 per person ($1069 for a couple) and assets under $6,000 ($9,000 for a couple). These are primarily individuals who receive Old Age Pension and/or Supplemental Security Income, as well as those who receive home and community based services (HCBS) and nursing home residents who are on Medicaid. Group 1 beneficiaries will pay zero for a monthly premium and annual deductible, a $1 or $3 co-insurance until they reach the equivalent of $3600 of out-of-pocket expenses, at which time, they will pay a zero co-insurance.

Group 2 beneficiaries are individuals whose monthly income is between $799 and $1077 for a single person ($1069 to $1443 for a couple) and assets under $6,000 ($9,000 for a couple). These individuals will pay a zero monthly premium and deductible. They will pay a $2 or $5 co-insurance for the equivalent of $3600 out-of-pocket costs, at which time, they will pay zero co-insurance.

Group 3 includes individuals whose income is between $1078 and $1197 ($1443 to $1604 for a couple) and assets under $10,000 ($20,000 for a couple) will pay a monthly premium based on a sliding scale, an annual deductible of $50, 15% co-insurance (or $540) on the cost of medications up to an equivalent of $3600 out-of-pocket costs; and a $2 or $5 co-pay after $5100 in out-of-pocket costs (if paying privately).

When calculating the assets, Medicare will not include the home, auto, personal possessions and property contiguous to the residence (such as a farm). Funeral plans will reduce the amount of available resources and increase the benefit.

In order for Medicare to assist with the payment for individuals whose income and resources are in Groups 1, 2 or 3, beneficiaries must sign up with the Social Security Administration. Most individuals should receive a mailing from Social Security before August 15, 2005 which can be completed and returned. Individuals who do not receive a mailing from Social Security to sign up, can call 3

Starting January 1, 2006, Medicare beneficiaries can enroll in Medicare Part D, or better known as the prescription drug benefit. For many years, seniors have faced ever increasing costs of prescription drugs.

Enrollment for the prescription drug benefit begins November 15, 2005 and will continue until May 15, 2006. Individuals will select a) a Medicare Advantage – Prescription Drug Plan or b) a stand-alone Prescription Drug Plan. The average monthly cost of the plan will be $37 per month.

Each plan will offer a formulary that is approved by Medicare. The standard benefit will include one generic and one name brand drug in each class of drugs. Changes can be made to the formulary by providing a 60-day notice to Medicare, the provider network and beneficiaries.

The plans will cover prescription drugs, biologicals, insulin, and medical supplies associated with the injection of insulin. Benzodiazepines, barbiturates, over-the-counter drugs, fertility drugs, and cosmetic drugs are not a covered benefit.

In addition, to the monthly premium of approximately $37, each person will be responsible for a $250 annual deductible, 25% of the costs from $251 to $2250; 100% of the costs from $2251 to $5100 and 5% for all costs over $5101.

Low income beneficiaries can receive assistance through Medicare to assist with the monthly premiums, deductibles, and co-insurances if they meet the income and asset requirements for Groups 1, 2 or 3.

Group 1 beneficiaries are individuals whose monthly income is less than $798 per person ($1069 for a couple) and assets under $6,000 ($9,000 for a couple). These are primarily individuals who receive Old Age Pension and/or Supplemental Security Income, as well as those who receive home and community based services (HCBS) and nursing home residents who are on Medicaid. Group 1 beneficiaries will pay zero for a monthly premium and annual deductible, a $1 or $3 co-insurance until they reach the equivalent of $3600 of out-of-pocket expenses, at which time, they will pay a zero co-insurance.

Group 2 beneficiaries are individuals whose monthly income is between $799 and $1077 for a single person ($1069 to $1443 for a couple) and assets under $6,000 ($9,000 for a couple). These individuals will pay a zero monthly premium and deductible. They will pay a $2 or $5 co-insurance for the equivalent of $3600 out-of-pocket costs, at which time, they will pay zero co-insurance.

Group 3 includes individuals whose income is between $1078 and $1197 ($1443 to $1604 for a couple) and assets under $10,000 ($20,000 for a couple) will pay a monthly premium based on a sliding scale, an annual deductible of $50, 15% co-insurance (or $540) on the cost of medications up to an equivalent of $3600 out-of-pocket costs; and a $2 or $5 co-pay after $5100 in out-of-pocket costs (if paying privately).

When calculating the assets, Medicare will not include the home, auto, personal possessions and property contiguous to the residence (such as a farm). Funeral plans will reduce the amount of available resources and increase the benefit.

In order for Medicare to assist with the payment for individuals whose income and resources are in Groups 1, 2 or 3, beneficiaries must sign up with the Social Security Administration. Most individuals should receive a mailing from Social Security before August 15, 2005 which can be completed and returned. Individuals who do not receive a mailing from Social Security to sign up, can call 303-333-3482 for assistance and applications.

03-333-3482 for assistance and applications.

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