Monthly Column - November, 2004

MEDICARE AUTO-ENROLLS SOME BENEFICIARIES INTO DISCOUNT CARDS

During the last two weeks of October the Centers for Medicare & Medicaid Services (CMS) began sending letters to Medicare beneficiaries enrolled in one of the “Medicare Savings Programs” advising them that they have been automatically enrolled in one of the 25 national Medicare prescription drug discount card programs. The Medicare Savings Programs, also referred to as “QMB”, “SLMB” or “QI-1”, provide low-income beneficiaries varying levels of assistance with paying Medicare premiums, co-insurance and deductibles. Beneficiaries eligible for these programs are often also eligible for the Medicare drug card’s “transitional assistance,” $600 annual credit for covered drugs. This credit, like the card program is available in 2004 and 2006.

The CMS letters sent to these beneficiaries informed them that they had been enrolled in a randomly selected Medicare drug card, how to access the drug card’s discounts, and the steps required to access the Medicare card program’s $600 yearly credit, which they can use to pay for prescription medications. To receive discounted prices, beneficiaries simply present the Medicare drug card to their pharmacist; use of the card will activate their enrollment, but they must make a call to access the $600 credit. If the beneficiary’s pharmacy does not accept the card that has been assigned, or they are unhappy with the card assigned, they can switch to another card by calling 1-800-MEDICARE. Beneficiaries who chose to switch to another card should carefully consider their choice since once they make the change to another discount card, they are locked into that card until the end of 2005.

In order to access the $600 credit, beneficiaries must contact the card sponsor or 1-800-MEDICARE and verify their monthly incomes. Normally, under current income guidelines, only single beneficiaries with monthly incomes at or below $1048 or couples with monthly incomes at or below $1406, will be eligible for the $600 yearly credit. However, under the automatic enrollment, Connecticut beneficiaries whose incomes may be over the income guidelines will be eligible by virtue of their enrollment in the Medicare Savings Program. Individuals who are eligible for the credit also are exempt from paying the yearly enrollment fee for the discount card.

Beneficiaries who have received the CMS letter notifying them that they may be eligible for the $600 yearly credit are encouraged to access the benefit by contacting their card sponsor or by contacting CMS at 1-800-MEDICARE. Any portion of the $600 credit which is not used in 2004 will be rolled-over and can be used next year, in addition to the $600 credit for 2005. Therefore, activating the credit before December 31, 2004 will provide a total credit of $1200 for prescription medications.

Beneficiaries who use their Medicare drug discount card, but do not call to arrange access to the $600 credit, will be responsible for paying the yearly enrollment fee, which can be up to $30. They will be billed by the card sponsor after the end of the year. Cards issued to individuals who choose not to use the card at all will be cancelled at the end of 2004.

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The Center for Medicare Advocacy, Inc. is a national, non-partisan education and advocacy organization that promotes fair access to Medicare and health care. The Center’s national office is in Mansfield with offices in Washington DC and throughout the country. For more information contact Attorney Lara Stauning at (860)456-7790 or visit the Center’s website: www.medicareadvocacy.org. Se habla espanol.