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A Joint Project of the Maine
Association of Interdependent Neighborhoods |
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Volume 10 No. 1 |
March 2006 |
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MAIN
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A Joint Project of the Maine
Association of Interdependent Neighborhoods |
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Volume 10 No. 1 |
March 2006 |
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Medicare and Part D Drug Coverage:
Information for People Enrolled in MaineCare or the Low Cost Drug Program (DEL)Please note: [If you are enrolled in MaineCare or DEL, and you don’t have Medicare, your benefits won’t change.]
Get November 2006 update
After months of planning – and worry - Medicare Part D started on January 1st. Medicare Part D, a federal program designed by Congress, provides prescription drug coverage through a prescription drug plan (PDP) run by private insurance companies. Maine’s low income seniors and people with disabilities got their prescription drugs through MaineCare or the Low Cost Drug Program (known as DEL) until the end of 2005. Now participants enrolled in MaineCare and Medicare (“duals”) and those enrolled in DEL and Medicare (“DELs”) get most of their prescription drugs through a Part D plan.
State Takes Action
The shift to Part D has difficult and confusing all over the country. In Maine, participants, advocates, providers, and people in the Governor’s office and DHHS worked together to try to make sure people wouldn’t fall between the cracks. Here are some of the actions that were taken:
- Enrollment assistance to improve plan coverage: Duals (MaineCare members who were also enrolled in Medicare) were randomly assigned to a PDP by the federal government in the fall. The state checked each plan assignment and, if it wasn’t a good match, the state reassigned people to another plan that covered more of the member’s drugs. The state also found a good match for most DEL members enrolled in Medicare.
- Assistance with Plan costs: Part D made drug costs higher for many people so:
- For DEL members, the state decided to pay:
- The cost of Part D premiums;
- Half the cost of the deductible;
- 50% of the cost of brand name drugs up to $10 per drug; and
- When people reach the ‘donut hole’ (when the member needs to pay the full cost of drugs), the state will pay the same amount that was paid under the DEL program.
- For MaineCare members (who don’t need to pay the premium or deductible and who don’t have a ‘donut hole), the state will pay:
- 50% of the cost of the co-payment for brand name drugs, reducing the cost for brand name drugs from $3 to $1.50 for most MaineCare members.
- Making more people eligible for extra help. DEL participants who are also enrolled in the Medicare Savings Program (also known as QMB, SLMB and QI) are able to get a better subsidy so their drugs don’t cost as much.
The Medicare Savings Programs pay the cost of the Medicare Part B premium (currently $88.50 per month). Some also have their Medicare deductibles and co-insurance covered. The Medicare Savings Program used to have an asset test that kept many people from being eligible, but the state eliminated the asset test on January 1st.
Now more people are eligible. For more information or to enroll in the Medicare Savings Program, call your local DHHS office or your local Area Agency on Aging at 1-877-353-3771.Maine 1st with Help
When Part D started January 1, big problems needed to be worked out. The federal government didn’t have records of which plan some people were enrolled in. For others, they had no record of their enrollment in MaineCare – so seniors were being told they had to pay $75 or $100 for a drug which had just a $2.50 co-payment in MaineCare. By the morning of January 3, the state had seen enough. They told pharmacists that they should go back to billing MaineCare or DEL, if they couldn’t bill the PDP, until the problem was worked out. About 30 other states also took emergency action, but Maine was first in the country to try and fix the problem for low income seniors and people with disabilities.
Legislature Proposes More Help
The legislature is currently considering two bills, one sponsored by Rep. Hannah Pingree (L.D. 1848) (D. North Haven) and the other by Sen. Michael Brennan (L.D. 1959) (D. Cumberland), to offer further protections to Maine’s seniors and people with disabilities. With proposed amendments, the bills would help ensure that people are able to get necessary drugs when they are not included in the prescription drug plan and also provide assistance with mandatory co-payments for those enrolled in both MaineCare and Medicare. We will let you know what happens with this legislation in our next newsletter and on the MEJP website.
