|
|
MAIN
|
 |
|
|
A Joint Project of the Maine
Association of Interdependent Neighborhoods |
|||
|
Volume 9 No. 1 |
February 2005 |
||
|
|
MAIN
|
|
|
|
A Joint Project of the Maine
Association of Interdependent Neighborhoods |
|||
|
Volume 9 No. 1 |
February 2005 |
||
Drugs for the Elderly, MaineCare and
the Medicare Part D Drug Benefit
All wrapped up in the State Budget!If anyone wanted to really confuse people insured by both Medicare and either MaineCare or the Drugs for the Elderly program, they couldn't have planned it better than with the new Medicare Part D program.
What is the Medicare Part D Benefit?
Medicare is the federal government program for those 65 and over and those with disabilities that covers many health care expenses. Until now, it hasn't covered most prescription drugs. As of January 1, 2006 (unless Congress delays its start), Medicare will offer a new prescription benefit, the Part D benefit. This benefit will have a monthly premium, deductibles and co-payments. These costs will be reduced for low-income people, depending on income level.
Different Part D benefit packages will be offered to Medicare participants instead of the current MaineCare or the Drugs for the Elderly and Disabled Program (“DEL”) prescription drug benefit. (MaineCare is Maine's Medicaid program run by the state.) For most participants, the Part D coverage will not be as good as current prescription drug coverage in MaineCare or DEL. We expect that some of the prescription drugs covered by MaineCare and DEL will not be covered in these Part D packages.
This means that in this legislative session, we must be sure the Legislature sets aside money so that all drugs presently covered in MaineCare and DEL will continue to be available after Medicare Part D is effective - even if it means paying for them with state dollars. You would think that the state would save money if Medicare were now providing the drug benefit to people on MaineCare. Not so. A “claw back” provision in the Medicare law requires states to pay the federal government back for most of the cost of the drugs.How does Medicare Part D fit with MaineCare?
In Maine, about 42,000 people are “dual eligible,” for both Medicare and MaineCare and presently get their prescription drugs through MaineCare. As of January 1, 2006, those who are dual eligible will lose their drug coverage under MaineCare and will need to sign up for Medicare Part D in order to maintain drug coverage.
In Medicare Part D, those who are in nursing homes or other institutions will have no premiums or co-payments. Those in the community and on MaineCare won't pay a premium, but will pay $1 for generics and $3 for brand-name drugs, with no co-payments after their total drug costs exceed $5,100 for the year. Co-payments will increase over time with inflation.Exactly which drugs the Medicare Part D packages will cover is not yet known. We do know, however, that Medicare will not cover some drugs like benzodiazapines (drugs for anxiety).
How will the Drugs for the Elderly program
fit with Medicare Part D?Maine's state-funded DEL program presently provides a drug benefit for people 62 and over and those with disabilities with income below 185% of the poverty level ($1,476/month for an individual; $1,980/month for a couple). The program covers 80% of the cost for all generic drugs and brand name drugs for 13 specified and often common conditions (with a $2 co-payment). It has been a lifesaver for many people who are just over the MaineCare income guidelines and have not had prescription drug coverage through any other plan.
As of January 1, 2006, people in the DEL program who also have Medicare (which is most, but not all people in DEL) will be asked to enroll in the Medicare Part D Drug coverage. The cost of the Medicare Part D premium, deductibles and co-payments will depend on your income and assets. But if your income is over 150% of the poverty level ($1,197/month for an individual; $1,605 for a couple), you will need to pay the maximum premium, deductibles and co-payments:
A premium estimated to cost each person $420 annually - or about $35 per month;
A $250 deductible;
A 25% co-payment until drug costs reach $2,250 annually;
100% for drug costs between $2,250 and $5,100 annually (no Medicare coverage for these costs); and
5% for drug costs exceeding $5,100.
If your income is under 150% of the poverty level and you meet the asset test, the cost of the monthly premium and the deductible will be reduced or waived. The co-payments - for the drugs, which are covered in the plan - will be lower. The Part D premium has a complex payment schedule, but for many people under 150% of the poverty level, these co-payments will be similar to the current discounts in the DEL program.
So what does this mean for the DEL program?
On the one hand, the DEL program will change a great deal because it no longer has to pay for drugs provided by Medicare Part D. That will save money in DEL - savings that are included in the Governor's proposed budget. On the other hand, to prevent harm to people in DEL, legislators, administrators and advocates must be sure that:
Anyone in DEL who is not covered by Medicare Part D continues to get at least the same DEL coverage they get today. (This primarily applies to those between 62 and 64 years old and to those with disabilities who must wait 2 years before qualifying for Medicare.)
Anyone in DEL who also can enroll in Medicare Part D continues to get coverage for drugs covered by DEL, but not by Part D; and
They examine Medicare Part D coverage so that anyone in DEL does not have to pay more in Medicare Part D than in DEL for their drugs. This will be a problem particularly for those in DEL whose income is above 150% of the poverty level.
So, we have a lot of work ahead to make sure that people will not be harmed as we figure out how to integrate Medicare Part D with MaineCare and DEL.
The message to policy makers?
Make sure that no one is hurt by Medicare Part D, and that people in MaineCare and on DEL are helped as much as possible!
