CONFUSED ABOUT THE NEW MEDICARE-APPROVED DRUG DISCOUNT CARD? CONTACT YOUR SHIP!
The Health Assistance Partnership
By Christine Engelhardt, Executive Director, Halth Assistance Partnership

In December of 2003, President Bush signed into law the Medicare Prescription Drug Improvement and Modernization Act (MMA) which will give Medicare beneficiaries a prescription drug benefit in 2006. The law also allows private companies, approved by the federal government’s Centers for Medicare and Medicaid Services, to offer Medicare beneficiaries drug discount cards that can be used from June 1, 2004 through December 31, 2005. If you are a Medicare beneficiary who does not have out-patient prescription drug coverage through Medicaid, you can get a Medicare-approved drug discount card if you want one. There is no enrollment deadline to worry about: you can sign up through the end of 2005.

The cards are intended to provide discounts on certain medications, and each card offers different discounts on different drugs at different pharmacies. (Keep in mind that while most prescription drugs are considered “covered” drugs, some medications can not be discounted under this new Medicare program. You should also remember that card sponsors may change weekly the price of the drugs as well as the drugs on which they offer discounts.) Some cards can be used only in certain states or regions, some anywhere in the nation. (If you live in a territory, the rules are slightly different.) Some cards have an enrollment fee of up to $30 a year, some none. Mail order is an option with many cards, if not all.

No question, Medicare beneficiaries have numerous choices of cards. As of early May, there are approximately forty national cards, plus many other regional cards. (However, if you belong to a Medicare Advantage, formerly Medicare+Choice, plan that offers a card only to its members, i.e., an exclusive card, you can have only that card unless you disenroll from that plan and enroll in traditional Medicare or in another plan that lets you get a card you want.) Medicare beneficiaries may have only one Medicare-approved drug discount card but can have as many other prescription drug discount cards as they like. At times drug store discount card programs or programs sponsored by pharmaceutical companies will give you a better price than a Medicare-approved drug discount card will.

In addition to creating the Medicare-approved drug discount cards, the MMA gives low-income beneficiaries a $600 credit to help pay for prescription drugs in 2004 and again in 2005. Medicare beneficiaries whose income is below a certain level—no matter what assets like a house, car, or savings you have—qualify for this credit. Medicare beneficiaries who receive help paying for Medicare premiums and/or Medicare deductibles from their state may also qualify for the credit. In order to obtain the credit, you must get a Medicare-approved drug discount card and you must apply for the credit. You should apply for the credit at the same time you apply for a Medicare-approved drug discount card. (In determining if you are eligible for the $600 credit, you may also want to consider if you can get additional help paying for prescriptions from any pharmacy assistance programs your state may have or from Medicaid.) If you are not currently eligible but you become eligible at a late
r date, you can apply for the credit until late 2005. If you submit your application after March 31, 2005, you will not get the full $600 for 2005 but only a pro-rated amount for that year.

It is clearly important to choose a Medicare-approved drug discount card carefully, but that can be difficult, given the number of cards available. The choice is made more complicated if you take several different medications and if your medication needs change.

So how do you decide if you should get a Medicare-approved drug discount card? And if you decide to get one, how do you decide which one? How do you apply for the $600 credit? If you are denied the $600 credit, how do you appeal that decision? Is there any other help available to you? Get answers from your SHIP: your State Health Insurance assistance Program. SHIPs provide free, objective information about Medicare coverage and benefits to beneficiaries and their caregivers, thanks to thousands of volunteers. Supported by the federal and state governments, SHIPs can also give you applications for both the card and the low-income credit. Every state and the District of Columbia have one, as does Guam, Puerto Rico, and the Virgin Islands. To find the SHIP in your state, go to www.healthassistancepartnership.org/ships, and call whenever you need information on Medicare issues.

Based in Washington, DC, the Health Assistance Partnership is a non-profit organization that serves consumer health insurance assistance programs that help people—whether uninsured or insured through Medicare or Medicaid or privately—understand health insurance coverage and benefits.

May 24, 2004