2009 Prescription Advantage Changes and Open Enrollment
TO: Outreach Partners and Interested Parties
FROM: Prescription Advantage
DATE: October 31, 2008
Due to the current nationwide fiscal situation and its impact on Massachusetts, it is necessary to impose significant budgetary restrictions on the Prescription Advantage program. These restrictions will result in changes to the assistance Prescription Advantage members receive with their co-payments.
Effective January 1, 2009, for members in categories S2, S3 and S4, Prescription Advantage will not provide co-pay assistance until members have reached the coverage gap (donut hole) with Medicare. In 2009 the coverage gap is reached when the total retail cost of a member’s covered prescription drugs is $2,700. Once the coverage gap is reached, Prescription Advantage co-payment assistance will begin at the same levels as 2008. For members with Creditable Coverage, co-pay assistance will also begin when the total retail cost of their covered prescription drugs is $2,700.
For members eligible for Medicare, all other benefits will remain the same, as described below:
- The income cap continues to be 500% of the Federal Poverty Level (FPL).
- There will be no changes to co-payment assistance for members in categories S0-S1.
- There will be no changes to the premium assistance for categories S1 through S3.
- All membership categories will continue to have an Out-of-Pocket Spending Limit.
Note: The annual increase to these limits will become effective January 1, 2009. - Benzodiazepines will still be covered for all active members.
There are no changes to benefits for members not eligible for Medicare.
A letter will be mailed to members affected by these changes within the next two weeks.
If you have questions or concerns, please contact Prescription Advantage Customer Service at 1-800-AGE-INFO (1-800-243-4636) or your local SHINE program (see end of this article).
Part D Open Enrollment Begins; Review your options for 2009
If you are a Medicare beneficiary, it is time to review your Medicare prescription drug plan options. The Medicare Part D open enrollment period begins November 15, 2008 and ends December 31, 2008. During this period, you can sign up for a prescription drug plan if you don't have one, or you can switch to a different plan if you are unhappy with your current plan. Even if you are happy with your current plan, you should make sure that it isn't changing significantly. In addition, there may be new plans available that have lower premiums or offer more drug options.
The SHINE (Serving Health Information Needs of Elders) at Franklin County Home Care can provide one-on-one help to elders and caregivers on any health insurance or prescription drug plan question. SHINE Counselors are in every town in our service are and can come to you if need be. Please contact the SHINE office at 413-773-5555 or 978-544-2259 or .