January 2006 Newsletter
Volume 5, Number 3
Important Medicare Part D Transition Issues for
Dually Eligible Individuals
A t this writing, we are hearing numerous negative reports about the experiences
of people with disabilities who have been moved to Medicare Part D from Medicaid
for their prescription drug coverage. Two main themes are emerging. First, people
do not yet have enrollment cards in hand from their new providers and their pharmacists
can not access their enrollment information. In this instance, individuals are
being charged full price for their drugs despite the fact that they have coverage
and are supposed to receive a one-time refill of any drug they need whether it
is covered by their new plan or not.
Second, even when people can demonstrate their coverage, they are being charged
inappropriate co-pays. A “full-benefit dual eligible” (i.e., anyone
who has both Medicaid and Medicare and qualifies for “extra help” with
their Part D premiums) is only responsible, by law, for a maximum $2 co-pay on
generic medications and $5 co-pay on name-brand medications.
It seems that individuals in Kansas are by no means alone in these problems.
Officials in numerous other states nationwide have reported that dual eligibles
in their states are also unable to fill their prescriptions at the correct co-pays
or fill them at all. At least a dozen states have intervened to help with co-pays
until coverage issues can be resolved. As this newsletter goes to press, Kansas
is joining these other states to ensure Kansans receive the medicines they need.
Governor Sebelius’s office has noted that pharmacies are having difficulties
with claims and that records of individuals’ plan enrollment are sometimes
missing. Because these issues have caused people to be unable to get the prescriptions
they need or to be charged inappropriate co-pays, the state will cover the cost
of providing prescriptions for Kansans experiencing these barriers. Kansas will
continue this intervention until these temporary problems with the federal Medicare
system are resolved. These problems seem to be related to the transition to the
new Part D program and should come to an end in the near future. In the meantime,
if you or someone with whom you are working is unable to get needed prescriptions
because of these issues, you should contact your local SRS office. With support
from Governor Sebelius, SRS is in the process of developing a cadre of individuals
to handle these issues.
In addition to your local SRS office you can contact either Senior Health Insurance
Counseling for Kansas at 1-800-860-5260 or your nearest Working Healthy Benefits
Specialist to receive assistance or to discuss your drug plan options. Further,
we would like to hear about any problems you have had with the process of transitioning
from Medicaid to Medicare Part D. Please contact Jean Hall at the University
of Kansas by email at jhall@ku.edu or call her at 1-800-449-1439 to share your
experiences.
Work Opportunities Reward Kansans (WORK) Update
Earlier this month, the Division of Health Policy and Finance submitted a response
to a fifth request for additional information about WORK from the federal
Centers for Medicare and Medicaid Services (CMS). If approved, WORK will
allow people who qualify for certain Home and Community Based Services (HCBS)
waivers to enroll in Working Healthy and still get some attendant care and
assistive services.
Benefits Specialist Corner
This issue features Working Healthy Benefits Specialist Earl Williams from
the Emporia Area SRS Office. In his spare time, Earl enjoys working with
young people. He currently serves as the Youth Director for his church and
coaches a community basketball team of 8th and 9th graders. Earl’s
dream weekend consists of spending quality time with his family. Earl’s
coverage area includes the counties of Rice, McPherson, Harvey, Marion, Morris,
Chase, Lyon, Butler, Greenwood, Elk, Cowley and Chautauqua. He can be reached
by phone at (620) 342-2505 ext. 233 or by E-mail at EXLW@srskansas.org.
I am here to tell you that the Medicare D outreach training has been very
successful. The Benefits Specialists have worked alongside staff from the
Senior Health
Insurance Counseling of Kansas (SHICK), the Social Security Administration
(SSA), the Centers for Medicare and Medicaid Services (CMS) and some local
pharmacies to try and get correct information out to our consumers. We not
only focused on helping our Working Healthy consumers, we helped all those
who came through the door looking for help with their Medicare D plans. During
the presentations, I would inform those who were in attendance that even
if they themselves were not receiving Medicare Part D, that it would affect
someone they know, a mother or aunt or even a brother or sister. The information
they received during the presentations should be networked to those who will
be affected. During one of my trainings, I took an informal poll. Out of
14 people in attendance who had received the book, ‘Medicare & You,” no
one had read it. To my surprise, no one had opened their book to read about
Medicare Part D and the changes soon coming into effect. I then asked them
how many had internet access at home and only two individuals raised their
hands. This showed me how important all of the outreach trainings were and
continue to be for consumers throughout Kansas. The trainings are very important
because this is the only resource available and utilized by many consumers.
I also wanted to congratulate the Working Healthy team for accomplishing a
goal in 2005 - reaching the milestone of 1000 enrollees. Due to the dedication
of the entire team, we reached this goal at the end of Novemeber. We advocate
for those who are disabled and want to be treated like everyone else. When
a person with a disability walks into a Human Resource office to apply for
employment, they want to be treated like any other prospective employee. If
the client can obtain Working Healthy benefits, this creates a environment
where there is one less barrier for this prospective employee with a disability.
-Earl Williams, Working Healthy Benefits Specialist
Medicare Part D Prescription Drug Coverage Tips
People who are dually-eligible for Medicare and Medicaid are automatically
enrolled in a Medicare Part D plan for prescription drug coverage. This
enrollment was done at random so the plans assigned to people may or may
not be their best option. The website, Medicare.gov, offers an online tool
to identify plan options that are best for an individual and his or her
needs. After utilizing the online tools, here are some tips to ensure you
have the plan that will cover all your medications before you proceed with
enrollment in your plan of choice.
TIP 1 - Call the plan you believe is best for you and make sure that they
will cover all your medications. Some base plans may not cover non-generic
drugs, so it may be in your best interest to pay a small amount for a plan
that has better coverage. Also, it has been noted by some that the information
provided about plans and the drugs they cover has been incorrect, so it
is best to call the plan directly to make sure all the drugs you need are
in
fact covered before you sign up for that plan.
TIP 2 - Call your pharmacy of choice to make sure they are providers with the plan you have chosen. Not all pharmacies are enrolled with all the plans.
TIP 3 - Prepare a list of all of the medications you are currently taking
and their dosages. Have this list on hand so that when you go online
to look at plan options, contact your pharmacy, or call plans to explore
your
options,
those providing technical assistance can give you the best possible information
available. Being well-prepared and informed is one of the best tools
you can have, especially when many others are seeking the same assistance.
TIP 4 - Know that you will be charged a co-pay of $1-$5 for each prescription
you have filled that is covered by your plan. A co-pay of $1-$2 is
charged for generic prescription drugs and a co-pay of $3-$5 is charged
for name-brand, non-generic prescription drugs.
TIP 5 - Know that if you are dually eligible you may change plans monthly.
So, if your prescriptions change or you find that you are not in
the best plan, as
a dual eligible participant you have this option. All others may change
plans at the Annual Enrollment period that lasts from November 15
through December
31 of each year.
If you need further assistance determining the best plan for you or have
any other questions regarding Medicare Part D, please call Working
Healthy at 1-800-449-1439
or contact your local Benefits Specialist. Their contact information
is provided below. Working Healthy Benefits Specialists are here to
help you
in any way
they can with the information available to them at any given time.
Centers for Medicare
and Medicaid Services is still developing the program policy and things
naturally have changed along the way and will continue to change during
this transition
period. Benefits Specialists continue to do great work with the technical
assistance they provide despite this constantly changing information.
They are dedicated
to what they do and are here to help as best they can.
West Region, Hays Service Center - Sherri Sherman, (785) 628-1066 ext.
268, HASAS@srskansas.org
Northeast Region, Manhattan Service Center - Judi Vargas, (785) 776-4011
ext. 227, MJXV@srskansas.org
KC Metro Region, Lawrence Service Center - Norm White, (785) 832-3711,
LNBW@srskansas.org
Southeast Region, Pittsburg Service Center - Dan Hallacy, (620) 231-5300,
ext. 330, CDLH@srskansas.org
Northeast Region, Topeka Service Center - Steve Curtis, (785) 296-5816,
SXXC@srskansas.org
South Central Region, Emporia Service Ctr. - Earl Williams, (620) 342-2505
ext. 233, EXLW@srskansas.org
Wichita Region, Wichita Service Center - Stefania Haessig, (316) 337-6427,
WSZH@srskansas.org
This newsletter and other Working Healthy information can be found online
at: http://www.workinghealthy.org
Working Healthy is published quarterly by the University of Kansas CRL, Division
of Adult Studies and in cooperation with the Kansas Department of Social and
Rehabilitation Services.Additional copies and copies in alternate formats are
available upon request by writing the University of Kansas Division of Adult
Studies, Attn: Noelle, 1122 West Campus Rd.. JRP Hall Rm. 517, Lawrence, KS 66045,
by phone (785) 864-7085, by email: pixie@ku.edu.
KU Research Team:
Jean Hall, Principal Investigator
Noelle Kurth, Project Coordinator and Editor
Kansas Division of Health Policy & Finance:
Mary Ellen O'Brien Wright, Program Director
Nancy Scott, Benefits Specialist Team Leader