State Representative Barbara L’Italien (D-Andover). Co-Chair of the Elder Affairs Caucus, is pleased to announce that Prescription Advantage, the Commonwealth’s pharmacy assistance program administered by the Executive Office of Elder Affairs, will conduct an Open Enrollment March 15 through April 28. This is the first open enrollment since Prescription Advantage became a program that wraps around Medicare Part D, the new Medicare prescription drug benefit.
“I hope all eligible seniors will examine the Prescription Advantage plan, which can assist them with the additional, and sometimes unexpected, cost of prescription drug payments and gaps in coverage.” commented Rep. L’Italien.
Prior to Jan. 1 when Medicare Part D took effect, Prescription Advantage was the state’s prescription drug insurance program, providing primary coverage for seniors and younger disabled individuals who meet specific income requirements. The new Prescription Advantage “wraps around” or supplements the Medicare prescription drug benefit for Medicare eligible individuals by helping pay for co-payments and coverage gaps for an individual’s Part D plan. Those with limited income may also receive help paying for Medicare Part D plan premiums. Prescription Advantage will also provide primary coverage that is comparable to Medicare Part D plans for those who are not eligible for Medicare.
“It is important for people who were not eligible for Prescription Advantage before, or who did not consider the program, to understand how much Prescription Advantage can help them now,” said Elder Affairs Secretary Jennifer Davis Carey. “We are pleased to announce the open enrollment. I encourage people to consider joining Prescription Advantage in order to reduce their out-of-pocket costs for their prescription medications. There is no monthly premium for people who join Prescription Advantage to receive help paying for their prescriptions.”
Who Can Join Prescription Advantage?
Prescription Advantage is available to those who are:
- 65 years of age or older who do not have a gross annual income that exceeds 500 percent or more of the Federal Poverty Level (single $49,000, married $66,000),
- Under age 65, work no more than 40 hours per month, meet MassHealth’s CommonHealth disability requirements, and have a gross annual household income at or below 188 percent of the Federal Poverty Level (single $18,424, married $24,816).
How Will Prescription Advantage Work for Those Eligible for Medicare?
- If you are Medicare eligible, you must join a Medicare Part D drug plan in order to be eligible for Prescription Advantage benefits;
- Limited income applicants (those at or below 188 percent of the Federal Poverty Level – single $18,424, married $24,816) must apply for “Extra Help” also known as “Low Income Subsidy” administered by the Social Security Administration to be eligible for Prescription Advantage benefits.
- Medicare Part D will be the primary drug insurance. Prescription Advantage will be the secondary payer supplementing the Medicare coverage during coverage gaps and will provide protection from catastrophic drug costs.
- Prescription Advantage will cover portions of co-payments. Co-payment amounts are on a sliding scale according to the member’s income.
- There will be no monthly premium for Prescription Advantage members with incomes below 300 percent of the Federal Poverty Level (single $29,400, married $39,600). There will be a $200 annual enrollment fee for those between 300 and 500 percent of the Federal Poverty Level (single $29,401 – $49,000, married $39,601 – $66,000).
- Prescription Advantage may also pay all or part of your Medicare Part D premium.
How Does Prescription Advantage Work for Those with Coverage that is “Creditable” or Comparable to Medicare Part D through a Union or Employer?
- Prescription Advantage will provide secondary coverage to members who are not in a Medicare Part D plan, but have “creditable coverage,” meaning that Medicare has determined that the prescription drug coverage is as good as Medicare Part D coverage. Creditable coverage is typically provided through an employer or union.
- How Does Prescription Advantage Work for Those Not Eligible for Medicare?
- For members not eligible for Medicare, Prescription Advantage will continue to provide primary prescription drug coverage.
- There will be no monthly premium for this coverage; however, members will pay a quarterly deductible and co-payments until an annual out-of-pocket spending limit is reached. At that time, Prescription Advantage will pay the full cost of the member’s covered prescription drugs through the end of the plan year.
Prescription Advantage Open Enrollment will run from March 15 through April 28. Those seeking more information or an application should call 1-800-AGE-INFO (1-800-243-4636) and press 1. Applications will be available on-line at www.mass.gov/elders and www.800ageinfo.com on March 15.
Enrollment in Medicare Part D prescription drug plans is open through May 15. To talk to a local SHINE (Serving the Health Information Needs of Elders) counselor for help making decisions about prescription drug coverage, including information on Medicare Part D and Prescription Advantage, call 1-800-AGE-INFO (1-800-243-4636) and press 2. MassMedLine staff is also available to help with decisions about prescription drug coverage at 1-866-633-1617.
Anyone with additional comments and concerns may contact Rep. L’Italien’s office at (617) 722-2080.
