Bay Area Reporter - November 10, 2005
Mark Folkman

An additional benefit, called Part D, will add prescription drug coverage to the Medicare system. Recipients will have the option to choose from over a hundred private insurance plans.

Last Friday, November 4, the Quan Yin Healing Arts Center, as part of its Healthy Choices program, hosted a community forum where 20 participants snacked on homemade soup and pasta salad as presenter Randy Allgaier, co-chair of the HIV Health Services Planning Council, shed light on the drastic changes.

"I want as much information as possible," said Stacia Scherich, a 39-year-old Medicare recipient living with HIV. She said she was anxious about how the changes would affect her health coverage.

Primarily a benefit for the nation?s senior citizens, Medicare also provides assistance to younger people with certain disabilities. People with HIV are eligible for Medicare if they have been disabled by their condition for longer than 24 months. Allgaier said that approximately 17,500 Californians with HIV/AIDS rely on Medicare.

The new prescription plan will cost enrollees an average of $25.41 per month, with a $250 yearly deductible. Recipients can choose to enroll in a stand-alone drug plan or a managed care plan that combines prescription drug coverage with HMO-style health care. Drugs to treat AIDS are covered under all plans and options.

According to Allgaier, low-income residents may be eligible for a low-income subsidy option that will kick in to help cover monthly premiums and drug co-payment costs of the new plan. He encouraged participants to apply for the subsidy, even if their income is above the $14,355 cap for a single individual.

The new Medicare plan will have a major impact on the AIDS Drugs Assistance Program, which uses a combination of federal and state funds to cover the cost of AIDS drugs for people with HIV/AIDS whom also make under $50,000 a year. Current Medicare clients with ADAP coverage will be required to enroll in a Part D prescription drug plan. ADAP will take a backseat to Medicare, but its funds will still be used to help with co-pays and deductibles. Allgaier applauded the San Francisco AIDS Foundation and Project Inform for extraordinary lobbying efforts that ensured continued ADAP coverage under the new plan.

Allgaier warned participants that those with dual Medicare/Medi-Cal coverage may be adversely affected by the upcoming changes. He said in California there are 13,500 Medicare recipients that are also eligible for Medi-Cal, which provides health insurance coverage for low-income state residents. Currently, ADAP funds are used to pay for AIDS drugs and other "share of cost" co-pays for dual Medicare/Medi-Cal recipients, but Allgaier said that modifications in ADAP coverage will force recipients to pay increased out-of-pocket costs.

Several meeting participants said they were overwhelmed and confused by the upcoming changes. "I'm definitely depressed by this," said Carl Stokes, a 47-year-old Mission District resident.

"My costs are going to go up," said Mike Wonder, a 51-year-old dual Medicare/Medi-Cal recipient. "They have programs to send AIDS drugs to poor countries - now we may need a program to send drugs to our own people."

Medicare, Medi-Cal, and ADAP will continue to cover the cost of AIDS drugs - which can run as much as $14,000 a year - for recipients, but Allgaier said he was worried how the changes would affect low-income clients who may face increased costs for vision, long term care, dental, and other services.

Allgaier hoped his presentation would help attendees make informed decisions about enrolling in the new benefit. "As a Medicare beneficiary myself, I realize that people need to be educated to make sure our health care is not compromised," he said.

Open enrollment for Medicare Plan D begins on November 15 and runs until May 15, 2006.

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