Bay Area Reporter - November 15, 2007
Heather Cassell, h.cassell@ebar.com

This year, Anne Donnelly, director of health care advocacy at Project Inform, said she is watching dual eligibilities closely. Dual eligibilities are beneficiaries that are enrolled in both Medicare and Medicaid. Donnelly estimates that about half of individuals enrolled in dual eligibility programs will be reassigned to a different benchmark plan this year.

That is more than 600,000 low-income California Medicare beneficiaries, reported the Los Angeles Times November 10, who will have to choose a new prescription drug plan before the end of the year or be automatically reassigned to a plan that may not include the services they need. An estimated 75 percent of beneficiaries have already been reassigned, according to the Times. This leaves an estimated 100,000 beneficiaries who choose their dual eligibility plans with a decision: Either pay the new higher premium for the plan in which they are currently enrolled or select a no-premium plan.

"If they don't want to pay an additional premium," said Donnelly, about individuals who chose their dual eligibility plans, "they will need to choose another plan."

Donnelly suggests that people review every letter they receive from Social Security or the Centers for Medicare and Medicaid Services. There are 56 plans to select from this year.

Health care advocacy organizations are available to assist individuals with explaining their Medicare Part D plan options and with selecting the best plans to meet individuals' needs.

According to House Speaker Nancy Pelosi's (D-San Francisco) office, most people will have access to at least one plan with lower premiums than they currently pay. Pelosi's office also stated that late enrollment penalties have been eliminated for low-income subsidy-eligible individuals.

"We are still having to do a lot of work with individual clients to help them navigate through all of this and make sure that they are properly enrolled," said Dana Van Gorder, the new executive director of the Project Inform. "We are always available to help anyone who is having any kind of issue."

While there aren't as many changes to Medicare Part D as there were last year during the enrollment period, Donnelly said, she doesn't expect this enrollment period to go smoothly.

Donnelly suggests the following things to help people to get through the enrollment period:

1. Review your plan to make sure that it's still working to provide the benefits you need both with medical and prescription coverage, but also with the pharmacy network. Also check other plans to see if they might work better. Narrow the plans down to the three that will work best for you.

2. Get refills on medications for January as back up.

3. Contact your medical benefits counselor or locate one immediately to help you with your questions, the enrollment process, and ask about alternative beneficial programs you may not be aware of.

4. If you don't receive the full low-income subsidy and are eligible for Medicare, contact the AIDS Drug Assistance Program to find out information about the ADAP Medicare Premium program.

5. Look to your pharmacist as an advocate and a resource.

Medicare Part D assistance

AIDS Hotline

800-367-AIDS

http://www.sfaf.org/aidsinfo/basics/hotline.html

ADAP Medicare, State Office of AIDS

www.dhs.ca.gov/AIDS

Centers for Medicare and Medicaid Services

800-633-4227

http://www.cms.hhs.gov/

Health Consumer Alliance

(310) 204-4900

http://healthconsumer.org/

Generic Drug Equivalents

www.crbestbuydrugs.org

Health Initiatives for Youth

(415) 274-1970

http://www.hify.org/wide_wide_world.htm

Health Insurance Counseling and Advocacy Program (HiCAP)/State Health Insurance Assistance Program (SHIP)

800-434-0222

http://www.calmedicare.org/counseling/index.html

HIV Medicine Association

(703) 299-1215

http://www.idsociety.org/HIVMA_Template.cfm

Medicare

800-633-4227

TTY 877-486-2048

www.medicare.gov

Medicare Advocacy

www.medicareadvocacy.org

National Senior Citizens Law Center

(510) 663-1055

www.nsclc.org

Positive Resources Center

(415) 777-0333

http://positiveresource.org/benefits/default.asp

Project Inform

800-822-7422

http://www.projinf.org/org/infoline.html

Treatment Access Expansion Project

http://www.taepusa.org/medicare_resources.html

WORLD

http://www.womenhiv.org

(510) 986-0340

071115
BR071106

Always watch for outdated information. This article first appeared in 2007. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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