People with HIV Must Reapply for Medicare Prescription Assistance Programs

Clients Urged to Enroll Immediately!

November 2009 -- The AIDS Foundation of Chicago (AFC) urges people with HIV who are enrolled in Medicare to reassess their coverage options for 2010. Case managers should pay special attention so prescription assistance is continued for next year. All applications must be submitted immediately.

The Make Medicare Work Coalition, AIDS Foundation of Chicago, and AIDS Legal Council of Chicago have worked closely with key state agencies to prepare updated materials for consumers and case managers.

HIV-positive Medicare beneficiaries with annual income between 135% and about 230% of the federal poverty level ($14,620.50 to $25,532 for a family of one) should immediately apply or reapply for Medicare Extra Help and Illinois Cares Rx for help paying for their medications. Medicare enrollees may also choose a new Medicare Part D drug plan beginning November 15 if they wish.

Two questions to determine if an HIV-positive individual needs to apply or reapply for the Illinois Cares Rx HIV Benefit or Extra Help:

1. Medicare: Is your client on Medicare, but not also on Medicaid (not dually eligible)?
   
   
2. Income: Is your client’s income between about $14,620.50 and $25,532 per year?
   

If the answer to both questions is “yes,” individuals should:

1. Apply or re-apply for the Illinois Cares Rx HIV Benefit. An application was mailed to all 2009 enrollees, but they should apply online at www.illinoiscaresrx.com for fastest processing. They should apply immediately. Clients must answer “yes” to the question about their HIV status. By doing this, they will be charged the correct cost sharing at the pharmacy.
   
   
2. Apply or reapply for Extra Help available under Medicare Part D through the Social Security Administration (SSA). Apply online or contact SSA at 1-800-772-1213 or 1-800-324-0778 (TTY for hearing impaired). If clients are determined ineligible for Extra Help, they may still receive prescription drug benefits under Illinois Cares Rx.
   
   
3. Enroll in a Medicare Part D plan that coordinates with Illinois Cares Rx. Coordinating plans for 2010 are Wellcare Classic (S5967154), SilverScript Value (S5601034), First Health Part D-Premier (S5768042), Humana Value (S5884107) and AARP Medicare Rx Saver (S5921081). NOTE: Two plans will automatically switch 2009 Illinois Cares Rx members into new plans for 2010. United members will be switched to AARP Medicare Rx Saver (S5921081). Humana will switch members to Humana Value (S5884107). Because plans may have changed, make sure all medications your client takes are covered by the plan.

If a client switches Part D plans, notify the new plan that they are enrolled in the “Illinois Cares Rx HIV Benefit”. This will assure that they are charged the correct cost sharing at the pharmacy.

DEADLINES: Submit all applications online and make plan changes no later than December 4 to avoid problems in 2010.

RULE OF THUMB: Is your Medicare-eligible client paying more than a co-pay of $6.00 per month in 2009 or $6.30 in 2010 for HIV drugs? If so, there is something wrong! Sign your client up for a benefits consultation today! Medicare-enrolled clients whose income is too high to qualify for Illinois Cares Rx can and should stay on Illinois AIDS Drug Assistance Program (ADAP).

For more information or assistance enrolling clients, contact AIDS Legal Council (312) 427-8990.

Fact Sheet for Case Managers (PDF)

HIV Medicine Association

Medicare Rights Center

Center for Medicare Advocacy

NEWS ARCHIVE

2007 Medicare Part D Enrollment Info

2006 Medicare Part D Enrollment Info

2005 Initial Medicare Part D Enrollment Info