People with HIV Must Reapply for Medicare Prescription Assistance Programs

Clients Urged to Enroll Immediately!

November 2007 -- The AIDS Foundation of Chicago (AFC) urges people with HIV who are enrolled in Medicare to reassess their coverage options for 2008. 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 225% of the federal poverty level ($13,800 to $22,800 for a family of one) should immediately apply or reapply for Medicare Extra Help and Illinois Cares Rx for help paying for their medications. Even consumers whose income or assets are slightly over the limit should apply, as some income or assets are not counted. Medicare enrollees may also choose a new Medicare Part D drug plan between November 15 and December 31, if they wish.

In 2006, AFC and partners worked with legislators to enact the Illinois Cares Rx HIV Benefit, which helps people with HIV enrolled in Medicare afford their HIV medications while reducing AIDS Drug Assistance Program (ADAP) expenditures.

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

Medicare: Is the individual on Medicare, but not also on Medicaid (not dually eligible)?

Income: Is the individual's income between about $13,800 and $22,800 per year?

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

• Apply or re-apply for the Illinois Cares Rx HIV Benefit. An application was mailed to all 2007 enrollees, but they should apply online 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.
  
  
• 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 HIV Benefit.
  
  
• Enroll in a Medicare Part D plan that coordinates with Illinois Cares Rx. Coordinating plans are AARP Medicare Rx Preferred, UnitedHealth Rx Basic, WellCare Signature , First Health Part D Premier, Humana PDP Standard, and SilverScript (the last three are new for 2008). There are also Medicare Advantage managed care plans coordinating with Illinois Cares Rx. Clients can switch plans between November 15 and December 31, but any switch should be done as soon as possible.
  
  
• If a client switches Part D plans, notify the new plan that they are enrolled in the “Illinois Cares Rx HIV Benefit”. This will ensure they are charged the correct cost sharing at the pharmacy.

RULE OF THUMB: Is a Medicare-eligible consumer paying more than a co-pay of $5.60 per month for HIV drugs? If so, there is something wrong! Sign 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 the Illinois AIDS Drug Assistance Program (ADAP).

For more information, contact AIDS Legal Council of Chicago, (312) 427-8990 or Health and Disability Advocates, (312) 223-9600.

MEDICARE RESOURCES

Tools:

Medicare Prescription Drug Benefit Presentation
Intended for use in training on the Medicare Part D prescription drug benefit and its implications for HIV/AIDS programs (PDF)

Medicare Prescription Drug Benefit Clinical Presentation
Intended for use in training clinicians on the Medicare Part D prescription drug benefit and its implications for HIV/AIDS programs, particularly for the Ryan White CARE Act (PDF)

Advocate’s Guide to AIDS Drug Assistance Program (ADAP) & Medicare Part D (PDF)

Medicare Part D & Ryan White Discussion Guide (HRSA, October 2007) (PDF)

Fact Sheets:

Tip Sheet: People with Medicare and HIV/AIDS
Centers for Medicare and Medicaid (October 2007)

Medicare and HIV/AIDS.
Henry J. Kaiser Family Foundation (October 2006)

The New Medicare Drug Benefit: An HIV/AIDS Enrollment Tool Kit
Treatment Access Expansion Project, HIV Medicine Association, American Academy of HIV Medicine and National Association of People with AIDS (September 2005)

Articles:

Medicare's New Drug Program Creates Challenges
Article from Positively Aware (September/October 2005)

Do You Speak Medicare Part D?
Definitions of Selected Health Insurance Terminology Under Medicare Part D. Medicare Advocacy Center

The New Medicare Prescription Drug Law: Issues for Dual Eligibles with Disabilities and Serious Conditions.
Kaiser Commission on Medicaid and the Uninsured

HIV Medicine Association

Medicare Rights Center

Center for Medicare Advocacy

NEWS ARCHIVE

2006 Medicare Part D Enrollment Info

2005 Initial Medicare Part D Enrollment Info