State Launches Medicare Prescription Assistance Program for People with HIV

Clients Urged to Enroll Immediately!

November 2006 -- In November 2006, the State of Illinois launched a new program to help more than 250 low-income and HIV-positive Medicare beneficiaries afford the high out-of-pocket costs of Medicare’s new prescription drug program.

Governor Rod Blagojevich approved legislation creating the program earlier this year. State Rep. Sara Feigenholtz (D-Chicago) and State Sen. Carol Ronen (D-Chicago) championed the legislation that created the new benefit.

“Illinois’ new program is a national model to help HIV-positive people maximize their Medicare benefits,” said Representative Feigenholtz. “Once again, thanks to Governor Blagojevich, Illinois is leading the nation in healthcare expansion.”

The program expands Illinois Cares Rx Basic to help low-income and HIV-positive Medicare beneficiaries cover premiums, the deductible, and co-insurance—include the period of no coverage know as the “donut hole”—for Medicare’s prescription drug coverage. Enrolled clients will pay about $2 or $5 per prescription.

In addition, the new program will allow hundreds of clients who currently rely on the state’s AIDS Drug Assistance Program (ADAP) for their HIV-related medications to afford drug coverage through Medicare. By decreasing the number of Medicare-eligible clients who access ADAP, the state can provide ADAP services to hundreds of new clients who have no other way of obtaining lifesaving HIV medications.

“For low-income people living with HIV, Medicare drug coverage is simply too expensive. They can’t afford the high-cost of lifesaving HIV medications,” said John Peller, the director of state affairs at the AIDS Foundation of Chicago (AFC). “By assisting these individuals, Illinois will help them leverage a comprehensive drug benefit. Illinois will also maximize AIDS Drug Assistance Program funding to help people who do not qualify for Medicare.”

Staff with the Make Medicare Work Coalition will enroll prospective clients during special benefits assistance seminars to be held at area HIV/AIDS service agencies. Clients must call to make an appointment.

To be eligible, individuals must be on Medicare, have an annual income below $21,218, and proof of HIV diagnosis. Very low-income clients who receive Medicare’s Extra Help subsidy are not eligible for the new state-funded program.

Individuals who believe they may be eligible should immediately contact one of the agencies hosting the special enrollment session to schedule a benefits consultation or learn about the next public enrollment event. It is critical that individuals begin the application process immediately so they can take advantage of the new program beginning January 1, 2007, the program’s start date.

All HIV-positive individuals on Medicare should review their Medicare Part D drug coverage during the open enrollment period, which ends December 31, 2006. During this period, they can switch drug plans. The Make Medicare Work Coalition created this guide for case managers to help HIV-positive beneficiaries review their Medicare coverage

HIV Medicine Association

Medicare Rights Center

Center for Medicare Advocacy

NEWS ARCHIVE

2007 Medicare Part D Enrollment Info

2005 Initial Medicare Part D Enrollment Info