Pointers If You are Losing IL Cares RX

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Some Information about Prescription Drug Coverage

Many people have lost a big part of their prescription drug coverage. This state program was IL CaresRx and it was terminated by the State on 6/30/12 leaving many people wondering what shall I do next?

First, know that you still have a Medicare Prescription drug plan. Unlike when you were on IL CaresRX, now you will be asked to pay the premiums of that plan; but you may have some nice coverage options open until August 31st. You now have a special enrollment period (SEP) to move to another Part D (RX) Plan or even into a Medicare Advantage Plan that may save you money.

Starting with some basics: Do you qualify for a government program called “Extra Help”? You may qualify if you have up to $16,755 in annual income ($22,695 for a married couple) and up to $13,070 in resources ($26,120 for a married couple) 2012 limits. You can apply at https://secure.ssa.gov/i1020/start or call Social Security at 1-800-772-1213

If you are a veteran, check with the VA. You may qualify to buy your drugs at a substantial discount through the VA. For special needs medications, contact organizations or associations for assistance through pharmaceutical patients’ assistance programs. In many cases there are foundations that will help patients in need – call the drug manufacturer. Ask your doctor’s office if they have samples. Check with your pharmacy for discounts programs.

Valuable information may be presented in seminars. Look for seminars put on by The Central Illinois Agency on Aging or SHIP. Contact your insurance agent.

You can look at changing plans, but be careful to watch for overall costs and possible restrictions on drugs you currently take. These restrictions include: the drug not being on the “formulary (covered) list”, requiring “prior approval”, “step therapy”, or “quantity limits’.

Another option in certain situations is to look at a Medicare Advantage Plan (MA) which includes drug coverage. MAs are private insurance companies offering coverage at least as good as Original Medicare. Most if not all of these plans have co-pays for hospital stays, doctors’ visits and other medical services and supplies. However, if you have limited expenses for hospital stays, durable medical equipment, therapy (including cancer treatment), you may be able to offset some of your (extra prescription) costs by reducing your premiums with a MA plan. This will not work well in all circumstances, but may be a viable option for you.

For more information contact a qualified insurance professional specializing in Medicare Plans, Additional resources can be found at www.medicare.gov.

Written by

Steven A. Buttice is the president of Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting seniors, including seminars and consultation on Medicare Plans, Long Term Care and other types of insurance, claims issues, and sales/service of insurance products since 1984.

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