What You Should Know About the New Medicare Drug Discount Cards

Written By: Jeffrey A. Marshall , CELA* and Lisa Barner, Geriatric Planning Specialist

1.         What is the Medicare drug discount card?

Beginning in June, most Medicare beneficiaries will be eligible to enroll in one Medicare approved drug discount card program.  The card will be effective from June 2004 through the end of 2005. Showing the card at a pharmacy that accepts it may save you money on some prescription drugs (estimated at 10% - 25%). 

Private companies, insurance companies, and pharmaceutical companies may offer the Medicare cards.  Dozens of such private companies have been approved to offer discount cards.  The various Medicare approved drug discount cards will offer different discounts on different drugs at different pharmacies.  You can only have one Medicare card, however, so you will have to try to choose the card that is best for you.

If you are already using a non-Medicare approved discount card, you may keep that card and also get a Medicare discount card.  Your old discount card may offer a better discount on a particular prescription than the Medicare card.  Unfortunately, you will not be able to use both cards in combination to get a lower price, so you will want to use the card that gives you the best price.

2.         Who can get a card?

Anyone who is enrolled in Medicare Part A and/or Part B can obtain a Medicare approved drug discount card unless they already have outpatient prescription drug coverage through Medicaid/Medical Assistance. Enrollment is voluntary, so you need to apply. If you already have good prescription drug coverage, you may not need a card.

3.         Do I qualify for additional assistance if I have low income?

Signing up for a Medicare approved discount card can offer significant help to persons with low incomes if they are eligible for a $600 annual drug allowance.  If your income is less than $12,569 ($16,862 for couples), you may qualify for this $600 credit. The credit can be used in conjunction with your Medicare approved drug discount card to help you pay for prescription drug costs in 2004 and in 2005. You cannot qualify for the $600 credit if you already have drug coverage from Medicaid, TRICARE for Life, the Federal Employee Health Benefits Program, or if you have other health insurance coverage that includes prescription drugs (such as employer or retiree plans).

If you qualify and your annual income is less than $9,310 ($12,490 for couples) you can use the credit to pay up to 95% of your covered drug costs (up to the $600 limit). If your income is between $9,310 and $12,569 ($12,490 and $16,862 for couples), you will be able to use the credit to pay up to 90% of the costs incurred (up to the $600 limit).  In addition, if you qualify for the low income assistance you will not have to pay a fee to get your Medicare drug discount card.

There is no asset test to qualify.  You only need to meet the income criteria and not have any other disqualifying coverage.  However, enrollment is not automatic. You need to apply for both a Medicare drug discount card and the low income assistance. First, you need to choose the card you want. Then, you need to complete and submit that company's application for people with low incomes.  There is a different application for Medicare drug discount cards with low-income benefits. 

The full $600 credit will be available for 2004, even though the discount cards will not be available until June. If you qualify for the credit in 2004, you will not have to reapply in 2005.  However, if you are applying for the credit for the first time in 2005, the amount of the credit will be based on when you apply.  If you apply before April 1, 2005 , you will get the full $600.  After that, your $600 credit will be reduced by $150 for every three months you delay in enrolling.

4.         How do I get a card and what do they cost?

You will be able to start using your Medicare drug discount card on June 1, 2004 .  However, you can apply for a card beginning on May 3, 2004 . To apply, first determine which card best meets your needs. Make sure the pharmacy you intend to use will accept that card. Then, contact the company whose card you have chosen and get their enrollment form. Each card sponsor will have their own application.  (Packages will include two applications: one for the standard drug discount card and the other for the special low-income benefits.)  Cards will cost no more than $30 a year. 

A list of cards is available on the Medicare website at www.medicare.gov.  The Medicare website also offers a valuable comparison tool to help beneficiaries make the best possible decision. You can use this tool to determine which card choice makes the most sense for you, given the drugs you take and the pharmacy you intend to use. 

Because of the confusing array of cards and the difficulty of choosing between them, Medicare recipients who think they will benefit from having a card should get help in figuring out which card will be best for them. Medicare intends to provide people with this help.  Those who are comfortable with the internet can go online to www.medicare.gov and select "Prescription Drug and Other Assistance Programs." This will take them to the drug discount card comparison tool referred to above.  In the alternative, people can call Medicare at 1-800-Medicare (1-800-633-4227) for help. 

Federal Court Opinion on Treating Disabled in Community Rather than Institutional Settings

Written By: Jeffrey A. Marshall , CELA*

  On April 13^th, the United States Court of Appeals for the Third Circuit issued its opinion in Frederick L. v. Department of Public Welfare.  The case involves Pennsylvania 's responsibility under the Americans with Disabilities Act (ADA) and the Rehabilitation Act (RA) to provide institutionalized patients at Norristown State Hospital with services in the most integrated setting appropriate to their needs.  (The "most integrated setting" means community based treatment rather than institutionalization where appropriate.) 

The Court of Appeals rejected the argument that Pennsylvania could limit community placements from facilities solely on the budgetary ground that they would not result in immediate cost neutrality or savings.  The Court remanded the case to the District Court so that it could direct Pennsylvania to provide the Court with a plan showing its commitment to take all reasonable steps to continue its progress in meeting the requirements of the ADA and RA. 

While the case involves institutionalized mental health patients, it has implications for the state's treatment of disabled seniors who are institutionalized in nursing facilities.   Here is a link to the case. http://caselaw.lp.findlaw.com/data2/circs/3rd/023721p.pdf

How to Save Money on Prescription Drugs

Written By: Lisa Barner, Geriatric Planning Specialist

  Beginning on May 3^rd, most seniors and disabled Medicare recipients will be able to apply for a Medicare approved discount drug card.  These cards can be used beginning June 1^st.  Medicare approved cards will be most valuable to those seniors whose incomes are low enough to qualify them for a $600 annual drug credit.  (For more information on discount cards and the $600 credit, see What You Should Know about the New Medicare Drug Discount Cards in this issue of the Elder Care Law Alert.)

Medicare discount cards are only one way of finding savings on the soaring prices of prescription drugs.  This article is intended to give you some tips on other ways you may be able to save. 

Request Samples - Ask your doctor for as many free samples as possible.  Pharmaceutical companies give doctors millions of drug samples each year.  Your doctor may even be able to ask the drug companies for more free samples.  These free samples often go unused, so be sure to ask.

Medical Assistance (Medicaid) - This program provides prescription drug coverage (and medical coverage) for individuals and families that meet certain income and resource limits.  You can apply through your County Assistance Office.

Veterans Benefits - The Department of Veterans Affairs covers prescription drugs (after a small co-payment) to veterans who meet certain guidelines. The drugs must be prescribed by a VA doctor.  Application for this benefit can be made at your local Veterans Administration Office.

Pharmaceutical Company Programs - Most drug companies have some kind of patient assistance program.  RXHope is a website that provides a list of pharmaceutical company patient assistance programs for over 1000 medications. http://www.rxhope.com/.  You can simply choose a medication, pharmaceutical company, or state and RXHope finds programs to meet your needs.  Some of these programs require that you have no other drug coverage and that you meet certain income requirements. 

Another useful website is www.needymeds.com/ where there is a list of 271 programs offered by various companies. 

Drug Discount Cards - In addition to Medicare approved discount cards, some pharmaceutical companies and pharmacy chains offer discounts of up to 20% - 40%. There are a myriad of cards available.  A list of some of these cards along with contact information is available on our website at http://www.paelderlaw.com/incomefirst.html.

Generic Drugs - Ask your doctor to prescribe generic drugs as much as possible.  Also, be sure to ask your doctor to consider less pricey, older drugs that may not cost as much as newer ones.

Deducting the Cost of Qualified Long Term Care

Services for a Dependent 

Written By: Perry Landon, Geriatric Planning Specialist

  You may be neglecting to benefit from an often misunderstood rule regarding long term care expenses. Did you pay for over half of a dependent's total support for the calendar year? If you did, and you also paid for that dependent's long term care expenses, you may be able to itemize those expenses on your 1040 Schedule A, along with your other un-reimbursed medical and dental expenses. The rules related to this deduction are described within pages 1 through 10 of IRS Publication 502. Key definitions are summarized in this article.

A dependent is someone for whom you paid for over half of that person's total support for the calendar year, and who is a U.S. citizen or resident, or a resident of Canada or Mexico .  The category "dependent" means an immediate or extended family member, including:

                        -your parent, grand parent, or other direct ancestor

                        -your stepfather or stepmother

                        -your father-in-law or mother-in-law

Long term care services include those services that are necessary diagnostic, preventive, therapeutic, curing, treating, mitigating, rehabilitative services, and maintenance and personal care services that are:

                         -Required by a "chronically ill individual,^" and

             -Provided pursuant to a plan of care prescribed by a licensed health care practitioner.

An individual is chronically ill if, within the previous 12 months, a licensed health care practitioner certified that the individual meets either of the following descriptions:

            -He or she is unable to perform at least two activities of daily living without

substantial assistance from another individual for at least 90 days, due to a loss of functional capacity.  Activities of daily living are eating, toileting, transferring, bathing, dressing and continence, or

                         - He or she requires substantial supervision to be protected from threats to health

and safety due to severe cognitive impairment. The maintenance and personal care services with the primary purpose of providing needed assistance to the chronically ill with their disabilities (including protection from threats to health and safety due to severe cognitive impairment).

If you paid for more than half of a dependent's total support for the calendar year, your tax preparer will be able to help you determine whether itemizing any long term care services expenses that you paid on behalf of your dependent will reduce your federal income tax burden.  Your tax preparer will also be able to determine whether you might benefit from filing an amended return for a prior year that you neglected to claim those expenses.

Carolyn's Son Returns Home from Iraq

  For Marshall, Parker & Associates' paralegal, Carolyn Toner, the last 14 months have been anything but a picnic. The constant media coverage of the War in Iraq and the continuing attacks on American soldiers was hard for Carolyn to hear.  Her son, Army Staff Sergeant Jason Furl of the 442^nd U.S. Army Reserves was deployed for Iraq last January.  Jason and the rest of his unit finally returned home on March 25^th to a huge crowd of supporters in Williamsport . 

"I am so proud of Jason," remarks Carolyn, "he helped refurbish schools and learned the language."  Jason, a civil engineering student at Pennsylvania College of Technology, also had the opportunity to travel and work with the Army Corp of Engineers in their rebuilding efforts. 

"Fourteen months is a long time not to see the face of one we love.  There were phone calls and e-mails, but it's not the same.  I'm just so happy to see him.to have him back.  It's been rough," his proud mom concluded.

Mark Your Calendars!

8^th Annual Marshall, Parker & Associates' Professional Update Planned

  Have you signed-up for our 8^th Annual Update that will take place from 8:00AM-12:00PM , May 6^th, at the Radisson in Williamsport and on May 7^th, at the Woodlands in Wilkes-Barre ?

This will be your opportunity to get the latest information on changes that are of critical importance to seniors and to those of us who provide services to them. You will learn about the new Medicare drug discount cards and the $600 transitional assistance credit.  Representatives from the Department of Aging, the Alzheimer's Association, the Assisted Living industry, and other experts will detail the many programs and issues involved in the great expansion of home and community based care that is taking place in Pennsylvania .

The Update is FREE and intended for professionals in the elder care and elder services network such as individuals working in nursing homes, hospitals, assisted living and personal care facilities, area agencies on aging, and county assistance offices.  It should also be of great interest to social workers, financial planners, accountants, lawyers, and trust officers who work with seniors too.  To register, call 1-800-401-4552.

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If you are interested in having an attorney or geriatric planning specialist from

The Elder Law Firm of Marshall, Parker & Associates' speak to your group, or at an upcoming event, please contact

our Public Education Coordinator,  Melissa Bottorf

at mbottorf@paelderlaw.com or 1-800-401-4552

*Attorney Marshall is certified as an Elder Law Attorney by the National Elder Law Foundation under authorization from the Pennsylvania Supreme Court