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 13th, 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 3rd, 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 1st.
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 & 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 442nd
U.S. Army Reserves was deployed for
Iraq
last January.
Jason and the rest of his unit finally returned home on March 25th
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!
8th
Annual Marshall & Associates Professional Update Planned
Have
you signed-up for our
8th Annual Update that will take place from
8:00AM-12:00PM
, May 6th, at the
Radisson in
Williamsport
and on May 7th, 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.
Stay
tuned to the Elder
Care Law Alert for more information!
Back
issues of The
Elder Care Law Alerts
are available on our website.
You
can even search our site by a keyword
or phrase!
Do
you have a friend or colleague who would enjoy reading the
Elder Care Law Alert?
If so, please feel free to forward it to them. Simply use the
"Forward" button on your e-mail program.
To
subscribe or unsubscribe to the Elder
Care Law Alert,
simply
send your request to:
webmail@paelderlaw.com
Does
Your Club Or Organization Need A Speaker?
If
you are interested in having an attorney or geriatric planning
specialist from
The
Elder Law Firm of Marshall & 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
