2004-06-04 / Community

Meeks Sponsors Senior Health Care Seminar

Meeks Sponsors Senior Health Care Seminar

Congressman Gregory W. Meeks of Southeastern Queens brought together seniors in his district for a seminar last week that explained the details of the recently legislated Medicare prescription drug benefit, which was put forth by President Bush and passed by a divided Congress. Meeks voted against the bill along with most other Democrats who see it as providing meager allowances to seniors.

At the seminar, Meeks provided a summary of the fundamentals of what seniors may expect.

The federal Medicare-based plan begins with a $600 prescription drug credit for the remainder of 2004 and the whole of 2005. Money unused in 2004 will be carried over to 2005. This is a stopgap measure to fill in while waiting for the actual benefit to kick in, which occurs in 2006. In the meantime all eligible seniors over 65 will have $600 for this year and next year to use towards any medicines they purchase.

Who is eligible? The first criterion is that the individual qualify for the
drug discount card, which is issued by any of a number of health plans in the state.

What is the Medicare drug discount card? Like a debit card, the discount card represents one of several optional plans approved by Medicare that allow drug discounts ranging from 16% to 30% or more of the retail price for brand name drugs, and up to 60% for generic versions. The card is issued to eligible Medicare recipients for obtaining immediate discounts at participating pharmacies.

Who qualifies for the discount card? Current Part A and Part B Medicare
recipients, with maximum incomes of $12,123 for singles, or $16,362 for married people. These figures represent 135% of the current federal poverty line.

Who is not qualified? Those already in an existing prescription drug plan,
and those receiving outpatient drug benefits through Medicaid. So if you already receive substantial assistance from elsewhere, you would not be eligible for a drug discount card.

Is there a cost to the individual? Through individually managed Medicare approved healthcare plans, a prescription discount card can cost up to $30 per year, though some plans charge no fee. In some instances the government will reimburse individuals for the fee.

How do you get a discount card? If you qualify, you can apply by telephone or on line. The telephone number is 1-800-MEDICARE, and the web address is www.medicare.gov.

The website also provides a feature that tailors an individual’s situation to an optimum available discount plan.

The State of New York has a number of excellent approved plans that give separate and often better discounts for prescription drugs to seniors than the Medicare plan. Representatives from several of these groups attended the forum to give details of their respective plan. These programs work in tandem with the federal program to help further defray the high cost of vital medicines.

Represented by Laura Mulvihill, EPIC, the Elderly Pharmaceutical Insurance Coverage program, provides substantial savings on prescriptions to seniors that supplement the Medicare plan. After Medicare’s discount is applied, EPIC provides discounts of an additional 80%. The fee for joining EPIC ranges from as little as eight dollars to $106 per year. Those who do not qualify for the Medicare discount card plan will be automatically enrolled in EPIC. In addition, those who participate in EPIC will be automatically enrolled to receive the $600 benefit if they are eligible.

To qualify for EPIC, one must be 65 years of age, a New York state resident, and an income of under $35,000 if single, $50,000 if married.

U.S. Department of Health and Human Services representative Deborah Konopko spoke about the government’s decision to focus their efforts on prevention of leading life-threatening diseases, i.e., heart and cardiovascular disease, stroke, and particularly diabetes which is a rising concern in the African American and Hispanic communities. Towards that effort, free screening tests are being given, as are free physical examinations on signing up for Medicare. Starting on January 1, 2005, Medicare will pay for a one-time initial preventive physical exam within 6 months enrollment in Part B, blood screening for early detection of cardiovascular diseases, and diabetes screening for those at risk.

Those belonging to "exclusive" HMOs would be required to remain in those plans since they are typically superior. Those include GHI, HealthNet NY, HIP, Independent Health Associations, United Health Care, and Wellcare.

Also speaking at the forum was Dayle Berke of the Centers of Medicare & Medicaid Services, the federal agency that administers Medicare and Medicaid to the 40 million and 33 million people, respectively, who receive benefits.

For help with the application or to get further information, Medicare
offers a 24-hour hotline staffed with service representatives. They can help determine the best available plan based on the prescriptions being taken, income, and even the preferred pharmacy. Due to high call volume, the best times to reach a service representative are after 6:00 pm, before 6:00 am (the middle of the night is a good time).

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