By Nancy J. Brady, RN, Esq. And Linda Faith Marshak, Esq.
This month’s column will hopefully provide some guidance for seniors in deciding whether to enroll in the new prescription drug program available through Medicare.
Individuals may enroll between November 15, 2005 and May 15, 2006 for the program. Following that window, penalties may apply.
The following groups of individuals may be eligible for a low income subsidy which will provide certain additional benefits to their Medicare Part D coverage:
1. People presently receiving Medicaid or SSI, or both. These recipients will immediately be eligible for the “low income subsidy” provided in the Medicare Part D program. As of January 1, 2006, these individuals will not get prescriptions through the Medicaid program. Medicare, Part D will now cover those expenses.
2. People with incomes at or below 135% of the Federal poverty level. That amount in the year 2005 is $1097 (monthly) for individuals and $1464 per month for couples. For people at or below these income levels, an application must be submitted for the low subsidy program. Qualified individuals will pay no annual premium, there will be no gaps in coverage, no deductible and a minimal co-payment. In addition to the income requirements, an individual may have no more than $6000.00 in resources and a couple may have no more then $9000.00 in resources to be eligible for the low income subsidy.
Limited Low Income Subsidy
Individuals with income between 135% and 150% of the federal poverty level are eligible for the limited low income subsidy. At 150% of the poverty level a monthly income would be $1217.00 per month for individuals and $1624.00 per month for couples. The resource limits are $10,000.00 or less per individual and $20,000.00 or less per couple. A monthly premium for this group of individuals will range from no cost to $37.00 per month with an annual deductible of $50.00 per year and a 15% co-insurance on all prescriptions. After an individual’s drug expenses exceed $3,600.00 there will be a $2.00 co-payment on generic drugs and a $5.00 co-payment on all other prescriptions.
Those Not Eligible For Any Subsidy
The following costs apply each calendar year for all other individuals-
A monthly premium of $37.00 for the year 2006 with a $250.00 deductible per year and a $25.00 co-pay on all prescriptions until expenses reach $2,250.00. For costs between $2,250.00 through $5,100.00, Medicare provides no coverage at all, but above $5,100.00 Medicare will pay all expenses minus a 5% co-payment. Additionally, Medicare recipients will be required to choose from one of several drug plans offered, and each plan will have a prescription list. If your particular prescription drug is not on the individual’s plan list, the individual will be required to pay for the prescription in full. These costs will not count toward the deductible.
EPIC and VA BENEFITS
Epic will continue after the start of the Part D program, but seniors may pay less in co-payments under the Medicare Part D Program. It is likely that those people receiving VA prescription benefits will want to remain with the VA program. The attorneys can be reached at (718) 945-7777.
The New York Sanitation Department has announced that pumpkins and leaves are now part of the Recycling Compost Program. Pumpkins and bags of leaves will only be picked up on scheduled leaf collection days, which are Sunday, November 20 and Sunday, December 4.