Medicare Resources
The Affordable Care Act made significant changes to the Medicare prescription drug coverage (Part D) program. Read these consumer fact sheets to find out about how the changes in 2011 may affect your prescription costs.
Starting in 2010 more Medicare beneficiaries could qualify for Extra Help with their Medicare prescription drug plan costs because some things no longer count as income and resources. The Extra Help is estimated by Social Security to be worth an average of $3,900 per year. Medicare beneficiaries who cannot afford their medications for psoriasis and psoriatic arthritis could see a considerable savings. If you applied for Extra Help in the past and didn't qualify, you might qualify now. See if you qualify and apply online or call Social Security for help at 800.772.1213.
Open Enrollment for Medicare prescription drug coverage (Part D) has closed, however the Medicare Access for Patients Rx Guide to Open Enrollment (pdf) has helpful information about the 2011 Medicare Part D benefit.
Medicare is a government funded health insurance program for retired individuals who have reached the age of 65, or who become disabled. The official U.S. government site for people with Medicare provides information about the program and tools for comparing prescription drug plans, hospitals, home health agencies and more, or call 1.800.MEDICARE (1.800.633.4227).
- You have the right to appeal any decision about your Medicare services.
A Medigap policy is health insurance sold by private insurance companies to fill the "gaps" in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover.
Some Medicare beneficiaries are eligible for Extra Help (800.772.1213) to pay for the costs—monthly premiums, annual deductibles, and prescription co-payments—related to a Medicare prescription drug plan.
Each state has a State Health Insurance Program (SHIP) which educates and assists Medicare beneficiaries, those eligible for Medicare, and caregivers about Medicare, Medicaid, Medigap, prescription drug benefits, and other issues related to health insurance benefits. Contact information for your SHIP can also be found by calling the Health Assistance Partnership at 202.737.6340.
The Medicare Rights Center (1.800.333.4114) helps answer questions about Medicare, and has caseworkers that can help you with a specific problem that you are having with Medicare including how to reduce premium and prescription drug costs, and how to appeal a denial by an HMO or Part D plan. Some helpful links on their site:
Medicare Part D (prescription drug coverage): If you have Medicare Part D, you may experience a gap in coverage (the donut hole) when your out-of-pocket costs reach a certain amount. To help with financial costs:
- Apply for Extra Help from the Social Security Administration or call 800.772.1213
- First, contact the manufacturer of your medication – if your income is very low, you may qualify for some assistance. Even if they cannot help you financially, they may be able to assist you in other ways and direct you to the fastest source of financial help.
- If you have already contacted the manufacturer, apply for grants from patient assistance foundations
- Use the Medicare Formulary Finderto compare plans
Find out what the Foundation is doing to advocate for better access to treatment under Medicare Part D.
Other Medicare resources:
- Eldercare Locator connects older people and caregivers with information on senior services including Medicare.
- Benefits Checkup is designed for people over age 55 and can be used to connect patients to government programs that help pay for prescription drugs, health care, utilities and other needs.
Medicaid is a separate federal and state-funded safety net program that provides health insurance for eligible individuals with disabilities, the elderly, children and families, and pregnant women. Eligibility for Medicaid is dependent upon state-established income and resource guidelines.
- Medicaid is not the same as Medicare, however some people may be eligible for both Medicare and Medicaid if they meet the eligibility guidelines. To find out if you are eligible for both, contact your State Health Insurance Program (SHIP) or call 202.737.6340.