April 13, 2006

Q: My aunt received a letter from Social Security saying that she qualifies for the extra help under the Medicare drug benefit. Her pharmacist says she will have to pay the full cost for her prescriptions because she hasn’t signed up for a drug plan. Doesn’t the letter from Social Security mean that Medicare will pay for her prescriptions?
-– Jackie

Dear Jackie,

It is good news that your aunt qualifies for the extra help available to people with low incomes because it is likely to significantly lower her drug expenses. But, in order for your aunt to receive this assistance, she needs to be enrolled in a Medicare drug plan. Many low-income people, like your aunt, are not aware that they need to both apply for low-income assistance and sign up for a Medicare drug plan. It is a two-step process.

Once your aunt signs up for a Medicare drug plan, her drug coverage will begin on the first day of the following month. For example, if you aunt enrolls in a Medicare drug plan on Apr. 14, her drug plan will begin to pay for her prescriptions on May 1. Because your aunt already qualifies for low-income assistance, the plan’s premiums and deductibles are significantly reduced or eliminated, and she will only pay small copayments for any medications covered by the plan.

As you may know, there are dozens of Medicare drug plans offered in each state, so it would be a good idea to do some research before choosing a plan. Contact 1-800-MEDICARE to find out which plans do not charge an extra premium to people with receiving the extra help. To avoid unexpected costs, look for plans that cover the medications that your aunt takes and include a convenient pharmacy in its network.   

If your aunt does not sign up for a drug plan, Medicare will automatically enroll her in a plan by May 1. If she is not satisfied with that plan, she can switch to another plan once before the end of the year.

This column was prepared by the Kaiser Family Foundation, an independent, non-profit private foundation based in Menlo Park, Calif., that is not affiliated with the Kaiser Permanente health plan. Do you have questions about the new Medicare drug benefit? Send your questions to Medicare Q and A. The Kaiser Family Foundation. 1330 G St., NW. Washington, DC  20005 or MedicareQ@kff.org. 

(c) 2006, Knight Ridder/Tribune News Service.

Distributed by Knight Ridder/Tribune Information Services.