Q: My mother received a letter and long application from the Social Security Administration stating that she might be eligible for help paying for prescription drugs. She already receives her drugs through a local social services program where we live. Does she have to do anything? Mom has Alzheimer's and can't cope with this long form.
A: If your mother is eligible for Medicare, and is receiving her prescription drugs through a state Medicaid program, her Medicaid drug coverage will be ending December 31st of this year. She should be automatically enrolled to get her drugs under Medicare in 2006 and if all goes without hitch, she should receive her drugs under Medicare through a private plan to which she will be automatically assigned. If she is currently receiving her drugs through Medicaid, she should be eligible for substantial Medicare assistance. And yes, TSCL recommends that you very carefully monitor the transition.
Earlier this year the Social Security Administration began sending notices to 20 million Medicare beneficiaries announcing extra financial assistance to pay for the annual deductible, premiums and co-payments under the new Medicare Prescription Drug Program. Included with the notices was a lengthy application.
From what we are learning, we believe there's a high risk for complications in transitioning to the new program for persons like your mother who receive both Medicare and assistance through your local social services. We strongly recommend, despite the extra work involved, that you fill out the application or get qualified help from the Social Security Administration (SSA) at 1-800-772-1213 or at www.socialsecurity.gov. SSA and state Medicaid agencies have already begun making eligibility determinations.
Unfortunately, that's not all you will have to do. You will also need to make sure that your mother is enrolled under a new Medicare drug plan. If your mother is now receiving her drug coverage under a state Medicaid program, she may be enrolled automatically in a new Medicare drug plan that's selected at random with coverage effective January 1, 2006. Because the new Medicare drug coverage is not standardized, you will need to find out if her assigned drug plan covers the prescriptions that she needs, and that there are no "excess" premiums, co-insurance or other surprise costs that are not covered by her Medicare assistance. You will have the opportunity to help her switch plans if you find the assigned plan unsuitable, but we suggest you try to get her drug plan coverage set up to start on January 1, 2006.
For more information about the new Medicare Prescription Drug program call 1-800-MEDCARE or visit www.medicare.gov. If you find long waits, you may also call your local Agency on Aging.
June 2005
