On December 31, 2005 the Vermont State Pharmacy
Programs (VHAP, V-Script and V-Script Expanded) are ending
for Medicare beneficiaries. Instead, seniors must enroll
in a Medicare drug plan Part D that will cover their prescriptions.
To transition smoothly into Vermont's new replacement V-Pharm
program so that you are covered by January 1, 2006, you
must also enroll in the Medicare Part D plan by the end
of 2005. Your premiums, deductibles and copays will be covered
under V-Pharm.
All Vermont seniors with income under $21,532 for an
individual or $28,867 for a couple will be eligible. This
includes all current recipients under VHAP Rx, V-Script,
and V-Script Expanded. Yet under the "Medicare Modernization
Act of 2003" seniors will have to evaluate a menu
of options and choose one of them in order to receive
the drug benefits.
There may be some potential unknowns in the transition
process. This could include differences between designated
drugs available under Part D that may be different from
those now available under our Vermont programs. Or the
necessity for a senior to show medical necessity for specific
brand drugs instead of those preferred under Part D.
In Vermont you may have 8-14 benefit plans with differing
coverages to evaluate and choose from, and the unsettling
news is that the savings cited by Congress as the driving
force behind the changes may already be negated by price
increases from pharmaceutical companies.
In the end it will probably be cheaper to be part of
Medicare Part D than not to be. Seniors, legislators,
health care providers and senior advocates are waiting
for clarification until October, when the plan options
come out. Vermont seniors must inform themselves about
the changes and determine if they will need "extra
help" (if they are on VHAP) and how to apply for
the V-Pharm plan. If you are on Medicaid and don't choose
a plan, the government will choose one for you, and it
is not guaranteed to be the best fit.
For people like Lilly the changes looming in 2006 will
not have a great affect. But for others who are not so
fortunate, the Medicare Part D plan offers challenging
decisions; the benefits must be compared and weighed against
personal circumstances, and there is a deadline. Those
on Medicare who are not enrolled in a new drug plan by
May 15, 2006 may pay a penalty and will have to wait for
coverage.
It is a dizzying process that could require research.
You can get help from the State Health Insurance Program
(SHIP), the Council on Aging, the Social Security office,
or your case manager. For those with Internet access there
is a special web service that can help Medicare beneficiaries
with limited means get assistance with health care choices.
It is available at www.BenefitsCheckUp.org/rx.
For help closer to home, talk to your peers, ask family
members for aid in understanding the written material,
and be aware of the timeline for enrollment.
RESOURCES
- Senior Help-Line of the Council on Aging (1-800-642-5119)
- www.medicare.gov
(1-800-Medicare)
- State Health Insurance Assistance Program (SHIP).
In southeastern Vermont call Marlene Eddy at 802-885-6636.
- Social Security (1-800-772-1213 or 802-775-0893).
