The AIDS Institute Encourages People With HIV/AIDS to Sign Up for New Medicare Drug Benefit
Expresses Concern That Beneficiaries Are Unaware of New Benefit and Won't Make Necessary Decisions
October 11, 2005
Washington DC -- The AIDS Institute is encouraging the nearly 100,000 people with HIV/AIDS who qualify to sign up for the new Medicare prescription benefit. "Given the importance of taking daily medications for survival and remaining healthy, the new Medicare drug benefit is critically vital to people living with HIV/AIDS," commented Dr. Gene Copello, Executive Director of The AIDS Institute. "Therefore, we urge all people with HIV/AIDS and their caregivers to become familiar with the new Medicare drug coverage, and take the necessary steps to enroll in the plan that best meets their needs. Failure to do so can result in a lapse in medications and severe health consequences."
Enrollment in Medicare's prescription drug coverage begins on November 15, 2005, while actual coverage begins on January 1, 2006. Beneficiaries will be able to choose a drug plan from a wide range of choices in each state. Details of these plans, including the costs and drugs they will cover, will be made available on October 15, 2005.
"The good news for people living with HIV/AIDS is that every drug plan will be required to cover all anti-retroviral drugs used in the treatment of HIV/AIDS," said Dr. Copello. He added, "This is a recognition of the treatment needs of people living with HIV/AIDS, who require a specific daily drug regiment and must have the ability to access other drugs, without any interruption, as they develop drug resistance or side effects to their current regiment."
"The bad news," said Copello, "is that there is little time for beneficiaries and their providers to learn about the new Medicare drug coverage, and make the many decisions prior to January 1, 2006. Failure to act can result in missed drug dosages, which can have life threatening consequences for people with HIV/AIDS. Since many HIV/AIDS beneficiaries are very poor and disabled, and do not have access to the internet, they require special assistance and outreach efforts. We are extremely concerned that not enough attention is being given to these hard to reach people, and lives will be at stake."
In selecting the drug plan that best meets their needs, since all anti-retrovirals will be included, beneficiaries with HIV/AIDS should consider whether the plan covers the other medications they need, such as for the treatment of Hepatitis; the amount of out of pocket costs; and the convenience of the participating pharmacies.
For the over 60,000 people living with HIV/AIDS who currently qualify for both Medicaid and Medicare, and receive their drug coverage from Medicaid, they need to know that their Medicaid drug benefit will end on December 31, 2005. However, they will be automatically enrolled in the new Medicare drug benefit, and begin receiving Medicare drug coverage on January 1. They will be auto enrolled in a drug plan in October, but have the right to switch to another plan that may better meet their drug and cost needs.
Beneficiaries who currently receive their drugs through the AIDS Drug Assistance Program and are eligible for the Medicare drug benefit, must enroll in the new Medicare drug benefit. If they do not, they risk losing their ADAP coverage. ADAPs are the payer-of-last-resort, and can cover drugs not on a Medicare drug plan. ADAPs also can cover Medicare drug plan premiums, deductibles, coinsurance and copays. Since ADAPs vary state to state, beneficiaries should consult their particular state ADAP.
Many beneficiaries with HIV/AIDS who are low-income qualify for extra help in paying for their Medicare drug coverage. For those who qualify for both Medicare and Medicaid or receive Supplement Security Income (SSI) benefits, the extra help is automatic. For other low-income beneficiaries, they should have received a low-income subsidy (LIS) application this past summer from the Social Security Administration (SSA) which asks questions about the level of income and assets.
"Based on the alarmingly low number of LIS applications that have been returned to SSA, we are very concerned that people are not aware of the new Medicare drug coverage and will not access it on January 1," said Carl Schmid, Director of Federal Affairs for The AIDS Institute, "This is particularly troubling for people with HIV/AIDS since many of them are poor and depend on public financing for their medications."
Low-income subsidy applications can be obtained from SSA by calling 1-800-772-1213.
For Medicare beneficiaries who do not qualify for the low-income subsidy, they can join a Medicare drug plan that best meets their drug needs. They will have to pay a monthly premium, a deductible, and co-payments. If they qualify for their state's ADAP, these costs may be covered by their ADAP. These beneficiaries can enroll in a plan beginning November 15, 2005. If they don't currently have prescription drug coverage that is at least as good as standard Medicare prescription drug coverage, they should enroll in a Medicare drug plan by May 15, 2006, to avoid paying a penalty.
"While we recognize the substantial education and outreach efforts that are being undertaken by both the public and private sectors," continued Schmid, "many people with HIV/AIDS, along with others with disabilities, need substantially more assistance in filling out forms and making the necessary decisions. Unfortunately, there is little time and few resources to make that happen; and the consequences are dire."
People can learn more about the new Medicare drug coverage by calling 1-800-MEDICARE or visiting www.medicare.gov. During the month of October, all beneficiaries will be receiving a handbook Medicare and You, which details information about coverage in their particular area.
An enrollment kit designed specifically for people with HIV/AIDS can be found at: http://taepusa.org/partd_outline.html. Additional information for people with HIV/AIDS can be found at www.hrsa.gov/medicare/HIV/about.htm.
This article was provided by The AIDS Institute. Visit The AIDS Institute's web site to find out more about their activities and publications.