ADAP Helps Fill the Gaps

People with HIV/AIDS should heed important recent changes which are likely to affect their access to health care.

None of the Medicare health-maintenance organizations in Los Angeles County offer unlimited prescription drug coverage for members under age 65. With the exception of Senior Care Action Network (SCAN) Health Plan -- which provides full prescription coverage for Medicare participants 65 years and older -- Medicare HMOs in Los Angeles County now have annual limits that range from $1,000 to $2,400 on formulary brand-name drugs.

This means that individuals under age 65 who receive Medicare through their Social Security Disability Insurance will need to enroll in the AIDS Drug Assistance Program (ADAP) and/or Medi-Cal to fill the gap in coverage created by these drug caps.

For assistance in finding an ADAP Enrollment Counselor, a participating ADAP pharmacy near you or a copy of the ADAP formulary, you can call PMDC at 1-888-575-ADAP (2327) or visit www.ramsellcorp.com. You may also enroll in ADAP or get more information by calling AIDS Project Los Angeles ADAP Enrollment Counselor Scott Hill.

Also, effective Jan. 1, 2002, Medicare HMO members are no longer allowed to change health plans at will. Medicare HMO members are now restricted to switching HMO plans or returning to original fee-for-service.

In November, HMO members will have the opportunity to change again. However, this change will not become effective until January 1, 2003.

There are three ways to disenroll from an HMO. Contact the HMO, fill out their disenrollment form and mail it to them. You can visit a local Social Security office and complete the disenrollment form in person, or disenrolling by phone by calling (800) 633-4227.

For more information on Medicare or Medicare+Choice health plans visit www.medicare.gov or contact AIDS Project Los Angeles' Benefits/Work Services Program at (213) 201-1472.

Steve Berg is an insurance counselor in AIDS Project Los Angeles' Benefits Program. He can be reached by calling (213) 201-1474 or by e-mail at sberg@apla.org.