Medicare Drug Card Q and A

WebMD Live Events Transcript

Medicare is a vital safety net for many Americans, but the changes in coverage and procedures can cause plenty of confusion. WebMD's own Medicare expert Marisa Scala Foley, CME, joined us on June 3, 2004, to answer our questions about prescription drug cards, coverage concerns, and more.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MEMBER QUESTION:
If I choose a drug card, why does it have to be a Medicare-approved provider?

SCALA-FOLEY:
It actually doesn't have to be a Medicare-approved provider. Medicare cards are new, and are being offered in addition to other prescription cards offered by private companies that are already out on the market. If those private cards offer you better savings, then by all means you should get one of those.

MEMBER QUESTION:
Is there a cost for the card? Is there a co-pay involved when they use it to purchase prescription meds?

SCALA-FOLEY:
There is a cost associated with the cards. It varies by card, but by law it can be no more than $30. That is the enrollment fee. You pay that in 2004 and 2005. Some cards are free; they have no enrollment fee, and many have fees that are less than $30. If you qualify for the low-income benefits under the Medicare drug discount cards then Medicare will pay your enrollment fee for you.

In terms of co-pays, you pay the discounted cost of the drugs that you're buying. And if you qualify for the low-income benefit, then you only pay 5% or 10% of the discounted price of the drugs you're buying.

MEMBER QUESTION:
Is there a specific application process involved in obtaining the card?

SCALA-FOLEY:
You can apply for the card that you choose through one of two ways: you can either use the standard application form that is available on the Medicare web site, which is www.medicare.gov (it's also available on WebMD's Medicare channel), or you can contact the company that offers the card you want to buy and ask them for an application form.

If you think you might qualify for the low-income benefit, then be sure to ask for or download the form that will allow you to apply for that benefit.

MEMBER QUESTION:
Do I have to give up my current prescription card from my private carrier, or can I have both and go back and forth, as it were?

SCALA-FOLEY:
You do not have to give up your private prescription card if you buy one of the Medicare-approved cards. You can keep them both and use whichever one gives you the best discount when you're buying your medications.

MEMBER QUESTION:
I have an HMO that has a co-pay on my prescriptions. I pay $14.00 a month for my medicine. I have part A Medicare. Would it be advisable to get a Medicare drug card?

SCALA-FOLEY:
You can get a card if you are enrolled in a Medicare HMO. However, many HMOs are requiring their members to purchase the cards that they are offering. You may want to check with your HMO to see what they will ask you to do.

"Medicare cards are new, and are being offered in addition to other prescription cards offered by private companies. If those private cards offer you better savings, then by all means you should get one of those."

MEMBER QUESTION:
Can some forms of equipment, like glucometers, be obtained by using the card? Is there an out-of-pocket cost involved when getting a glucometer this way?

SCALA-FOLEY:
Insulin and other supplies for people with diabetes are covered by the Medicare drug discount card. I don't know whether glucometers are included as part of supplies. If you check on the Medicare web site, which is www.medicare.gov, and click on the prescription drug assistance program tool, you should be able to find that there. You can also contact the card sponsors or call 1-800-MEDICARE to find out that information.

In terms of what it would cost, if they are covered then you would pay the discounted price offered by the card you enrolled in.

MEMBER QUESTION:
Why isn't there a cap on what the pharmaceutical companies can charge for medication? They can raise it week to week without notice, making the cost rise and overtake any discount. It seems as though we're being sold a pig in the poke.

SCALA-FOLEY:
Unfortunately, the law was written so that pharmaceutical companies and card sponsors can change prices as often as weekly. I will tell you that the average wholesale price of prescription drugs can vary from week to week so the changes that you see reflect those variations.

MEMBER QUESTION:
I am so confused about the many prescription card plans. How do you know which one is right for you? I am disabled and have Medicare part A & B and qualify for the free enrollment and the $600.00 credit.

SCALA-FOLEY:
First off, that's great that you qualify for the $600 credit. That will hopefully save you some money. You should also know that several pharmaceutical companies are offering additional benefits to people with low incomes once the $600 credit has run out.

In terms of which card is right for you, that depends on your situation. You will want to consider which drugs you are taking and how many, any other insurance coverage you might have that covers prescription drugs, any other prescription drug discount cards that you might already have, and the pharmacy that you like to go to when you make this decision.

If you visit the Medicare web site once you have all the information and have thought about the factors I mentioned earlier, you can compare the drugs being discounted by each card and see which one will work best for you.

MEMBER QUESTION:
My mother is retired and receives a pharmacy drug card in the amount of $1,500 per year toward her prescriptions. She is on Medicare. Her income totals about $1,100.00 a month. When it states you must not have any other insurance other than Medicare for prescriptions is she disqualified due to the $1,500.00 a year she receives as part of her retirement?

SCALA-FOLEY:
Even though she has other prescription coverage she can still get one of the Medicare-approved drug discount cards. The only thing she will not qualify for is the $600 credit for people with low incomes.

MEMBER QUESTION:
How does a Medicare recipient who qualifies for the low-income benefits also tap into the pharmaceutical company's additional discounts you mentioned earlier?

SCALA-FOLEY:
Details are still coming out as to how these additional benefits will work, so I can't really answer your question yet. I would suggest that once you've picked out the card that's right for you, you contact the card sponsor and ask how these additional benefits will work once the $600 credit has run out.

MEMBER QUESTION:
Please advise what is considered as monthly income for a senior citizen. Is an occasional withdrawal from an annuity account considered as income?

SCALA-FOLEY:
Social Security does count as a source of income. Basically, anything you would count as income on your taxes counts as income when you are trying to qualify for the $600 credit. I would contact 1-800-MEDICARE, that is 1-800-633-4227, if you have any more specific questions about income.

MEMBER QUESTION:
My mother has a discount Rx card through her insurance. However, it does not discount anything on at least one of her prescriptions, which is quite expensive. I am trying to find out what she is paying for this card or if it's just a part of the medical insurance she has. How do the new cards work when someone has a prescription card from another carrier? Will the pharmacy give her the best/lowest price (comparing the price charged by each card) or accept the pharmacy price if it is lower than the discount card price? Wow. There are so many questions. No wonder seniors are hesitant to sign up!

SCALA-FOLEY:
In terms of how the discount cards work with other insurance coverage, you can choose whichever coverage or card gives you the best price. In answer to your question, your mother can have one of the Medicare drug discount cards, as well as the coverage she already has. The pharmacy should allow you to use whichever card gives you the best price. If that is the base price that the pharmacy offers, then the pharmacist should tell you that and that is what you can pay.

"This can be a tough choice for people with Medicare and their families. Take your time, do your homework, and think about your own situation before choosing one of these cards."

MEMBER QUESTION:
My income is approximately $800.00 a month on social security disability. How will the Medicare drug card work for me?

SCALA-FOLEY:
With the income that you are reporting here you should be able to qualify for the benefits for people with low incomes under the new Medicare drug discount cards. The only way you would not qualify is if you have prescription drug coverage from some other insurance, such as Medicaid or employer-sponsored insurance.

If you do qualify for the low-income benefit, you will receive a $600 credit that will be applied to the drug discount card you choose, and that will help you with your prescription costs. In addition, depending on your income, you will also pay only either 5% or 10% of the discounted cost of the drugs you are buying until the $600 credit runs out.

MEMBER QUESTION:
How flexible is the card plan as far as changing cards? Is there a yearly enrollment? If your life situation changes can you get a better card for your new situation (move to a nursing home, etc.)?

SCALA-FOLEY:
Unfortunately, the cards are not very flexible. Once you have picked a card in 2004, you will not be able to switch to another card until between Nov. 15 and Dec. 31 of 2004, unless you fit into one of the following four categories:
  • You move to another state in which your card is not offered.
  • You join or leave a Medicare managed care plan, also called a Medicare Advantage Plan.
  • You enter or leave a long-term care facility.
  • The company sponsoring your card stops offering that card.



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