Published DateFor those people who are on Medicare, "Part D" offers the ability to select a drug insurance plan from any one of a number of providers. The options, or variables, are many. Some plans offer relatively low monthly premiums, but others are quite expensive. Some offer lower premiums but have higher deductibles. Co-pays vary as well. For these reasons, Medicare has developed an excellent website (http://www.medicare.gov/part-d/index.html) where individuals can compare insurance company coverage and cost, based on the medicines the individual is taking.
Most people have heard about the coverage gap, commonly called the "donut hole" in Medicare Part D. When a person has incurred $2,970 in drug costs during the year (which is the combined cost paid by the insurance company and the policy holder), they then go into the coverage gap. While in the gap, their co-pay for brand name drugs will be 47.5 percent of the drugs retail cost, and 79 percent of the price for generic drugs. This continues until a total value of the drugs purchased amounts to $4,750. At that time, what is called "catastrophic" coverage takes over and co-pays are reduced dramatically . . . until the new year, when the whole process starts anew.
For those people with limited resources, Social Security offers what is called "Extra Help", or low income support for the individual's Part D insurance. To qualify, an individual's income must be $17,235 or less, $23,265 if married and living together. If qualified, a modest monthly premium is provided, co-pays are reduced, and the coverage gap is eliminated. Social Security indicates that the "Extra Help" provision can save a person an average of about $4,000 per year. For more information about this program you can access this website, http://www.ssa.gov/prescriptionhelp/ .
The statewide Service Link organization has an office in Laconia. They are an excellent resource serving the Belknap County area, and they have assisted countless citizens in their Medicare Part D search process. They may be reached at 528-6945. As a side note, while Medicare Part D has a defined enrollment period at the end of the year, there are some situations that allow individuals to enroll in a plan beyond the open enrollment period. For more information you may contact Service Link or access the following website, http://www.medicare.gov/publications/pubs/pdf/11219.pdf
Medicaid, also called Title XIX, provides health coverage to children, pregnant women, parents, seniors and people with disabilities. The minimum income level for eligibility is 133 percent of the Federal Poverty Level (FPL). However, in calculating eligibility the state Department of Health and Human Services (DHHS) takes into account all income and assets, and a series of deductibles, to arrive at individual or household eligibility. If approved, the person/family may be eligible for doctor, hospital, dentist, vision, and other medical benefits, including prescription medicines. Those who think they may qualify for Medicaid benefits, may call New Hampshire's DHHS office at 1-800-852-3345 X5254. For those who are internet savvy, there are a number of internet links. However, the most direct link, and the quickest to determining possible eligibility is https://nheasy.nh.gov/ . This site is very user friendly and can provide you with an answer as to whether or not there's a possibility you may qualify for cash assistance, medical services, food stamps, or Medicare.
It is recommended that families with children under the age of 19, who do not have health insurance, either call DHHS at the above number, or access the Internet link to determine if, based on their income, they might be eligible to qualify for the Children's Health Insurance Program (CHIP). Depending on household income, insurance may be provided at partial or no cost for children's coverage.
Those who qualify for Medicaid may receive their prescription medicines as part of that program. This website will link the reader to more information on eligibility and benefits. http://medicaid.gov/medicaid-chip-program-information/by-topics/eligibility/eligibility.html
Another very useful discount program is called RX Outreach. It is a non profit organization, a fully licensed mail order pharmacy, that offers prescription medicines to uninsured and underinsured individuals and families, as well as those who have limited prescription drug coverage. They are often used by those who either fail to qualify for direct help from a drug company, or the medicines they need are not part of a drug company's patient assistance program. The reader may access this website, http://www.rxoutreach.org/ .
Walmart gained some recognition for their pharmacies when they came out with their program to provide a large number of generic medicines, charging $4 for a one month supply, $10 for three months. Once a drug company's patent expires on its brand name drug, other companies can provide their generic version of that medicine. Walmart's list of available generic medicines can be viewed by connecting to their internet website, http://i.walmartimages.com/i/if/hmp/fusion/customer_list.pdf Some other companies are offering prescription discount plans similar to Walmart's. You may access the Kroeger, Target, and Hannaford's drug plans via this website, http://www.ehow.com/info_8078094_stores-4-drug-plan.html.
In summary, there are some excellent resources available to the people in Belknap County. Service Link, at 528-6945, is a good place to call when you don't know who to call. The need for medicines can be addressed in any number of ways but the first one to talk to should be your Primary Care Provider. She or he can often determine the path you need to take in obtaining your medicines. The Department of Health and Human Services covers a wide range of support services for those with limited income and resources.
A following column will deal solely with a variety of benefits veterans have earned.
(Bob Meade is a Laconia resident.)