ARIZONA BRIDGE TO INDEPENDENT LIVING: November 2005 Newsletter

ABIL offers and promotes programs designed to empower people with disabilities to take personal responsibility so they may achieve or continue independent lifestyles within the community. ABIL is a member of the National Council on Independent Living (NCIL). "Not just responding to change, but leading it!"

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Back when Medicare was first legislated, Congress made it available to seniors who qualified for Social Security retirement benefits. Later Congress voted to add a Medicare healthcare benefit for individuals who qualified for Social Security Disability Insurance (SSDI). However, they created this Medicare healthcare to start 24 months after the individual was determined to qualify for SSDI cash benefits.

If the individual’s total income, including their SSDI cash benefit is under the federal poverty level, ($798 in 2005) they will qualify for AHCCCS (Medicaid). If his or her income, including their SSDI cash benefit is over the AHCCCS income eligibility they will not qualify for healthcare through either Medicare or AHCCCS during that waiting period. That is a two-year wait for healthcare for newly disabled taxpayers!

Finally, there are bills in Congress to correct this egregious wrong to Americans who have worked and paid taxes into the system (FICA). Senate Bill 1217 would phase out this two-year waiting period for Medicare. This issue has already been studied by the Government Accounting Office, which recommended to remove the waiting period long ago.

Ų Make it easier to get on benefits and people will not be so afraid to get off. People are more likely to try to get back to work once their disability has stabilized and they have adapted, if they don’t fear another devastating wait to get healthcare should they be unable to work due to disability in the future. Those memories of initial disability and lack of healthcare are psychologically difficult to forget!

Ų People’s disability often worsens without adequate healthcare at critical stages of their injury or illness. Surely Congress is not hoping to save money by people dying before they get Medicare due to lack of healthcare?

Ų Most employer paid Long Term Disability plans (unfortunately, many don’t have them) provide healthcare immediately to disabled workers in an attempt to get them stabilized and back to work as soon as possible - it saves them disability payments. Other countries do the same. Why not us?

Ų Fairness. Seniors get Medicare right away, why not individuals with disabilities who have equal if not more medical concerns?

l Tell them your story! Tell about your wait for Medicare as a person with a disability.

All Social Security beneficiaries who have Medicare can benefit - but you need to understand your choices! Below is a brief timeline outlining the implementation steps for the new Medicare Prescription Drug Coverage (Medicare Part D).

July 1, 2005: SSA offices and AHCCCS offices began making eligibility determinations on applications for the low-income subsidy. Applications will also be taken on-line and by telephone. Online applications will be available in 14 languages to use as a guide when filling out the English application (www.socialsecurity.gov).

Fall 2005: Parties outside the federal government will also have responsibilities to implement Part D. These include:

l AHCCCS offices will send notices to dual-eligibles that they will be losing their AHCCCS prescription drug coverage and will be automatically be enrolled in a Medicare Part D Prescription Drug Plan (PDP).

l Employers will have to send notices to the individuals for whom they provide health insurance, either as an active worker, retiree, or dependent, explaining whether the insurance meets the definition of “creditable coverage,” i.e., provides a drug benefit that is “actuarially equivalent” to (or at least as good as) the Part D benefit.

l Medigap issuers will have to send notice to individuals with any benefits for prescription drugs. The notices must explain the options available for people who hold one of those policies, and whether the policies meet the definition of creditable coverage and are equal to or better than Medicare’s prescription drug benefit.

October 13, 2005: Part D plan comparison information will be available through Medicare’s website (www.medicare.gov)

October 15, 2005: Centers for Medicaid/Medicare Services (CMS) will send the “Medicare and You” booklet to all Medicare beneficiaries describing the Part D Prescription Drug Plans (PDP) that will be available to them.

November 15, 2005 – Jan. 1, 2006: People on AHCCCS and Medicare (Dual Eligibles) will be automatically enrolled in a Prescription Drug Program (PDP). They can change programs any month to choose a different PDP that better meets their needs.

November 15, 2005 - May 15, 2006: “Initial enrollment” period for the Part D program for all Medicare beneficiaries not on AHCCCS. If Medicare beneficiaries don’t enroll by May 15th, but decide to enroll later, they will have to pay a one percent penalty for every month they delay enrollment unless they can show that they had coverage under another drug plan that was at least as good as the Part D benefit. Beneficiaries must have had this other drug coverage within 63 days of enrolling into a PDP. If a beneficiary goes without other drug coverage for more than 63 days, the late penalty will start accruing. They will not be able to enroll into a PDP until the next annual enrollment period (November 15 through December 31) with the plan becoming effective as of January 1.

January 1, 2006: Medicare Part D prescription drug program begins. Beneficiaries who have AHCCCS and Medicare will have to get their prescriptions through the Medicare Prescription Drug Plan. In most cases, AHCCCS will no longer cover prescriptions.

Timeline adapted from the Center for Medicare Advocacy Medicare Part D implementation timetable.

Call the State Health Insurance Assistance Program (SHIP) at 602-542-4446 or 1-800-432-4040 or 1-800-Medicare

Members have choice to enroll unless already eligible for ALTCS or AHCCCS in which enrollment is automatic.

-Co-pay2 on first $5,100 of Drug Cost of $1/$3 Generic/Brand if Income ≤$798/mo. Single or ≤$1,070/mo. Couple

-Co-pay2 on first $5,100 of Drug Cost of $2/$5 Generic/Brand if Income >$798/mo. Single or >$1,070/mo. Couple

-Auto-enrolled in Subsidy & Plan3 - Subsidy and plan selection are separate procedures.