EagleTribune.com, North Andover, MA

March 25, 2013

How to apply for Prescription Advantage

Roseanne DiStefano
Elder Q&A

---- — Q: My parents take multiple medications and are having difficulty affording the monthly costs. They have a Part D plan but it isn’t enough. A cousin told me her parents are getting help through a program called Prescription Advantage. How can I find out if my parents would qualify?

A: Prescription Advantage is the Massachusetts State Pharmacy Assistance Program (SPAP) for residents (seniors and individuals with disabilities) administered by the Commonwealth of Massachusetts Executive Office of Elder Affairs. Although changes have been made periodically over the years due to funding limitations the program has been in existence for quite some time yet so many potential eligible individuals are unaware of the benefit.

Eligibility Guidelines...Individuals who are:

1. 65 years of age or older eligible for Medicare and have a gross annual household income less than 500 percent of the federal poverty level, or

2. 65 years of age + and not eligible for Medicare, or

3. Under age 65, work no more than 40 hours per month, earn no more than the maximum income to qualify for category 2 or S2 and meet MassHealth’s CommonHealth disability guidelines

4. Not MassHealth or CommonHealth members, in some circumstances and individual receiving assistance from MassHealth to pay for Medicare Part A and/or Part B premiums, deductibles and co-payments may be eligible for Prescription Advantage

Prescription Advantage works somewhat differently depending upon whether or not the member is eligible for Medicare. The program provides secondary coverage to assist with the cost of prescriptions included in the formulary of a primary Medicare Part D plan or credible coverage plan. The co-payment benefit varies according to the membership category (income based). In the event a member reaches out-of-pocket spending limits Prescription Advantage would cover the cost of co-payments for the remainder of the calendar year. Out-of-pocket expenses are calculated upon acceptance into the program, any costs incurred prior to the effective date of coverage are not included.

Non-Medicare members are required to pay all co-payments until an annual out-of-pocket spending limit is met. A quarterly deductible may also be required depending on the category an individual falls in. Once the spending limit is reached prescription Advantage pays the full cost of covered drugs.

Prescription Advantage uses gross annual household income to determine the qualifying category for an applicant. Income reviewed includes Social Security benefit, employment, pensions, annuities, dividends/interest, retirement account disbursements, rental, alimony, unemployment and capital gains. In order to prepare for the application process copy all necessary verification documents (do not send originals). Married couples (living together) must both sign the application even if only one spouse is applying. In order to prevent delay of processing the application forms must be completely filled out and all documentation requested included.

Anyone interested in applying for Prescription Advantage can call 1-800-AGE-INFO (1-800-243-4636) and press 2. Representatives are available to provide assistance Monday-Friday, 9:00 am until 5:00 pm. If you would be more comfortable meeting with someone in person or believe you will need help in the process contact a SHINE Counselor to set up an appointment. You will be able to find a counselor located nearby through the AGE-INFO phone number statewide or for a trained representative in the 23 cities and towns of the Merrimack Valley call 1-800-892-0890. The SHINE program provides no cost counseling and health insurance information to Massachusetts residents enrolled in Medicare or soon to be eligible for the federal health benefit.

Do you have a question? We encourage inquiries and comments from our readers. Direct correspondence to ro@esmv.org or Elder Services of the Merrimack Valley, Inc. 360 Merrimack Street B#5, Lawrence, MA 01843. Rosanne DiStefano is the Executive Director of Elder Services of the Merrimack Valley.