By Lisa Zamosky
A reader of this blog named Regina recently left a question about what, if any, financial assistance is available to help her cover the high cost of her insulin:
I am on Medicare and have a supplemental insurance policy. I am a diabetic who takes insulin. I cannot afford my insulin for the rest of the year. I make $200 too much for programs that help people (Pacenet). My doctor is giving me some samples, but it will not be enough. I have contacted the drug company, but again that extra $200 is holding me back. I live on my Social Security. Any advice?
Help Paying for Prescriptions
Difficulty affording prescription medication is, unfortunately, a common complaint. I talked with Elaine Wong-Eakin, executive director of California Health Advocates, a Medicare advocacy organization, for some recommendations about how this reader and others can get help covering the cost of prescription drugs.
Medicare Savings Programs
To start, there are a number of Medicare Savings Programs that offer people with low incomes financial assistance. Extra Help is one such program that specifically assists people with prescription drug costs.
Regina mentioned having already checked into the Pennsylvania-based prescription assistance program for older adults, called PaceNet, and found that she earned too much money to qualify. PaceNet eligibility requires an annual income of no more than $14,500 for a single person. Unfortunately, in this case, that likely means Regina also earns too much to qualify for the Extra Help program, which has an annual income cap of $16,755.
“There will always be a group of people who are not wealthy enough or poor enough and are caught in between,” Wong-Eakin says of qualifying for assistance programs.
For this reader and anyone else having trouble affording their Medicare-related costs, Wong-Eakin highly suggests contacting your local State Health Insurance Counseling and Assistance Programs (SHIP). These programs are located throughout the country, and offer beneficiaries free, one-on-one help with virtually any Medicare-related question or concern. SHIPs can also connect you with federal and/or local programs for which you qualify. You can find your local program by visiting the Medicare Helpful Contacts page at Medicare.gov or by calling (800) MEDICARE.
Medicare Part D
Regina also doesn’t mention whether she has a Medicare Part D plan, which helps to cover the cost of prescription drugs. We’re coming up on Medicare’s Annual Election Period (AEP), which runs from October 15 through December 7 for plans that will be effective January 1, 2013.
“If she has a Medicare Part D plan now but it is not covering her medications and/or is more expensive than she can afford, she can change plans during the Annual Election Period,” Wong-Eakin says.
According to Wong-Eakin, it’s so important that seniors use the Annual Election Period to review their existing Medicare policies to make sure they’re enrolled in one that’s best suited for both their medical and financial needs. Yet, studies show that only about 10% of people with Part D coverage change their plan each year. That’s often a financial mistake.
According to a new survey by PlanPrescriber.com, an online provider of free Medicare education and plan comparison tools, 95% of people with Medicare Part D coverage are not enrolled in the lowest-cost plan.
For the survey, monthly premiums, co-pays, and deductibles were all calculated for more than 100,000 user sessions of the site. The findings: Switching to the plan with the lowest out-of-pocket costs has the potential to save folks with Part D coverage an average of $654 annually.
Share Your Thoughts
Are you having a hard time affording your prescription drugs? What solutions or programs, if any, have you found to help?
How many of you plan to review and possibly switch Medicare Part D or supplemental plans this fall during Medicare’s Annual Election Period?