Social Services Office Bracing For Federal Drug Plan Confusion

By John Voket

Staff members in the small Newtown Social Services office are already anticipating big headaches over the new federal prescription drug plan known as Medicare Part D. The local senior center is expecting more than 100 attendees for its public information session on the program next week, and the massive expected turnout has already prompted the scheduling of a second session on September 23 at Nunnawauk Meadows senior housing complex.

Official registration for the federal drug program will not begin until November 15 of this year, but Social Services Director Ann Piccini and case manager Joanne Klopfenstein are already concerned because several thousand Newtown residents may have already received or replied to an application for additional assistance that would offset the anticipated personal contributions for the plan.

“Some people are receiving this notice and returning it thinking they have completed the application for the plan itself,” Ms Klopfenstein said during an interview at the Social Services office earlier this week. “But this form [labeled SSA-10208-OCR-SM] is for assistance in helping people pay for the plan, not an application for the plan.”

Ms Klopfenstein said that there may be hundreds more Newtown residents, not necessarily seniors, who may qualify for premium assistance or state ConnPACE underwriting, who did not receive the federal Social Security Administration assistance application. That is why she is encouraging every Newtown resident, regardless of age or health condition, to become familiar with the basic conditions and stipulations of the new plan.

In an email, she noted that anyone interested in learning more about the program should visit one or more websites that are helpful.

“You can go to www.wcaaa.org, the site for the agency that trains us and leads the informational sessions,” Ms Klopfenstein said. “You can look at any of the articles, but near the bottom, click on Quick Facts for good information. Also at the bottom you can click on Enrollment Sessions to find out about other information sessions locally, or if you have a relative or loved one elsewhere in the state that should attend an information session in their community.”

Other sites recommended by the local Social Services staff include: www.medicare.gov (click on The Facts about Medicare Prescription Drug Plans) or www.aarp.org (scroll down the right hand column to: Medicare — Key Dates and Information).

Filling The Gaps

Ms Piccini said those considering participation in the federal plan who reside in Connecticut have a unique benefit available to them through the decade-old state-sponsored ConnPACE program, which will underwrite most of the basic costs of the federal program, as well as curbing costs for expensive drugs that may not be covered on an individual’s chosen federal plan.

“ConnPACE fills the gaps nicely,” Ms Piccini said. “And many people who think they won’t qualify because of their high level of assets are pleasantly surprised when they learn the program is exclusively based on income guidelines, unlike many other subsidy programs.”

Anyone who may want help paying for their prescriptions with individual income less than $21,400, or $28,900 for a couple will likely qualify for ConnPACE assistance, she said.

“Those individuals must still apply to participate in the Medicare Part D plan,” Ms Piccini said. “But ConnPACE will pick up the anticipated $32 monthly federal plan fee. Qualified ConnPACE participants will only pay the annual participant fee and a maximum of $16.25 for any prescription.”

According to the ConnPACE website, ConnPACE is a state-funded health insurance program for most prescription medicines and insulin supplies. With a ConnPACE membership card, your only out-of-pocket expense is a co-payment for each prescription. This co-payment is $16.25.

When you apply for ConnPACE, there is a $30 annual enrollment fee. Your application is then processed by the ConnPACE customer service center. Eligible applicants get a ConnPACE membership card in the mail to use at participating pharmacies.

There is no yearly dollar limit on the amount of prescriptions covered by ConnPACE. Generic drugs must be substituted for brand-name drugs, unless otherwise indicated by the prescribing physician.

“It couldn’t hurt for every low-income senior or disabled person in Newtown, who currently receives prescription medication or who anticipates they may need to in the near future, to apply for ConnPACE,” Ms Klopfenstein added.

Ms Klopfenstein said a dedicated information campaign in the media informing the public about the new federal prescription plan will begin October 15, and anyone interested in participating in the voluntary program can sign up between November 15 and May 15, 2006.

“So there’s no need to run right in here to get signed up on November 15,” she said.

Those electing to opt out of the plan should know that they could be assessed a penalty if they want to sign up at some point in the future when and if they require prescription medication. A penalty of one percent of the benefit cost per month will be added to the premium of anyone not opting in to the plan by May 15 of next year, she said.

However, those who already have “creditable coverage,” like the benefit covered by most state employee and certain private sector retirement benefit plans, will not be charged the penalty if and when they opt in, Ms Piccini said. But it is stipulations like this and dozens of others in the fine print she believes will further add to the confusion as the federal plan is rolled out in the coming months.

For instance, those of any age receiving current Medicaid or Title 19 assistance will not have to cover the basic monthly premium, but they do have to choose a plan they will participate in by December 31 of this year, otherwise a plan will be randomly assigned to them.

“The problem there is, if someone on Medicaid who is receiving expensive medication ignores the application to choose a plan, and a plan is assigned that doesn’t cover the drugs they are on, they may get stuck paying for the prescription in full,” Ms Klopfenstein said.

In the short term, the Social Services staff recommends every person in Newtown taking prescription medication to list all the drugs they take including dosage and frequency, so when the many plan choices are released, individuals can match the drugs they need to one of the Medicare plans covering those prescriptions.

Ms Piccini also warned of scams already being perpetrated by unscrupulous individuals hoping to exploit the new wave of mail correspondence by the federal government about the plan as an opportunity for identity theft. She noted one client who already received an official-looking letter from a company in Texas requesting the recipient reply with personal information to help qualify her for the new federal program.

“We suggest that at this point, if you receive anything in the mail requesting you reply regarding the new federal prescription drug plan, that you bring it by our office or at least call us to see if it is legitimate,” Ms Piccini said.

Anyone looking to sign up for the September 23 information session at Nunnawauk Meadows should call 426-0659 for reservations, or check the Area Agency on Aging website mentioned above for other sessions scheduled in the region in the coming weeks. Registration for the August 24 session at the Newtown Senior Center is closed, and the event is full.