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New York Plan Shifts Low-Income Seniors to Medicare Drug Plan

Posted on: Thursday, 26 January 2006, 00:00 CST

By Tami Luhby, Newsday, Melville, N.Y.

Jan. 26--Nearly a hundred thousand low-income senior citizens could be shifted into the confusing Medicare drug plan, under a state budget proposal that would save money for both the seniors and the state.

The move would make Medicare the primary insurer for their prescriptions instead of the state's discount drug program as of July 1, officials said. Consumer advocates said they support the proposal as long as the seniors are given time to choose a Medicare plan and are guaranteed their medicine during the transition.

"It will save the state money and will save the enrollee money," said Bill Ferris, the state AARP's legislative representative. "But we want to make sure there's a smooth transition with safeguards."

Under the budget plan, seniors citizens who are in the state's Elderly Pharmaceutical Insurance Coverage plan and are eligible for the Medicare Part D low-income subsidy would be enrolled in the federal drug program. EPIC would continue to provide a "wrap around" benefit if their drugs are not covered by their Medicare plan. The shift would affect 91,000 people.

With 358,000 participants, EPIC provides drugs at a discount for those older than 65 with incomes of less than $35,000 for singles and $50,000 for couples -- too much to qualify for Medicaid.

Only those who also are eligible for assistance to pay for the Medicare Part D plan would be shifted. To be eligible, individuals must have 2005 incomes of less than $12,920 and assets of less than $7,500, while couples can't make more than $17,321 or have assets of more than $12,000. These people will pay $2 for generic drugs and $5 for brand-name prescriptions, with no premiums or deductibles.

As EPIC enrollees, the seniors pay annual fees of up to $300 and co-pays of up to $20.

The state is expecting tens of millions of dollars in savings. Officials are projecting a savings of $113 million in fiscal 2007 with the 91,000 seniors required to enroll in a Part D plan, as well as 45,000 voluntary enrollments by other EPIC members, said John Sweeney, spokesman for the state Division of the Budget.

But the Medicare drug program has proved difficult to navigate, especially because seniors have to make sure they choose a plan that covers their medicine. Senior citizen advocates said the EPIC enrollees need time to research which plan would be best for them. Also, they said, the state must make sure these seniors are never turned away at a pharmacy.

"It's a trade-off," said Michael Burgess, executive director of the Alliance for Retired Americans state chapter. "They'll save more money, but they'll be subject to the confusion of picking a private plan."

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Source: Newsday, Melville, N.Y.

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