Missouri Rx Changes Effective July 1, 2017
Missouri Rx – Missouri’s State Pharmaceutical Assistance Program has been reauthorized by the state legislature for another 5 years until August, 28, 2022. Missouri Rx works with a person’s stand alone Part D plan or Medicare Advantage plan to pay 50% of a person’s costs at the pharmacy. Eligibility benefits for MO Rx benefit has been reduced to only those Medicare beneficiaries that are also enrolled into Medicaid. This change affects 64,000 enrollees. Our certified counselors can help you determine your options if you have lost this benefit. You have not lost your Medicare drug coverage.
Missouri Rx coverage will no longer pay 50% of the cost of Part D prescriptions for people enrolled in Medicare whose
- Income $21,660 for a single person or $29,140 for a couple or
- Enrolled into Extra Help from SSA sometimes called Low-Income Subsidy (LIS).
CLAIM Counselors can provide the following.
- If you are affected by this change you have a Special Enrollment Period for two months to change your Part D plan. Counselors can assist with the comparison and enrollment into a another plan if this is your choice.
- Counselors can screen and provide application assistance for Low-Income Subsidy through Social Security or Medicare Savings Program.
- Check eligibility for Patient Assistance Programs to help cover some of your higher cost medications
www.rxassist.org – provides info and application links to assistance programs
www.needymeds.org – provides info and application links to assistance programs
www.rxoutreach.org - discount purchasing program website
- Other options may include talking with your doctor or going to a public health center that provides a sliding fee scale for prescriptions.
We encourage you to call or contact us to understand any options available to you.
March is National Kidney Month
1 in 3 American adults is at risk for kidney disease. Medicare Part B covers preventive screening tests that help detect diabetes and high blood pressure - 2 conditions that may lead to kidney damage. Visit Medicare.gov/coverage/preventive-and-screening-services.html for more information.
Medicare Part B also covers up to 6 sessions of kidney disease education services if a person has Stage IV chronic kidney disease that will usually require dialysis or a kidney transplant. For more information, visit Medicare.gov/coverage/kidney-disease-edu.html.
Scammers masquerade as Health & Human Services' officials in new telephone scam targeting senior citizens.
A telephone scam in which crooks alter caller ID to make it seem as if the call is coming from the U.S. Department of Health & Human Services’ Office of the Inspector General’s Hotline 1-800-HHS-TIPS (1-800-447-8477) to get beneficiaries and members of the public to verify or share personal info which is used to victimize them via financial and other crimes – draining their bank accounts. The Office of the Inspector General wants the public to know that the U.S. Department of Health & Human Services’ Office of the Inspector General will not use the Hotline telephone number to make outgoing calls and individuals should not answer calls from 1-800-HHS-TIPS (1-800-447-8477).
The Office of the Inspector General recently confirmed that the Hotline telephone number is being used as part of a telephone spoofing scam targeting individuals throughout the country. These scammers represent themselves as Department of Health & Human Services’ Hotline employees and can alter the appearance of the caller ID to make it seem as if the call is coming from the Department of Health & Human Services’ Office of the Inspector General Hotline. The perpetrator may use various tactics to obtain or verify the victim’s personal information, which can then be used to steal money from an individual’s bank account or for other fraudulent activity. The Office of the Inspector General takes this matter seriously. We are actively investigating this matter and intend to have the perpetrators prosecuted.
It is important to know that the Department of Health & Human Services’ Office of the Inspector General will not use the Hotline telephone number to make outgoing calls and individuals should not answer calls from 1-800-HHS-TIPS (1-800-447-8477). We encourage the public to remain vigilant, protect their personal information, and guard against providing personal information during calls that purport to be from the Hotline telephone number. We also remind the public that it is still safe to call into the Hotline to report fraud. We particularly encourage those who believe they may have been a victim of the telephone spoofing scam to report that information to us through the Hotline, 1-800-HHS-TIPS (1-800-447-8477) or firstname.lastname@example.org. Individuals may also file a complaint with the Federal Trade Commission 1-877-FTC-HELP (1-877-382-4357).
If you would to learn more, visit: https://oig.hhs.gov/fraud/consumer-alerts/alerts/phone-scam.asp
Joplin TV news station shines a spotlight on CLAIM's efforts
Joplin TV news station shines a spotlight on CLAIM's efforts
JOPLIN, Mo. - Now until December seventh is annual open enrollment. If you're enrolled in Part D, Medicare's drug coverage, you have the chance to either switch or stick with that insurance.
Karen Wells and her husband visited Mercy Hospital Joplin Friday to speak with CLAIM, the Missouri State Health Insurance Assistance Program about being enrolled in Part D, Medicare's drug coverage.
"Confused, cause there's so many plans and I work in the health care field, but still it's all like Greek to me. So she helped to dispel a little bit of that and told me how they'll use a computer and input a lot of our data and tell us which plans will probably be best for us," Wells says.
Experts say from year to year, coverage changes, which means providers may not carry the same prescription drugs or the cost of coverage may increase. And it can get very confusing for the average person.
"We can't imagine someone that doesn't deal with this all the time to even understand it and the problem being if they don't understand it and they don't make necessary changes now, they're in it for a year, so they can be out a lot of money simply from one little mistake," Stacy Childs, Claim Missouri Regional Liaison Trainer for the Southwest District of Missouri.
To read the full story, click here.
Social Security and Veterans Affairs Partnership Means Faster Disability Decisions for Veterans
Today, the Social Security Administration announces the launch of a new Health IT initiative with the Department of Veterans Affairs (VA) that enables all Social Security disability case processing sites to receive medical records electronically from all VA facilities. Veterans will receive a faster decision on their Social Security disability claim, speeding them and their dependents through this new process. Both agencies will save time and money with an automatic request through the eHealth Exchange.
“President Obama has said, ‘we must maintain the sacred covenant we share with our veterans by ensuring they have the care and benefits they deserve,’ and I could not agree more,” said Carolyn W. Colvin, Acting Commissioner of Social Security. “We are committed to providing our veterans with the world class service they so richly deserve and improving the speed and efficiency of our disability program.”
The new Health IT program was tested successfully at Social Security locations around the country. On Veteran’s Day, November 11, the eHealth Exchange will go live, nationally, to all Social Security disability case processing sites.
Social Security requests nearly 15 million medical records annually from healthcare providers and organizations to make medical decisions on about three million disability claims. Medical documentation is essential to make a disability determination. Historically, the agency obtained medical records through a manual process (mail, fax, secure mail). This new national initiative puts in place an automated process to obtain medical records electronically without human intervention.
“VA is currently improving quality of life by enabling Veterans to share their health information with federal partners and integrating their data into a safe and secure health-related consumer application,” said Dr. David Shulkin, Under Secretary for Health of the Department of Veterans Affairs. “Currently, when eligible Veterans apply for Social Security Disability Insurance benefits the average wait time for Social Security to receive paper records from VA can take months; this partnership allows Social Security and VA to share the Veteran’s health information electronically in minutes. The Social Security and VA partnership allows VA to continue to be a leader in interoperability efforts among federal partners while improving overall quality of life for our Veteran patients.”
This partnership adds the VA to Social Security’s more than 50 other Health IT partners, including the Department of Defense, in approximately 7,000 facilities across the United States providing electronic health records. Social Security’s goal is to continue expanding the number of healthcare organizations and federal agencies providing electronic health records within a safe and secure environment.
To learn more about Health IT, please visit www.socialsecurity.gov/disabilityssi/hit.
Social Security offers two other programs to expedite disability claims filed by veterans. Wounded Warriors and veterans with a VA disability compensation rating of 100% Permanent & Total have their Social Security disability claims treated as high priority and receive expedited decisions. For more information about these programs, please visit www.socialsecurity.gov/people/veterans.
To get more Social Security news, follow the Press Office on Twitter @SSAPress.
Medicare Q&A: Who can I contact to learn more about Medicare enrollment and benefits?
Call your local SHIP program. The phone number is listed on your copy of the Medicare and You handbook. In Missouri, call 1-800-390-3330. We refer your call to a trained SHIP counselor in your area who will know the local program(s) you seek. We have 300 counselors statewide to help you.
Medicare Q&A: What do I do if I am enrolled in a non-benchmark Medicare Plan, but found out that I am eligible to enroll into a “Benchmark” plan.
There are four benchmark plans in 2017 that a beneficiary receiving extra help can enroll. The premium for the benchmark plan will be zero and there is no deductible. If a beneficiary, who receives full extra help, enrolls in a non-benchmark plan then the premium will be reduced and the beneficiary will be required to pay that monthly premium.
Also, another important reason to work with a SHIP Counselor, and to have the Counselor enter the current drugs that the Beneficiary takes, is to make certain that all drugs are on the ‘Benchmark’ Plan’s Formulary! Even though a Beneficiary is eligible and could enroll into a $0 Premium plan, if their drugs are not covered by the Benchmark Plan’s formulary, this could cause a much bigger issue. The cost of those drugs that are not covered, could end up causing the Beneficiary to pay a great deal of money out of pocket! As a result, a small premium might not be so bad.
Medicare Q&A: What do I do if I am already enrolled in Medicare, but also have employer-sponsored or other third-party insurance plan?
If a beneficiary, 65 years or older, is enrolled in Medicare while he/she is still working and is also enrolled in their employer sponsored plan, the employer plan will be primary to Medicare, in many cases. In order for this statement to be true for the employee and/or 65 year old spouse, there has to be 20 or more employees, and the beneficiary must still be actively working.
If the employee (or spouse) is under the age of 65 and is enrolled in Medicare due to a disability, in order for the employer plan to be primary in this situation, there must be 100 or more employees. If the employer plan IS primary to Medicare, the beneficiary is able to delay Part B, or if already enrolled, could drop Part B, without incurring a penalty. While the employee is still working, he or she may sign up for Part B at any time. When the Beneficiary decides to end employment, they will then receive a Special Enrollment Period to enroll (or re-enroll) into Part B.
This Special Enrollment Period will last up to eight months after employment ends, or until the employer insurance ends, whichever comes first.
Medicare Q&A: Who do I contact for information about Long Term Care assistance?
To obtain the most accurate and helpful information regarding Long Term Care Insurance, start with Missouri Department of Insurance. The department’s website is http://insurance.mo.gov/consumers/LongTerm. On this site you will find information such as Frequently Asked Questions, Long Term Care Costs, and a variety of additional links and resources.
Medicare Q&A: What do I do if I enroll in a Medicare plan and later have to make an adjustment because of a major life event?
Call your local SHIP program. The phone number is listed on your copy of the Medicare and You handbook. In Missouri, call 1-800-390-3330. Almost all major life events will have a Special Enrollment Period (SEP). This will let you make the changes you need for Medicare coverage. Call to find out if a Special Enrollment Period can work for you.