This week, the New Jersey Department of Health and Senior Services is sending PAAD and Senior Gold participants a letter describing prescription benefit changes that will take effect August 1, Health and Senior Services Commissioner Heather Howard announced today.

 

“Beneficiaries and caregivers should watch for these important letters, which describe how the changes will affect them personally,” said Commissioner Howard.  “Senior Gold participants will need to take action.  Beneficiaries must now sign up for federal Medicare Part D prescription coverage in order to remain eligible for Senior Gold.

 

“Department staff is available to answer participants’ questions about the changes, which also affect co-pays and coverage for diabetic testing supplies, she added.

 

New Jersey’s Fiscal Year 2009 budget makes several important changes in the two benefit programs as of August 1:

 

• PAAD Co-Pays – The first increase since 1992 will raise the co-pay for a generic drug prescription $1 (to $6) and the co-pay for brand-name medications $2 (to $7).  PAAD participants with the lowest income and assets – about 50,000 beneficiaries -- will not be affected by the increase. 

 

• Senior Gold Co-Pays -- Co-pays are unchanged for all beneficiaries.

 

• Diabetic Testing Supplies -- PAAD and Senior Gold participants must use their federal Medicare Part B coverage or other insurance for diabetic testing supplies.  PAAD and Senior Gold will no longer pay for test strips, lancets and other such items.

 

• Senior Gold Eligibility -- The approximately 6,000 Senior Gold members who haven’t yet enrolled in a Medicare Part D prescription plan must do so, if they are eligible, and pay their own Part D premiums, in order to remain in Senior Gold.  The two plans will work together to help beneficiaries reduce their prescription costs, such as out-of-pocket costs for deductibles, co-insurance and the coverage gap known as the “donut hole.”

 

The Department of Health and Senior Services is sending letters tailored to the needs of beneficiaries.

 

As a courtesy to Senior Gold participants who must sign up with Medicare Part D, DHSS will recommend a plan that best matches each person’s prescription needs and pharmacy use.  The plan’s phone number will be included so beneficiaries can sign up directly if they decide to choose the suggested plan.

 

After making their choice, beneficiaries should call Senior Gold at 1-800-792-9745 so the program’s records may be updated.

 

Senior Gold members should not wait to sign up during the normal 2008 Part D enrollment period, which begins on November 15.  The DHSS letter is proof that the Senior Gold member is eligible for a Part D Special Enrollment Period.

 

To obtain diabetic testing supplies after August 1, Senior Gold and PAAD members must ask their pharmacist to bill their Medicare Part B or other health plan for these items.  PAAD and Senior Gold will no longer pay for them.

 

Members who are on Medicare or have private insurance may look into companies that deliver diabetic testing supplies and will bill Medicare or a private insurance company on behalf of beneficiaries.  A list of such companies and their phone numbers is included in each DHSS letter.

 

The DHSS letters also are available on the Department’s website at: http://nj.gov/health/seniorbenefits/services.shtml.

 

About 168,000 people are currently enrolled in the PAAD program for low-income seniors and disabled people.  About 21,000 people are enrolled in the Senior Gold prescription discount program for people with moderate incomes.

 

For more information on enrolling in Part D, Senior Gold participants or their family members should call the Medicare program at 1-800-633-4227 and have ready their Medicare card, a list of current prescription drugs including strength and dosage, and the name of their pharmacy.  They may also contact the New Jersey SHIP health insurance assistance program at 1-800-792-8820.

 

For other questions, PAAD and Senior Gold program members should call the PAAD/Senior Gold hotline at 1-800-792-9745.

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