SenioRx
Because the high cost of prescription drugs can be a great burden, we strive to reduce economic stress, promote better health and improve the quality of life of Alabama's older population by providing ways to reduce the expense of life sustaining medications.
SenioRx is a partnership of state agencies and community organizations that assists seniors with applying for drug assistance programs provided by pharmaceutical manufacturers.
To be eligible for pharmaceutical assistance programs a Senior must:
- be at least 55 years of age
- be a legal resident of the state of Alabama
- have chronic medical conditions
- NO prescription insurance coverage
- limited financial means (less than $20,000/person) (less than $26,000/ 2 persons)
To apply for the SeniorRx program, please download the application provided by the Alabama Department of Senior Services (requires Adobe Acrobat Reader). Complete the form and return it to one of the area offices listed below. You will then be contacted for an appointment.
We also offer information and assistance regarding medication management and health promotion to all Seniors age 60 and up. Please contact the SARCOA SeniorRx offices for these services.
SARCOA
Barbour, Coffee, Covington, Dale, Geneva, Henry and Houston County Residents:
SeniorRx
1691 Ross Clark Circle
Dothan, Alabama 36301
(334) 678-0440
Locally Sponsored Offices:
Henry County Residents
Abbeville Office (334) 585-2086
Headland Office (334) 693-3545Coffee County Residents
Enterprise Office (334) 393-8538Covington County Residents
Opp Office (334) 493-1699
PRESCRIPTION ASSISTANCE
MEDICARE PART D
Anyone who has Medicare can participate in the Medicare drug benefit (also known as Medicare Part D). This is a complicated program, so follow the following steps in determining what you should do.
Do you need Medicare Part D?
If you have TRICARE for Life, PEEHIP, State Retirement coverage, Civil Service retiree health insurance, or other good coverage because of your or your spouse’s current coverage or because of you or your spouse’s retirement plan, you do NOT need Medicare Part D. You should have received a letter from your current plan explaining whether you drug coverage is at least as good as the coverage available from a Medicare Part D plan.
If you do not have good coverage from such a source, you should strongly consider enrolling in a Medicare Part D plan.
When can I enroll?
Open enrollment for all Medicare beneficiaries occurs from November 15th through December 31st every year. During this period each year, you can make an initial enrollment or change from one plan to another.
You also have an initial enrollment period when you first become eligible for Medicare, which may be when you turn age 65, when you have been eligible for Social Security disability for 24 months, when you are diagnosed with Lou Gehrig’s disease, or when you need kidney dialysis or a kidney transplant.
If you are eligible for full Medicaid (through SSI or nursing home Medicaid), QMB, SLMB, QI, or the low-income subsidy (LIS) or if you become a nursing home resident, you can enroll or change Part D plans at any time.
Can I receive help with the cost of Part D?
If you are eligible for Medicare, you should be aware of additional programs that may help pay for the Medicare premium, deductibles, and copayments. These programs apply to persons who have Medicare for whatever reason, including people who are over age sixty-five, those who receive Social Security disability, and certain renal disease and Lou Gehrig’s disease patients.
If you qualify for full Medicaid (through SSI or nursing home Medicaid) or for QMB, SLMB, or QI, then you are automatically eligible for free coverage under Medicare Part D, with no deductible, no coverage gap, and only very small copayments. If you qualify for any of these programs, then you do not need to apply separately for help with Part D through the Low-income Subsidy (LIS) program at the Social Security office.
In Alabama, eligibility for QMB, SLMB, and QI is based solely on income and being on Medicare. The State of Alabama does NOT count what a person owns in determining eligibility, so having a bank account or owning a home does not prevent eligibility.
To determine whether your income falls below the income limits: First, if you or your spouse receives any wages or salaries from current employment or self-employment, add together the GROSS amount of earnings for the month (before any deductions or withholding). Then subtract $65.00. Divide the balance by two. This result is the amount of earned income that counts.
Next, add ALL your and your spouse’s gross monthly amount of rent received, Social Security, pension, veterans, and other retirement or disability benefits. Count the amount of these benefits BEFORE any deductions for taxes, insurance, or any other withholding.
Add together the amount of countable earned income, if any, and the total of all rent, retirement, and disability income to determine the amount that counts toward the income limits that are printed below. DO NOT COUNT INTEREST OR DIVIDENDS AS INCOME.
NOTE: Unlike SSI, Alabama DOES average income received weekly or bi-weekly. To convert to monthly income, multiply weekly income by 4.333 and bi-weekly income by 2.166. Income receive less frequently than monthly is counted only in the month in which it is received as is also the case with SSI.
The countable income limits for the QI program, which will pay the Medicare Part B premium ($93.50 in 2007), are as follows:
Married people who reside together: $1505 per month
(combined income)
Single or married but not residing together: $1123 per month.
The QI program in Alabama is currently oversubscribed, so new applications are currently being denied, but you may want to apply to be considered once new slots are available.
The countable income limits for the SLMB program, which will pay the Medicare Part B premium ($93.50 in 2007), are as follows:
Married people who reside together: $1340 per month
(combined income)
Single or married but not residing together: $1000 per month.
Being eligible for either QI or SLMB will simply result in an increase in monthly income by the amount of the Part B premium. It does NOT cover any copayments or deductibles, so you should keep your supplemental health insurance unless income is also lower than the QMB limits listed below.
Being approved for SLMB or QI does provide automatic eligibility to receive Medicare Part D drug benefits free (no premium for the card of one’s choice) with only the requirement of paying small copayments (roughly $2.15 for generic and $5.35 for brand-name prescriptions).
The countable income limits for the QMB program, which will pay the Medicare Part B premium AND also all Medicare deductibles and copayments, are as follows:
Married people who reside together: $1120 per month
(combined income)
Single or married but not residing together: $ 837 per month.
Being eligible for this program will not only result in an increase in monthly income by the amount of the Part B premium, but will also cover all copayments and deductibles, so you should drop any supplemental health insurance unless it is free or nearly free to you. For example, those eligible for Tricare for Life, PEEHIP, or coverage that is provided at no cost through a union or retirement plan should keep the coverage even when eligible for QMB. On the other hand, those eligible for QMB who have Blue Cross C+ should drop the C+ coverage because it costs money for coverage that is already provided at no cost by QMB.
Being approved for QMB also provides automatic eligibility to receive Medicare Part D drug benefits free (no premium for the card of one’s choice) with only the requirement of paying small copayments (roughly $2.15 for generic and $5.35 for brand-name prescriptions).
NOTE: The income limits for QMB, SLMB, and QI will increase in March 2007. During January and February 2007, do NOT count the 2007 cost of living increase in determining eligibility for these programs. The income limits for these programs do NOT increase exactly in line with the cost of living increases in Social Security and other benefits checks. The QMB income limit is equal to 100% of the federal poverty level plus $20, the SLMB limit is 120% of the poverty level plus $20, and the QI limit is 135% of poverty plus $20.
To apply for QMB, SLMB, or QI, contact the Medicaid District office at (334) 702-3101. If you have questions about whether you should apply or need help in applying for any of these programs, contact Davis & Neal, which is SARCOA’s contractor under the State Health Insurance Program (SHIP), at (334) 671-3990 or 1-888-671-5246. There is no charge for this assistance.
What if my income is too high to qualify for QMB or SLMB? Can I qualify for help with Part D in any other way?
If you cannot qualify for QMB or SLMB and you are not already eligible for QI, you should check to see whether you can qualify for the Low-income Subsidy (LIS) through the Social Security office. To apply, telephone 1-800-772-1213 (TTY 1-800-325-0778) or apply online at www.ssa.gov. If you have questions about whether you should apply or need help in applying for LIS, contact Davis & Neal, which is SARCOA’s contractor under the State Health Insurance Program (SHIP), at (334) 671-3990 or 1-888-671-5246. There is no charge for this assistance.
MONTHLY INCOME LIMITS FOR HELP WITH MEDICARE PART D
WHEN APPLYING THROUGH THE SOCIAL SECURITY OFFICE
(INCLUDES $20 PER MONTH ANY INCOME DISREGARD)
HOW TO DETERMINE HOUSEHOLD SIZE: COUNT YOURSELF AND YOUR SPOUSE (IF HE OR SHE LIVES WITH YOU) AND ALSO COUNT ANY OTHER RELATIVE WHO LIVES WITH YOU FOR WHOM YOU PROVIDE MORE THAN ONE-HALF OF THAT PERSON’S SUPPORT.
HOW TO DETERMINE GROSS INCOME: IF ANY OF YOUR OR YOUR SPOUSE’S INCOME IS FROM WORK (A JOB OR SELF-EMPLOYMENT), FIRST DETERMINE MONTHLY GROSS EARNED INCOME (GROSS PAY BEFORE DEDUCTIONS OR NET EARNINGS FROM SELF-EMPLOYMENT), THEN SUBTRACT $65.00, THEN DIVIDE THE REMAINDER BY TWO, THEN ADD ALL OTHER INCOME.
ASSETS/RESOURCES LIMITS: YOUR RESOURCES (NOT COUNTING YOUR HOME AND LAND ADJOINING IT, YOUR VEHICLES, HOUSEHOLD PERSONAL PROPERTY, AND UP TO $1500 PER PERSON IN FACE AMOUNT OF LIFE INSURANCE) MUST BE LESS THAN $11,500 IF SINGLE OR $23,000 IF MARRIED AND LIVING IN THE SAME HOUSEHOLD IF YOU ARE APPLYING THROUGH THE SOCIAL SECURITY OFFICE FOR HELP WITH MEDICARE PART D. THESE LIMITS INCLUDE THE $1500 PER PERSON FUNERAL AND BURIAL EXEMPTION.
| Household Size | 100% | 135% | 140% | 145% | 150% |
|---|---|---|---|---|---|
| 1 Person | 836.67* | 1122.50* | 1163.33 | 1204.17 | 1245.00 |
| 2 Persons | 1120.00* | 1505.00* | 1560.00 | 1615.00 | 1670.00 |
| 3 Persons | 1403.33 | 1887.50 | 1956.67 | 2025.83 | 2095.00 |
| 4 Persons | 1686.67 | 2270.00 | 2353.33 | 2416.67 | 2520.00 |
| 5 Persons | 1970.00 | 2652.50 | 2750.00 | 2847.50 | 2945.00 |
| Add For Each Additional Person | +283.33 | +382.50 | +396.67 | +410.83 | +425.00 |
* A SINGLE PERSON WITH GROSS MONTHLY INCOME OF $1000 OR LESS (NOT COUNTING INTEREST AND DIVIDENDS) SHOULD APPLY FOR QMB/SLMB TO BECOME AUTOMATICALLY ELIGIBLE FOR HELP WITH PART D. A MARRIED COUPLE WHO LIVE TOGETHER WITH GROSS MONTHLY INCOME OF $1340 OR LESS (NOT COUNTING INTEREST AND DIVIDENDS) SHOULD APPLY FOR QMB/SLMB TO BECOME AUTOMATICALLY ELIGIBLE FOR HELP WITH PART D. ASSETS/RESOURCES DO NOT COUNT IN DETERMINING ELIGIBILITY FOR QMB/SLMB/QI-1. IF YOU ARE ALREADY ELIGIBLE FOR QMB, SLMB, OR QI-1, THEN YOU ARE AUTOMATICALLY ELIGIBLE FOR HELP WITH MEDICARE PART D, AND YOU DO NOT HAVE TO APPLY THROUGH THE SOCIAL SECURITY OFFICE.
SPECIAL NOTE FOR MARRIED COUPLES IN WHICH ONLY ONE OF THEM IS ELIGIBLE FOR MEDICARE: FIRST COUNT ONLY THE GROSS INCOME OF THE PERSON WHO HAS MEDICARE (NOT COUNTING INTEREST AND DIVIDENDS). IF THAT AMOUNT IF LESS THAN THE $1000 MONTHLY LIMIT FOR SLMB, THEN ADD TOGETHER THE MONTHLY GROSS INCOME OF BOTH SPOUSES (NOT COUNTING INTEREST AND DIVIDENDS). IF THAT AMOUNT IS LESS THAN $1340, THEN THE PERSON WHO HAS MEDICARE SHOULD APPLY FOR QMB/SLMB THROUGH THE STATE MEDICAID OFFICE TO BECOME AUTOMATICALLY ELIGIBLE FOR HELP WITH MEDICARE PART D. IF, ON THE OTHER HAND, EITHER THE GROSS INCOME OF THE PERSON WHO HAS MEDICARE (NOT COUNTING INTEREST AND DIVIDENDS) IS MORE THAN $1000 OR THE COMBINED GROSS INCOME OF BOTH SPOUSES IS MORE THAN $1340 (NOT COUNTING INTEREST AND DIVIDENDS), THEN THE PERSON WHO IS ELIGIBLE FOR MEDICARE SHOULD APPLY THROUGH THE SOCIAL SECURITY OFFICE FOR HELP WITH MEDICARE PART D AS A TWO-PERSON HOUSEHOLD.
SPECIAL NOTE FOR HOUSEHOLDS OF MORE THAN A SINGLE PERSON ALONE OR A MARRIED COUPLE LIVING TOGETHER: IF YOU CANNOT QUALIFY FOR QMB/SLMB, AND YOU ARE PROVIDING MORE THAN ONE-HALF THE SUPPORT FOR ONE OR MORE OTHER RELATIVES WHO LIVE WITH YOU, THEN YOU SHOULD CHECK TO SEE IF YOUR AND YOUR SPOUSE’S INCOME (INCLUDING INTEREST AND DIVIDENDS) IS BELOW THE AMOUNT LISTED UNDER 150% FOR THE HOUSEHOLD SIZED LISTED ABOVE. IF SO AND IF YOUR ASSETS/RESOURCES ARE LESS THAN $11,500 SINGLE OR $23,000 MARRIED AND LIVING TOGETHER, THEN YOU SHOULD APPLY THROUGH THE SOCIAL SECURITY OFFICE FOR THE LIS.
How do I choose a Part D plan?
Because dozens of private companies are competing to become your Part D provider, choosing the plan that is best for you may seem overwhelming.
DO NOT CHOOSE A PLAN BASED SOLELY ON THE RECOMMENDATION OF A FRIEND OR RELATIVE OR BECAUSE YOU LIKE THE SALES AGENT.
Every plan has a different list of drugs that it covers. Different pharmacies accept different plans. Copayments, premiums, deductibles, and whether coverage is available in the coverage gap vary widely among plans.
Because the plans change their premiums and coverage each year, you should determine which plan in which to enroll each year during the November 15th through December 31st open enrollment period. Be aware that if you do not do anything during the open enrollment period, you will automatically remain enrolled in the plan you had during the previous year, even if that plan has increased its premium or changed its coverage.
Because everyone takes different medicine and uses different pharmacies, you should make an individual decision about which plan to choose. Even spouses may need to enroll in different plans because they take different prescriptions.
The best way to choose the plan that will save you the most money is to enter onto the Medicare website plan comparison tool all the prescriptions that you take, including how many you take each month and the specific variety of each drug that you have been prescribed (number of milligrams, etc.). The computer program will show you the plans that will save you the most money by taking into account all the costs, including the premium, deductible, cost of each drug (which varies widely among plans), whether coverage is available in the coverage gap, and whether some of you drugs are simply not covered under each plan. The sensible decision would be to enroll in one of the plans that will result in the lowest overall cost out-of-pocket to you each year.
You or a friend or relative can use the Medicare plan comparison tool on the Internet at the Medicare website www.MEDICARE.gov. You can also telephone Medicare at 1-800-633-4227. The local SHIP program can also provide this service to you at no cost. SARCOA’s local contractor for this service is Davis & Neal, telephone (334) 671-3990 or 1-888-671-5246.
