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Consumer Center for Health Education and Advocacy


The Consumer Center for Health, Education, and Advocacy is an independent program of the Legal Aid Society of San Diego, Inc. which provides education and advocacy to help customers get the health services they need. Our mission is to empower consumers through effective education and advocacy.	size:56K

Part D Project Funders:

a. California Wellness Foundation
b. Alliance Healthcare Foundation
c. The California Endowment

Medicare Part D

1. Beginning 1/1/06, a new Federal law went into effect that changed the way that Medicare beneficiaries receive their prescription drugs.
2. Prior to 1/1/06, some Medicare beneficiaries did not have prescription drug coverage and were paying the full price of their medications; therefore, in 2003, Congress passed the Medicare Modernization Act (Part D).
3. With this law, Medicare contracts with private prescription drug companies to provide drug coverage.
4. Even though these changes are good for some Medicare beneficiaries, people with Medicare and free Medi-Cal experience problems at times with Part D. Prior to 1/1/06, these beneficiaries received their drugs from Medi-Cal. Now they have to receive most of their drugs from a Medicare Part D plan. At times, these beneficiaries experience problems accessing their prescriptions drugs through their Part D plan due to enrollment problems.

Government Programs We Help People Apply For

1.*Part D and dual eligibles
2.*The Low-Income Subsidy, also known as the Extra Help
a.Pays for (or greatly reduces the costs of) co-pays, deductibles, monthly premiums, and the donut hole
b.Some people automatically receive it (SSI, MSPs, Medicare and free Medi-Cal)
c.Some people have to apply for it
d.Income and asset guidelines for people who have to apply: Single $1,353 monthly income and $12,510 in assets. Married $1,821 monthly income and $25,010 in assets.
3.*The Medicare Savings Programs
a.Many Medicare beneficiaries do not realize that Social Security takes $96.40 a month from their Social Security check to pay for Medicare Part B.
b.Example – net is $1000 but gross is $1093.50; that’s almost 10% of the monthly income
c.For those who qualify, Medi-Cal will pay for these premiums
d.Income and asset guidelines: Single $1,218 monthly income and $4,000 assets. Married $1,639 and $6,000 in assets.
4.Drug plan searches for people who qualify for our program
a.Use the Medicare website
b.Enter the medications, dosage, and strength
c.Provide three options of plans that appear to be the least expensive and least amount of exceptions needed
d.WE DO NOT ENDORSE ONE PLAN OVER ANOTHER!
5.Other programs we advise people on:
a.Medi-Cal
i.Federal program (known nationally as Medicaid)
ii.Based on residency, income, assets, and disability, Medi-Cal provides health care coverage, including hospital visits, doctor’s visits, prescription drug coverage, dental, vision, etc.
b.Food Stamps

The Medicare Part D Team assists beneficiaries
face to-face at local Social Security Administration:
National City
Chula Vista
El Cajon
La Mesa
Oceanside

For help with these issues call 1-877-734-3258.

English Only
Lynda Johnson at extension 2654

English / Spanish
Kristi Evans at extension 2681
Jessica Becker at extension 2791
Elsie Thorres at extension 2740

English / Tagalog
Michelle Sherman at extension 2743

English / Vietnamese
Yen Vu at extension 2710

What is Medicare?

Medicare is administered by the Centers for Medicare & Medicaid Services (CMS), a Federal agency in the United States Department of Health and Human Services. The Social Security Administration (SSA) enrolls most people in Medicare. Beneficiaries do not have to be retired to enroll in Medicare. They can enroll in Medicare up to three months before age 65. If they are already receiving Social Security benefits, they will be automatically enrolled.

Who gets Medicare?

Medicare is a Federal health insurance program for people:
. Age 65 of older
. Under age 64 with disabilities, who received
. Social Security Disability for 24 months
. Of all ages with End-Stage Renal Disease (permanent kidney failure)

Different Parts of Medicare

Part A (hospital)
Part B (medical)
Part C (Medicare Advantage Plans)
Part D (prescription drug coverage)

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