Medicare Benefits for Indigent Extended, but Viagra Eliminated

October 30th 2005

I was asked a couple questions from my readers and I would like to share them with you here.  I have purposely picked these two questions from my over flowing mailbag. Remember, I always condense questions and your anonymity is guaranteed.
 

Q.: Dan, my mother has some type of program that pays her Medicare premium. I have heard that she will now have to pay this Medicare premium even with her income less than $1,000.00 per month. I have read that because of this she will not qualify for the new prescription drug law. Why so late in the game does this happen? I have called every one that I think of, but I cannot get an answer of what to do?

Q.: Dan, I am on Medicare and Medicaid. I am under age 65, but I do get Medicare, because I am disabled and have advanced diabetes, among other medical conditions. I keep reading about Viagra and I am not sure if the new Medicare law will cover this drug or not. Can I still get from Medicaid?

A:

Last Wednesday, Congress agreed to agree on HR 3971, which addressed both of these issues. The compromise bill was passed by voice vote with some modifications, which do not have anything to do with the readers’ questions.

But the first question concerns some 200,000 indigent Medicare beneficiaries in regard to their monthly Part B premium, $78.20 per month, which will soon to be a minimum of $88.50 per month. The person that qualifies for the federal/state benefit is referred to as a Qualifying Individual; hence, the acronym QI. A QI must have an income of between $1,097 and $1,464 per month and pass a state asset limitation. And, yes, QI beneficiaries do qualify for the new Part D benefit with a full government subsidy - no premium, deductible and no gap in coverage. A QI will pay no more than $2. to $5. per prescription.

So, why the confusion?

Well, Congress took a 10-day break on October 7th, some seven days after the QI plan expired. I know that you may find this difficult to believe, but everyone in Washington D.C., the administration, Congress and even the Center for Medicare and Medicaid Services (CMS) – forgot these 200,000 people. Finally, after request from the states of New York, Florida, Iowa and Nevada wanting to know something from the CMS, what is the process of terminating QI benefits?

The program has been extended to September 30, 2007. It still needs the president’s signature, but he will sign it.

The answer to the second question also passed as part of the awakening of Congress on October19th.

All erectile dysfunction (Ed) drugs have been effectively eliminated.

Think about it – we no longer see the bombardment of ED advertisements. That is because a friend of the pharmaceutical industry, Senator Charles “Chuck” Grassley (R-Iowa), Chairman of the Finance Committee, allowed us all to know, as far back as the beginning of this year – they would go! And they are, indeed gone. They will not be part of Part D, although some plans may include them, of course, for an additional premium.

The second questioner also must understand that, as of this December 31st, he will no longer have Medicaid. From what I can gather from my brief reading of this legislative proposal is: No ED in Part D, after December 31st, no ED in Medicaid, However, I have deciphered something about ED coverage by Medicare until January 1, 2007. I am not quite sure what this means. However check with your treating physician.

By Dan Rohan
Dan’s columns are currently published in a number of states, with a heavy concentration in central Florida. Dan is published somewhere 5 days per week; his column is published as “Senior Advocate” and syndicated as “Senior Focus.”  Contact Dan
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Keywords and misspellings:  Medicare Medecare Medicair Medicaire plan d