Medicare: New Changes on the Horizon - What Will They Mean For You?

MEDICARE –  the national health care program for Americans 65 and older and younger people who qualify because of a mental or physical disability – is about to undergo the most dramatic change in its 40-year history.

Whether you’re a mental health consumer, patient, caregiver or advocate, you need to know about these changes.

The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) aims to make many improvements to Medicare.  Most importantly, all 42 million Medicare beneficiaries will have prescription drug coverage for the very first time.  And the new coverage has important implications, especially for those people eligible for both Medicare and Medicaid.

Note: Dual eligibles are persons who are entitled to Medicare Part A and/or Part B and who are eligible for Medicaid.

These 6.3 million dually eligible people– almost 40 percent of whom have serious mental illness or cognitive impairments – will receive their prescription medication through Medicare rather than Medicaid starting January 1, 2006. 

The prescription drug coverage is for everyone in Medicare, regardless of their income or how they their Medicare.  The Centers for Medicare and Medicaid (CMS) – which oversees the program – is committed to a safe transition for people with Medicare and Medicaid. 

CMS has also established certain safeguards for people with mental illness and for people with Medicare and Medicaid.  For example, Medicare requires prescription drug plans to include at last two medications within each class of drug.  However, CMS has designated six classes of drugs labeled “of special interest” and three of these include medications used most frequently by people with mental illness:  antidepressants, antipsychotics and anticonvulsants.  In thee drug categories; plans are required to offer virtually all available medications.

The following information is designed to help you understand the key changes ahead; educate you about the new prescription drug plan; important dates; where to go for help and available resources.