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Mrs. Jones contacted HICAP because she was having difficulty getting her heart medication. She was on a Part D plan that covered her medications in February, but the 20% cost for her medical care was too expensive. An agent told Mrs. Jones that she could join an HMO plan that did not have a premium and cost $0 to see a Primary Care Physician. She wanted to keep her prescription drug plan, because it covered all her medications, and the agent told her it wouldn't be a problem. If she joined the HMO "Only" Plan, the one without drug coverage, she could keep her Part D plan the way it was. Unfortunately Mrs. Jones received wrong information.
Mrs. Jones enrolled in the HMO "Only" Plan, under the advisement of the agent. However, this enrollment, kicked her out of her Part D plan for April. When she discovered the truth and what she should have done, it was too late. Now Mrs. Jones was without her heart medication and very stressed about how she was going to pay for her life sustaining medication.
Dianne Marcil, Registered HICAP Counselor, spoke with Mrs. Jones to find out how she could help. After talking to her, Dianne discovered that Mrs. Jones is eligible for the Extra Help for prescription costs because she is low income. Fortunately, Medicare has developed a "safety net" so that individuals who run into situations where they find themselves without prescription drug coverage, can still get their life sustaining medications.
Dianne explained the Low Income Newly Eligible Transition (LI-NET) Program and advised her that the pharmacy can bill LI-NET so she wouldn't have to pay for her medications out-of-pocket. All Mrs. Jones needed to do was to take her letters to her pharmacy and show them that she is eligible for the LIS program. The pharmacy, in turn, is supposed to know to process her prescription through the Li-Net system, a system that Medicare set up for just such a situation.
The client went to the pharmacy and did what she was instructed, however, the pharmacy technician had no idea what to do. The client was able to call HICAP (she had her trusty cell phone with her!) and Dianne was able to talk directly to the technician. In addition to educating this pharmacy about the LI-NET program, HICAP was able to give the technician the special Medicare "pharmacy dedicated" toll-free number. This number allows pharmacies to call and verify a beneficiary's eligibility and verify the process of billing for, and dispensing the prescription.
Mrs. Jones was able to get her heart medications the same day. The technician herself called HICAP to let us know that it was taken care of and processed per Medicare instructions.