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Prescription Advantage

Prescription Advantage is a prescription drug insurance plan available to all Massachusetts residents age 65 and older, as well as to younger persons with disabilities who meet specific financial and employment criteria. Members pay premiums, deductibles, and co-payment amounts (up to an annual out of pocket limit), based on gross annual income. Prescription Advantage offer members most oral outpatient drugs (generics at the lowest co-payment, then progressively higher co-payments for brand name drugs), insulin, and disposable syringes with needles.

Persons who have no MassHealth medication coverage and (1) are 65 years of age or older; OR (2) are under 65, disabled, work no more than 40 hours a month, and have income of not more than 188% of the federal poverty level (in 2004, $1,408 for one; $1,872 for a couple; to be adjusted in April 2005).

Yes. Having a Medicare endorsed or other drug discount card does NOT disqualify an individual from Prescription Advantage. In fact, Prescription Advantage encourages those who qualify for the $600 low income assistance offered by the Medicare approved cards to apply for one of those cards.

If you are 65 or under, you may enroll in Prescription Advantage at any time. If you are 66 or older you may only enroll in Prescription Advantage during a designated open enrollment period (in 2004, the open enrollment period was the month of September), OR, within six months of the occurrence of one of the following circumstances: (1) you have recently moved to Massachusetts; (2) you have involuntarily lost health care coverage; or (3) you have recently become ineligible for Medicaid. You may obtain application forms and more information from SHINE counselors, at www.800ageinfo.com ,or by calling 1-800-243-4636.