For Residents of Puerto Rico and the U.S. Virgin Islands
By: Source: AARP Bulletin Date Posted: 2005-11-15 10:22:00-05:00
For Residents of Puerto Rico and the U.S. Virgin Islands
All Medicare beneficiaries have the option to choose prescription drug coverage as part of their Medicare benefit choices for 2006. Those with limited incomes could also be eligible for Extra Help to cover premiums, deductibles, and copays. In Puerto Rico, the U.S. Virgin Islands, and other U.S. territories, however, the options and eligibility requirements for Extra Help are different from those for beneficiaries living on the U.S. mainland. Only those differences for Extra Help are outlined below.
Puerto Rico
In Puerto Rico, Medicare beneficiaries must also be certified as eligible for Reforma, the government's medical assistance program, to receive Extra Help through Medicare Platino, Puerto Rico's newly created plan. To be certified, individuals must have a monthly income of $800 or less. If they earn $400 or less, all their health care costs are covered, including premiums, deductibles, and copays for Medicare Part D. Those with incomes from $401 to $800 will have prescription drug copays ranging from $0 to $5, based on income. At least 500 prescription drugs are covered by Medicare Platino, and participants may select any Puerto Rico government-contracted Medicare Advantage Organization on the island for medical services and drug coverage. These plans must offer coverage that will always be the same or better than the government's Reforma health plan.
To find out whether you qualify for financial assistance through Medicare Platino, call 787-294-8060 or toll-free 866-596-4747.
U.S. Virgin Islands
In the U.S. Virgin Islands, Medicare beneficiaries with limited incomes have two options if they participate in Medicare Part D. Both options are voluntary:
1. Individuals eligible for both Medicare and Medicaid pay no premiums, deductibles, or copays for the prescription drug plan they choose. (The Virgin Islands will offer a variety of plans.) Annual income limits to qualify for Medicaid are $5,500 for singles, $6,500 for couples, and $8,500 for a family of four. Participants must verify their income eligibility by visiting their local Medical Assistance Program office. For more information, call 340-774-4624 in St. Thomas or 340-773-1311 in St. Croix.
2. Medicare beneficiaries who do not qualify for Medicaid are still eligible for assistance if they meet the following annual income limits: $18,000 for singles or $30,000 for couples. Once eligibility is established, beneficiaries could receive up to $700 per year to help pay for premiums, copays, and deductibles that the selected prescription drug plan does not cover.
Additional financial assistance is available for limited-income Medicare beneficiaries with chronic or catastrophic illnesses, such as diabetes or cancer. These individuals could receive up to $3,986 to help pay their out-of-pocket expenses (including the premium, deductible, copay and to cover the "doughnut hole" for the Medicare prescription drug coverage plan they choose. To find out whether you are eligible, call the Department of Human Services Pharmaceutical Assistance Program at 340-774-5265 ext. 2 in St. Thomas/St. John and 340-773-2323 ext. 2023 in St. Croix.
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