Like millions of other Medicare recipients, Jeff Taylor, 43, had todevise his own complicated combo to pay for HIV meds. Taylor’sfinancial regimen included AIDS drug assistance programs, his own cashand driving from his native Palm Springs, California, to Tijuana tosnag cheaper pills. Imagine his relief, then, when he heard aboutCongress’ new, supposedly simpler Medicare prescription plan, whichkicked in January 1, 2006. But relief turned to horror when he tried tounderstand it. The plan, called Medicare Part D, pays for meds throughhundreds of private drug plans. Plans vary by state, have differentpremiums and cover different drugs, requiring nightmarish research tofind one that fits your needs. For months, Taylor has spent up to threehours a day on the phone or Internet—and has yet to pinpoint hisout-of-pocket costs. Even benefits counselors remain baffled. “Thisplan is so confusing some think that it might have been better ifCongress hadn’t passed a bill at all,” says Jeffrey Crowley, an HIVexpert at Georgetown University’s Health Policy Institute. “But forsome people with HIV, it is an opportunity to get better coverage.”Here’s a primer.

Two-thirds of HIVers on Medicare are alsoeligible for Medicaid—and before January 1, Medicaid covered theirprescriptions. Now Medicare covers them instead. Those eligible forboth who didn’t pick one of Medicare’s many new private plans byJanuary 1 were randomly assigned one. “Dual eligibles are the sickestand poorest people with HIV who can’t afford to pay extra if they arerandomly assigned the wrong plan,” says Crowley. “People will fallthrough the cracks. Even if it’s a statistically small percentage, thatis thousands of people.” Peter Ashkenaz, a spokesperson for the Centerfor Medicare and Medicaid (CMS), says the government has takenprecautions to prevent this, but that any dual-eligible person unhappywith the new regimen can find help at his or her pharmacy. For theone-third of HIVers on Medicare who, like Taylor, aren’t dual-eligible,enrollment in the new prescription plan is optional. Their enrollmentdeadline is May 15—after which they’ll pay a penalty premium.

Noplan is permanent. Dual-eligibles can switch monthly andsingle-eligibles at least once a year. What’s more, all plans coverevery antiretroviral (though not necessarily meds for side effects).Can’t find a plan right for you? Crowley recommends dropping Look at overall cost, including copays and drugcoverage. Or visit an AIDS service organization or benefits counselor.Remember: Pick your plan—don’t let your plan pick you.  

Find more info at the following:

Centers for Medicare &
Medicaid Services


Gay Men’s Health Crisis Public Policy Department

Treatment Access Expansion Project