CHICAGO – Because of changes in the federal Medicare prescription drug program, in just more than a month seniors across the state will have to choose from nearly 20 different prescription drug plans. But, the choice for Illinois seniors and persons with disabilities will be clear. Gov. Rod R. Blagojevich today announced that the State of Illinois is partnering with two prescription drug plans, UnitedHealth Group and PacifiCare, to coordinate the new Illinois Cares Rx prescription drug program. Illinois Cares Rx will fill in the gaps created by the new Medicare Part D program. The Governor also announced the second wave of outreach events for his Illinois Cares Rx Caravan to inform seniors and persons with disabilities about upcoming changes to Medicare and updates to the state prescription drug program.
“We want to make sure that no senior or person with disabilities falls through the cracks when the federal prescription drug program starts this January,” said Gov. Rod R. Blagojevich. “Today we announced a partnership with two comprehensive plans that will offer great benefits for Illinois Cares Rx, so Illinoisans won’t experience the gap in coverage and pay the high out-of-pockets costs that will result from the federal program.”
This month the federal government announced the 17 Medicare Prescription Drug Plans that will compete for enrollees in Illinois, many offering multiple plans. The marketing for these plans is set to begin in October. In order to ensure that the combined Illinois Cares Rx and Medicare benefits were administered in a manner that required no extra steps for beneficiaries and pharmacies, the Department of Healthcare and Family (HFS) invited companies sponsoring the Medicare drug benefit to submit proposals for seamlessly coordinating the two benefits. UnitedHealth Group and PacifiCare both submitted proposals that met the needs of HFS and Illinois seniors.
“We recognize that affordable access to prescription drugs is one of the most significant health challenges for seniors today,” said Lois Quam, Chief Executive Officer of Ovations, the UnitedHealth Group business that serves seniors. “This program is a significant step forward in meeting that challenge. No senior should have to choose between buying prescription drugs and meeting their basic living needs.”
“We are extremely excited about this new public-private partnership opportunity to provide Illinois Medicare beneficiaries with comprehensive, quality prescription drug coverage,” said Jacqueline Kosecoff, Ph.D., PacifiCare’s executive vice president. “With more than 20 years’ experience delivering affordable, quality health care coverage to America’s seniors, PacifiCare looks forward to offering Medicare beneficiaries in Illinois the kind of flexible and comprehensive prescription drug benefits they have been asking for.”
The Governor also announced that the Illinois Cares Rx Caravan would continue to travel statewide making an additional 130 stops to inform seniors and persons with disabilities about upcoming changes to Medicare and updates to the state prescription drug programs. A wide variety of organizations, elected officials, state agencies, areas agencies on aging, senior centers and municipalities will participate in the events to offer area residents one-on-one assistance to educate them about what the plans have to offer and clear up any concerns or confusion about the upcoming changes to Medicare.
In June 2005, Gov. Blagojevich signed the “No Senior or Person with Disability Left Behind” law, which created the Illinois Cares Rx program, the nation’s most comprehensive response to fill in the gaps created by the federal prescription drug program that begins January 1, 2006.
The first wave of Governor Blagojevich’s Illinois Cares Rx Caravan reached over 2,500 people in 19 cities. The second wave of the Caravan is scheduled to travel to 130 communities across the state including: Addison, Alton, Aurora, Belleville, Belvidere, Canton, Carbondale, Centralia, Charleston, Chicago, Coal City, Collinsville, Columbia, Edwardsville, Elgin, Evanston, Evergreen Park, Forest Park, Fox Lake, Granite City, Greenville, Gurnee, Hanover Park, Harrisburg, Hillside, Huntley, Jacksonville, Joliet, Kankakee, Kewanee, Lake Villa, Lawrenceville, Lincolnshire, Lincolnwood, Macomb, Maywood, Mokena, Morris, Morton Grove, Mt. Carmel, Morton, Naperville, Niles, Northfield, Oak Lawn, Oak Park, Oregon, Orland Park, Oswego, Ottawa, Palatine, Park City, Paris, Pekin, Peoria, Peru, Plainfield, Red Bud, Riverwoods, Schaumburg, Sherman, Shorewood, Skokie, Springfield, Sterling, Sycamore, Tinley Park, Toledo, Vienna, Waukegan, Westmont, Wheaton, Woodstock, and Yorkville. More information on the events will be announced as it becomes available.
“The Illinois Cares Rx Caravan has been a huge success, reaching hundreds of thousands of Illinoisans, but there is more to be done to prepare for the changes ahead,” said Gov. Blagojevich. “Over the next several months Medicare recipients will receive a ton of information and some misinformation too, so we want to make sure they have a reliable source through this caravan to get personal assistance in their community and help them navigate the program.”
The nearly 250,000 SeniorCare and Circuit Breaker beneficiaries in Illinois will be automatically enrolled in Illinois Cares Rx and randomly assigned to one of the two coordinating companies’ Medicare plans with the option to switch plans before January. Advocates for seniors and many healthcare professionals feared that the large number of plans would cause widespread confusion among seniors. By narrowing it down to two comprehensive plans and automatically assigning seniors to them, HFS hopes to reassure beneficiaries that with Illinois Cares Rx they will see no disruption in coverage come January. The Governor’s goal is to provide a safety net for seniors and persons with disabilities when their out-of-pocket costs for prescription drugs go up under the federal program.
The federal Medicare Modernization Act helps seniors by paying 75 percent of prescription drug costs up to $2,250 after a $250 deductible with an average $32 per month premium. Beneficiaries are responsible for all of their costs between $2,250 and $5,100, with the plan paying 95 percent of costs beyond that top threshold. The gap where a beneficiary has to pay all the drug costs between $2,250 and $5,100 is commonly referred to as the “donut hole.”
The new “wrap around coverage” provided to Illinois seniors and persons with disabilities through Illinois Cares Rx will help cover the increased costs of the Medicare program, including premium costs, coinsurance, coverage during the “donut,” and the deductible.
For example, a senior whose income is around $19,900 for a family of two (160 percent of the federal poverty level) who has annual drug costs of $5,100 would have to spend over $4,000 in out of pocket costs if the new Illinois program did not exist, but less than $1,000 with the new Illinois program. A senior who has $1,800 worth of drug spending would spend $120 on average in the new Illinois program but over $1,000 in Medicare if they did not receive assistance.
Illinois Cares Rx will cover those who were previously enrolled in either the SeniorCare drug program or the Circuit Breaker pharmaceutical assistance program. Through this program, Gov. Blagojevich is ensuring that both groups will receive similar coverage to what they previously received. In addition, those who are not eligible for Medicare will have their current SeniorCare or Circuit Breaker pharmaceutical benefits maintained in the Illinois Cares Rx program. The Illinois Cares Rx program will be administered by HFS and the Illinois Department on Aging.
As many as one-quarter of the 20.3 million seniors in the United States who will be using the federal benefits without low-income assistance are expected to have drug costs high enough to bump them into that coverage gap. Since taking office, Gov. Blagojevich has been a proven leader when it comes to providing access to quality health care for Illinois families from young children to senior citizens, in stark contrast to methods taken by several other states such as Michigan and North Carolina. Both states are eliminating their state prescription drug programs and transferring people completely to the Medicare drug program, which will significantly increase their out-of-pocket expenses.
The Illinois Cares Rx program is part of Gov. Blagojevich’s long standing effort to make sure that more people get more health care and better benefits, protect coverage for those who have health care, and help hospitals, doctors and nurses provide better health care. Under the Blagojevich administration, Illinoisans benefit from a wide array of programs designed to assist them with the high cost of prescription drugs: SeniorCare, Circuit Breaker (soon to be Illinois Cares Rx), the Rx Buying Club and the I-SaveRx drug importation program.
Illinois seniors and persons with disabilities who want to find out more about the Illinois Cares Rx program law should call the Department on Aging Help Line at 1-800-252-8966 or the Senior Health Insurance Program at 1-800-548-9034.
UnitedHealth Group is a diversified health and well-being company dedicated to making health care work better. Headquartered in Minneapolis, Minn., UnitedHealth Group offers a broad spectrum of products and services through six operating businesses: UnitedHealthcare, Ovations, AmeriChoice, Uniprise, Specialized Care Services and Ingenix. Through its family of businesses, UnitedHealth Group serves more than 55 million individuals nationwide. The company’s Medicare Prescription Drug Plans are underwritten by United HealthCare Insurance Company and its affiliates.
PacifiCare Health Systems:
PacifiCare Health Systems is one of the nation's largest consumer health organizations with nearly 3.3 million health plan members and approximately 11.3 million specialty plan members nationwide. PacifiCare offers individuals, employers and Medicare beneficiaries a variety of consumer-driven health care and life insurance products. Today, PacifiCare is the nation’s second-largest senior health insurance company with more than 20 years’ experience delivering affordable, quality health care coverage to America’s seniors. PacifiCare’s specialty plan operations include behavioral health and dental and vision, as well as complete pharmacy benefit management with more than a decade of experience specializing in the senior prescription-drug market. More information on PacifiCare Health Systems is available at www.pacificare.com