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Prescription Advantage is the Massachusetts state pharmaceutical assistance program (SPAP), which is overseen by the Commonwealth of Massachusetts Executive Office of Elder Affairs. It is one of the most comprehensive SPAPs in that the program provides financial assistance to both Medicare and non-Medicare qualified individuals.
Individuals who are eligible for Medicare must enroll or be enrolled in a Medicare Part D plan. When filling a prescription, Medicare is the first payer, and costs not covered by Medicare are then eligible to be paid for by the Prescription Advantage program.
For persons ineligible for Medicare, the program helps with prescription costs directly, requiring only small deductibles or co-payments from the program participant.
There is also an annual maximum out-of-pocket spending amount set for individuals enrolled in this program, regardless of whether they are Medicare eligible or not.
To be eligible for this program, the state of Massachusetts considers the following factors. Note that there are interdependencies between some of these requirements.
Residency - applicants must be a Massachusetts state resident.
Age - applicants must be 65 years of age or if they are under 65, they must be blind or disabled as certified by the state.
Income - applicants are permitted annual income of up to 500% of the federal poverty limit. As of 2017, single applicants can have income up to $60,300 and married applicants up to $81,200. Note that this is maximum income limit and benefits increase for persons of lower annual incomes.
Medicaid Dependency - to be eligible, one cannot also be eligible and receiving assistance from Massachusetts Medicaid (MassHealth).
Worth mentioning is that assets are not an eligible factor, nor is the applicant's health or veteran status.
The Prescription Advantage program provides different benefits depending if the enrolled individual is or is not on Medicare. For those individuals on Medicare, Prescription Advantage will help them with the cost of their Part D drug coverage. For those individuals who are not enrolled in Medicare, the program will pay for their prescription medications provided they have reached their individual out-of-pocket spending limit. The out-of-pocket limits vary depending on their income level.
The Prescription Advantage program does not have application or enrollment fees.
To gather more information about this program or to receive an application, one can visit the Prescription Advantage website, go to their local Mass Area Agency on Aging or call the toll free number at (800) 243-4636.