Avera Public Forum Issues: Medicare Prescription Drug Plans
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Medicare Prescription Drug Coverage
Starting January 1, 2006, Medicare will offer insurance coverage for prescription drugs through Medicare prescription drug plans and other health plan options. The new coverage, which is provided for a monthly premium, will typically pay over half of a person’s drug costs for a year. Every person with Medicare is eligible and has two choices:
- To join a plan that covers prescription drugs only and keep original Medicare; or
- To join a Medicare Advantage Plan or other Medicare Health Plan that covers doctor and hospital care as well as prescriptions.
To select a plan that works for you, a friend or family member, start by making note of any current drug coverage (including, if retired, information from a former employer or union about how they will work with Medicare), prescription drugs and preferences about pharmacies or additional coverage.
Important points you need to know:
- Medicare prescription drug coverage helps pay for the prescriptions you, your friend or family member needs.
- Medicare prescription drug coverage is available to all people with Medicare
- There is additional help for those who need it most.
- Medicare prescription drug coverage pays for brand name as well as generic drugs.
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How Much Will Medicare Pay?
For an average monthly premium of about $32, you get two levels of coverage: standard and catastrophic. After a $250 deductible, Medicare pays 75% of the cost of covered drugs until yearly costs reach $2,250. When yearly out-of-pocket prescription costs exceed $3,600 — which often happens in the event of serious health problems such as heart disease and cancer — catastrophic coverage takes effect, and Medicare pays up to 95% of drug charges for the rest of the year. Many plans will offer more coverage, smaller deductibles or premiums lower than $32. Most people with limited income and resources will pay only a few dollars for each prescription.
(from Centers for Medicaid & Medicare Services insert in Parade, September 25, 2005)
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Four Things to Consider
This fall, all persons who are Medicare eligible should have received the Medicare & You 2006 handbook in the mail. Consult this handbook for a listing of the Medicare prescription drug plans available locally. In addition, the Centers for Medicare & Medicaid Services suggest considering the following factors when making the choice:
Coverage – All plans will have to provide at least a standard level of coverage, which Medicare will set. Compare plans on how they meet needs for access to medically necessary prescription drugs, both generic and brand-name, at participating pharmacies in your area. The Centers for Medicare & Medicaid Services have tools available on-line to help beneficiaries compare plans, including a Prescription Drug Plan Finder and a Medicare Prescription Drug Plan Cost Estimator, available at www.medicare.gov. Continue to check the site for updates as the enrollment period draws closer. You can also call 1-800-MEDICARE (1-800-633-4227) to talk to a Medicare representative, 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
Cost – Costs will be different depending on the drug plan chosen. Compare plans based on monthly premium, deductibles or co-payments. Plans will also discount the price of the drugs they cover.
There is additional financial help for Medicare beneficiaries with limited incomes and assets. You may qualify for this extra help if your income is below $14,355 a year (or $19,245 if you are married and living with your spouse – and more if you have dependent children or grandchildren living with you), and if your assets are below $11,500 (or $23,000 if you are married). Your assets include things like bank accounts, stocks, bonds and life insurance policies. They do not include the house you live in, your cars and other personal possessions such as your furniture or jewelry. To learn if you, a friend or family member qualifies for extra help for low income, download an application from www.ssa.gov/pubs/10129.html or call 1-800-772-1213, TTY 1-800-325-0778.
Convenience – Where and how prescriptions are purchased will be important in making a choice. If prescriptions are purchased locally, learn which pharmacies in the neighborhood participate in the Medicare prescription drug program. Some plans offer prescriptions through the mail.
Peace of mind. Now and in the future – Prescription drugs may not be an issue for you, a friend or family member now, but it is still a good idea for those in good health to consider joining now. Part D plans are designed to reduce drug costs for most enrollees and protect against catastrophic drug expenses in the future.
Another reason for enrolling for 2006 is to avoid a financial penalty for late enrollment. Unless the person making the choice has drug coverage that is at least as good as what will be offered by Medicare drug plans (such as retiree health benefits from an employer), payment of a premium penalty may be required for signing up for a Medicare drug plan in a future year.
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Important Dates to Remember
October 2005 -Watch the mail for the Medicare & You 2006 handbook and information from insurance and other private companies about the prescription drug plans they offer.
November 15, 2005 - Enroll for a plan between now and December 31, 2005 for coverage that begins on January 1, 2006.
January 1, 2006 - Enroll for a plan between now and May 15, 2006 for coverage that begins the first day of the month after the month joined.
May 15, 2006 - Last day to join a plan without paying a higher premium later.
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You May Need to Know
- As of January 2006, if you have both Medicare and full Medicaid benefits, you will no longer receive drug coverage through Medicaid. Medicare will provide our prescription drug coverage instead of Medicaid. If you have Medicare and full Medicaid benefits and do not choose a plan by December 31, 2005, Medicare will enroll you in one. However, you will be able to change plans at any time.
- Medicare prescription drug plans are different from the Medicare-approved drug discount cards that were available in 2004 and 2005. You can use your Medicare-approved drug discount card until May 15, 2006, or until you join a Medicare prescription drug plan – whichever is first.
- If you have a Medigap (Medicare Supplement) policy with drug coverage, you will get a notice from your insurance company telling you whether or not your policy is as good as or better than Medicare prescription drug coverage. This notice will explain your rights and choices.
- If you have prescription drug coverage from an employer or union, your employer or union will notify you about whether your current drug coverage is as good as or better than Medicare prescription drug coverage. If it is, you can keep your current drug coverage, and if you decide to join a Medicare prescription drug plan later, your monthly premium will not be higher. If you drop your current drug coverage and join a Medicare prescription drug plan, you may not be able to get your employer or union drug coverage back.
- If you are in a nursing home, you may get your prescription drugs from a long-term care pharmacy that contracts with a Medicare prescription drug plan.
- Your Medicare prescription drug plan must notify you 60 days before taking one of your prescriptions off its list of covered drugs.
(from Centers for Medicare & Medicaid Services “Medicare & You”)
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Resources
Medicare Helpline -- For help choosing Part D prescription drug coverage, and for questions about Medicare: 1-800-MEDICARE (1-800-633-4227), TTY: 1-800-486-2048.
Social Security Administration – For help with questions about eligibility for enrolling in Medicare, Social Security retirement benefits, and disability benefits, and for questions about eligibility for help with costs of a Part D plan: 1-800-772-1213,
TTY 1-800-325-0778.
Your health plan’s customer service center – For questions about your existing health coverage, call the telephone number on your identification card.
Your state’s Medical Assistance or Medicaid office – For questions about your state’s Medicaid program, call your state’s Medical Assistance or Medicaid office. Offices in the Avera service region are listed here:
- Iowa 1-800-338-8366
- Minnesota 1-651-297-3933
- Nebraska 1-800-430-3244
- North Dakota 1-800-755-2604
- South Dakota 605-733-4678
Your state’s Health Insurance Assistance Program – For help with questions after buying insurance, choosing a health plan, buying a Medicare supplement policy, and your right an protections under Medicare, call your state’s Health Insurance Assistance Program office. Offices in the Avera service region are listed here:
- Iowa 1-800-351-4664
- Minnesota 1-800-333-2433
- Nebraska 1-800-234-7119
- North Dakota 1-800-247-0560
- South Dakota 1-800-536-8197
AARP Website
For information about Medicare and other programs for seniors: www.aarp.org.
Medicare Website
For help with choosing Part D. prescription drug coverage, and for questions about Medicare: www.Medicare.gov.
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