Medicare Prescription Coverage is Changing: What You Need to Know!!

Starting in January of 2006, Medicare beneficiaries are entitled to a new prescription drug benefit. It is called Medicare Part D and it is new. Since Medicare is working with health care organizations and private companies to offer this benefit, the actual details for individual plans are greatly varied.

What Choices do I have?

Senior citizens will have to decide whether to enroll in Part D and select the policy that best meets their needs. Since health care organizations, such as Kaiser Permanente and private companies, such as Aetna are setting up the plans with Medicare, consumers will have lots of decisions to make. Some plans may use only certain pharmacies and others may cover only certain drugs. The costs are also going to vary significantly depending on which plan you choose. Therefore, it is important to pick one that meets your needs.

What steps do I have to take?

1. Making the right choice will require extensive research of your current prescription benefit to determine if it meets your needs for the rest of 2006. If it does, you can continue with this coverage until the next open enrollment for Medicare Part D which will be in November, 2006.
2. Even if you believe your current prescription coverage is adequate, by May 15, 2006 each Medicare recipient must decide between a stand-alone prescription drug plan or an integrated Medicare Advantage Prescription Drug Plan. A stand alone prescription drug plan may be offered by your current HMO's plan, and thus you may decide not to join a Medicare Part D plan and simply save yourself the monthly premiums which will be about $32.00 per month.
3. Be aware that different insurance plans cover different medications. You may you’re your providers’ drug lists (known as their formulary) by visiting either their web site or the cms.gov site. The federal government requires approved Medicare Part D providers to disclose their drug formularies to the public and are required to provide beneficiaries with a copy to view themselves. However, every therapeutic category of prescription drugs will be covered under the Medicare Part D prescription drug plans.
4. If you choose a Medicare Advantage Prescription Drug plan be aware that enrollment is voluntary, but there is a penalty, of 1% per month that you are late, if you decide to enroll in Part D after the May 15, 2006 cutoff.
5. Understand the costs. The Part D standard benefit design costs about $32 per month in premiums and has a $250 deductible which means that you have to pay for the first $250 worth of drugs that you buy.
6. Appreciate that for the next $2000 in drug costs, Medicare Part D will pay 75% of the drug cost and the patient will have to pay for the remaining 25%.
7. Be aware that if your drug expenses in a given year range from $2250 to $5100, the patient pays 100% of these costs. This is being called “the donut hole” because there is a gap in Medicare Part D coverage with some plans.
8. Understand that many insurers are offering $0 deductible plans and plans with low co-pays as well as plans that fill in the donut hole to some extent.
9. Know where to get more information from the government. You can call 1-800-MEDICARE (1-800-633-4227) You can also call the Elder Care Locator at 1-800-677-1116 or visit www.eldercare.gov. You can also contact the Social Security Administration at 1-800-772-1213 or www.ssa.gov/prescriptionhelp for people with limited incomes and resources.