|
Medicare Part D: Top 10 Things to Know About Prescription Coverage.
The Medicare Prescription Drug, Improvement and Modernization Act of
2003 establish a new Medicare Part D program for prescription drug
coverage. Beginning January 1, 2006, Medicaid recipients who are
eligible for Medicare will receive prescription drugs under Medicare
instead of Medicaid.
This provision, as well as other Medicare changes,
will affect many individuals and families that apply for or participate
in our programs. You may get questions about these Medicare changes in
the coming months.
These are the 10 things you need to know.
- Open to all people with Medicare
- Pay to participate
- Safety net and peace of mind
- Discounted prices
- Choices in plans
- Two kinds of plans
- Enroll late, pay more
- Choose drugs from a formulary
- No free drugs
- Extra help for people who need it
1. Open to all people with Medicare
Part D plans are open to everyone who's eligible for Medicare in the
U.S. and U.S. territories. Generally, that means people who are 65
years old or older, and some younger people with certain disabilities.
You cannot be denied coverage for health reasons. You get to decide if
you want to enroll or not. If you have Medicaid, you will be enrolled
automatically if you have not selected a plan by 2006, so there is no
lapse in your Medicaid prescription drug coverage. The first enrollment
period starts November 15, 2005, for coverage beginning January 1,
2006. There will be annual enrollment periods from then on. If you
decide to join later, your monthly premiums may be higher because
there's an additional fee for late enrollment.
2. Pay to participate
Participation has a cost and you will pay a portion. Typically, the
government pays about 75 percent of the enrollment costs of the plan.
You pay the rest.
3. Safety net and peace of mind
All the Medicare Part D plans are private insurance plans. Most
participants will pay monthly premiums. That premium buys you the peace
of mind of knowing that if your drug costs become very high, you will
be protected.
4. Discounted prices
If you join a Medicare Part D plan, and use its network pharmacies,
you'll have access to discounted prices. Plans will negotiate lower
prices with drug companies and pass those savings along to you. So when
you pay for drugs within the plan, you'll have access to discounted
prices even when you are responsible for 100 percent of the payment.
5. Choices in plans
You'll have choices in plans. All Medicare Part D plans will be run by
private companies. Companies will release details of their plans after
October 1, 2005. Although all plans must meet the government's
requirements, there will be differences between plans, including what
drugs are covered and what pharmacies you can use. Some plans may offer
mail-order service. You will want to see which one is best for you.
You'll be able to change plans once a year.
6. Two kinds of plans
Plans will come in two basic types. The most simple is a prescription
drug plan (sometimes called a PDP), which covers only drugs and can be
used with your traditional Medicare and/or a Medicare supplement plan.
The other type combines a prescription drug plan with a Medicare
Advantage plan that includes medical coverage for doctor visits and
hospital expenses. This kind of plan is called Medicare Advantage plus
Prescription Drug, or MA-PD.
7. Enroll late, pay more
Enrollment for Medicare Part D benefits begins November 15. Just like
other types of insurance plans,
the longer you wait, the higher your premium may be. If you are
eligible, and don't sign up during the initial enrollment period, which
ends on May 15, 2006, you may pay more if you sign up later. The late
enrollment fee is approximately one percent of your premium for each
month you delay, and you'll pay it for as long as you stay in a
Medicare Part D plan. If you're late because you were participating in
a qualified prescription drug plan, such as a plan from your former
employer, the fees may not apply to you.
8. Choose drugs from a formulary
Each Part D drug plan will have a government-approved list of drugs it
covers -- called a formulary, or a preferred-drug list. The formulary
may vary from plan to plan, but you and your doctor will have choices.
Before you choose a plan, you'll probably want to compare plan
formularies to see which one fits your needs best.
9. No free drugs
Don't expect free drugs. For each prescription, you'll pay a portion of
the cost. The plan will help you with some of the costs. How much you
pay and how much the plan pays varies.
10. Extra help for people who need it
People with lower incomes get extra help through Medicare Part D.
Premiums may be reduced or eliminated, and other payments may be less.
Information excerpted from Introduction to Part D: Medicare's New Prescription Drug Coverage. |
