Prescription Drugs Resource Page
Medicare
Prescription Drug Coverage - Part D
|
Summary |
Timeline |
Important Terms |
Contact Information |
Further Resources |
FAQ |
Helpful Figures |
In 2003, Congress passed the
Medicare Prescription Drug Modernization Act. This legislation
provided for Medicare Part D to begin covering prescription drug
costs on January 1, 2006. Participation is voluntary for most
Medicare beneficiaries and enrollment will begin on November 15,
2005. Only beneficiaries who have both Medicare and
Medicaid (MassHealth) will be automatically enrolled in Medicare
Part D. The coverage will be run through private plans, which
participants choose according to their individual needs.
Coverage will vary by plan but each plan will cover at least 2
drugs in each therapeutic class. There is a monthly premium
that varies slightly between plans. The standard plan has a gap
in the coverage, referred to as the doughnut hole; beneficiaries
have to pay 100% of costs between $2,250 and $5,100.
Beneficiaries with limited income and resources can
qualify for extra help that can reduce or eliminate premiums,
deductibles and co-payments. They must return the application they will
receive to the Social Security Administration. Only dual-eligibles, SSI,
and those who receive help with Part B premiums will automatically
qualify and do not need to apply for help with Part D premiums.
Contact Information
Medicare
General Questions about Medicare and
the Extra help with Prescription Drug Costs
1-800-MEDICARE (1-800-633-4227)
www.medicare.gov
Social
Security
For assistance with or to request an
Extra Help for Prescription Drug Costs Application
1-800-772-1213,
www.ssa.gov
SHINE
Provides free health care information,
assistance and counseling to Medicare beneficiaries and can help
with choosing appropriate plan.
1-800-AGE-INFO (1-800-243-4636)
www.medicareoutreach.org
MassMedLine
Pharmacists on staff can answer
questions about medications and recommend a Medicare plan that best
meets a beneficiary’s needs.
1-866-633-1617,
www.massmedline.com
Prescription Advantage
State-administered prescription drug
coverage insurance
1-800-age-info,
www.1800ageinfo.com
Further Resources
Medicare: The Medicare Prescription Drug Benefit
The Henry J. Kaiser Family Foundation,
March 2005
Medicare Part D: A Summary
Open Minds Industry Resources Library, February 2004
The 2003 Medicare Modernization Act
Neighbor Care, 2005
AARP Healthcare Notes
American Association of Retired Persons, 2005
Important Terms
CMS
Centers for Medicare and Medicaid Services.
This is the federal bureau that administers Medicare.
SSA
Social Security Administration.
Social Security will be involved in determining which
beneficiaries are eligible for extra help with prescription drug
costs.
“Extra Help”
Reduced co-payments, premiums, and
deductibles for beneficiaries with limited incomes and
resources.
Low Income Subsidy
Same as “Extra Help”
Dual Eligibles
Beneficiaries on both Medicare and
Medicaid (MassHealth)
Timeline
| Date |
Event |
| May, 2005 |
Dual-eligibles will receive letters regarding the
extra help they will automatically receive with Medicare Part D. No
action needs to be taken. |
|
May 27, 2005 - August 16, 2005 |
Non Dual-eligibles will receive applications from
Social Security for extra help with prescription drug costs. These
applications should be filled back and returned quickly. |
| July 1, 2005 |
Extra-help eligibility determination period
begins. |
| October, 2005 |
Beneficiaries will receive the
Medicare & You 2006 handbook, listing available plans and
providing more information about Medicare Part D. Companies will
begin to market their drug coverage. |
| Mid-October, 2005 |
Dual-eligibles are notified by CMS about their
randomly assigned drug plan. If the beneficiary does not enroll in
another plan, he/she will be automatically enrolled in the plan they
were randomly assigned to. If dual-eligibles want to change their
plan, they can do so at any time. |
| November 15, 2005 |
Enrollment Period begins. Beneficiaries can now
begin to enroll in specific plans. |
| December 31, 2005 |
End of Medicaid drug coverage for dual-eligibles. |
| January 1, 2006 |
Part D Coverage begins for those who enrolled
between November 15-December 31 and for Dual Eligibles. |
| February, 2006 |
Beneficiaries who have not yet enrolled in a Part
D drug plan will receive a letter from CMS. |
| May 15, 2006 |
Initial Enrollment Period Ends. Beneficiaries may
still sign up for Part D coverage but will pay a surcharge after
this date. |
| Spring, 2006 |
CMS Sends letters to non-dual eligible
beneficiaries who qualify for extra help but have not enrolled in a
Part D plan, notifying them of their randomly assigned plan.
Beneficiaries do not have to take any action if they are happy with
their plan. If they want to change, they must do so by June 1. They
contact the specific company to enroll. |
Frequently Asked Questions
For More Answers, go to
www.medicare.gov
and click on “Frequently
Asked Questions”
How do I enroll in a
plan?
Starting November 15, you can contact the
company that is providing the plan and sign up through them.
What is the standard drug
benefit from Medicare Part D?
Medicare will pay 75% of costs up to $2,250; 0% of costs from
$2,250-$5,100; 95% of costs above $5,100.
See Figure 1
What are the rates and
premiums for Medicard Part D?
There is around a $37/month premium and $250 yearly deductible.
See Figure 2
What are the low
income/extra help plans?
See Figure 3
How do I know which plans
are available?
You will receive the Medicare & You
handbook in October which will list some plans. You will also
receive information in the mail from specific companies marketing
their plans. You can always go to
The Medicare Website
for updated information.
How should I go about
selecting my plan?
Compare prices, drug coverage, and
transition costs (the companies’ policy when they change drug
coverage). You may want to talk to your pharmacist or contact
SHINE or the
MassMedLine.
How often can I change my
plan?
You can only change your plan once a year.
The only exception is for dual-eligible beneficiaries who can change
plans at anytime.
Do I have to apply for
extra help if I have MassHealth, Medicare cost sharing (help paying for part
B premium), SSI?
No. If you have any of these programs, you
do not have to apply for extra help. However, if you have Medicare
cost sharing or SSI, you must still enroll in a plan. MassHealth
participants will be automatically enrolled in a program, but can
change their program if they are unsatisfied with it.
I just got a letter that
Medicare will being paying for my drugs instead of Medicaid. What do
I do?
Nothing for now. You will receive a letter
in October with the name of a plan chosen for you. If this plan best
meets your needs, you do not need to do anything and Medicare will
enroll you in that plan. If you want to select a different plan, you
must do so by December 31 for your coverage to begin January 1,
2005. You can change plans at any time.
I have MassHealth but no
Medicare. What is going to happen?
You will remain on MassHealth. Your
coverage will stay the same.
I have Prescription
Advantage. Should I sign up for Part D?
Yes, you should enroll in Part D.
Prescription Advantage may provide additional benefits.
What if I
already have prescription drug coverage from an employer or a union?
If your plan covers as much or more than a
Medicare prescription drug plan, you can:
a) Keep your current drug plan. You can later join Part D for no
additional surcharge.
b) Drop your current plan and join Part D. You may not be able to
get your current plan back.
If your plan
covers less than the Medicare prescription drug plan, you can:
a) Keep your current plan and join Medicare for more complete drug
coverage
b) Keep your current plan. You will be charged an additional
surcharge if you decide to enroll in Part D later.
c) Drop your current plan and join Part D. You may not be able to
get your current plan back.
What drugs are covered?
Coverage will vary by plan but each plan
must cover at least 2 drugs in each therapeutic class. Plans also
have to contain a majority of drugs within six classes (antiretrovirals,
antidepressants, antipsychotics, anticonvulsants, immunosuppressants,
and antineoplastics–cancer drugs)
What
drugs are not covered?
- Over
the Counter drugs
- Weight gain and loss drugs
- Fertility drugs
- Cosmetic Drugs
- Cough and Cold relief drugs
- Vitamins and Minerals (except prenatal vitamins and fluoride)
- Outpatient drugs for which associated monitoring must be purchased
exclusively from manufacturer
- Barbituates and Benzodiazepines
Helpful Figures
Reprinted with
Permission from the Kaiser Family Foundation
|
Standard Drug Benefit
|
Premiums and Cost-Sharing |
Extra-Help/Low Income Plans |
Figure 1 illustrates the amount of money that will
be paid by the beneficiary (in black) versus the amount that
Medicare will cover (in white).
Figure 2 shows the costs of participation
in the standard Medicare Part D program.
Figure 3 shows the levels of extra help
(low-income subsidies) for which beneficiaries can qualify.
|
