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Medicare
Part D In
the past, Medicare never covered prescription drugs that were
purchased in the retail pharmacy, but now, effective January 1, 2006,
things are about to change. Beginning
November 15 through May 15, 2006, Medicare beneficiaries can sign up
for one of the many Medicare Part D prescription plans administered
through private insurance companies but regulated through Medicare
(similar to Medicare Supplemental Plans). If
you sign up after the deadline (May 15, 2006) then you may have to pay
a penalty of 1% of the average national premium for every month you
are not enrolled. In
addition, you would have to wait for the next Medicare Part D open
enrollment period, which is each November 15th through
December 31st. An
exception to this penalty is if you were switching from another plan
(i.e. group plan) that is considered credible (at least as good as
Medicare’s plan). Who
will be eligible for the Medicare 2006 Prescription Plan? An
individual must be a U.S. citizen or permanent legal resident for 5
continuous years AND meet one of the following criteria:
How
much will Medicare Part D cost me and what will it cover? The cost per month as well as the cost share of the prescriptions will vary from one plan to the next. The average premium for the standard plan is about $32 per month. This standard plan covers 75% of your drug costs up to a maximum of $2,000 per calendar year after a $250 deductible has been satisfied. After that, you pay up to $2,850 in additional drug cost yourself. Then Medicare pays 95% of any drug costs above that for the remainder of the calendar year. Costs will vary depending on which drug plan you choose. Some plans may offer more coverage and additional drugs for a higher monthly premium. If you have limited income and resources, and you qualify for extra help, you may not have to pay a premium or deductible. Are
the prescription drugs I take covered? Not all prescription drugs are covered. Most plans will have a “Formulary” or preferred list of drugs that the plan will cover. This list always meets Medicare’s requirements but may change as plans get new information. Your plan must let you know of any changes to the Formulary at least 60 days prior to any change. You should make sure that the plan you are interested in covers the particular drug you take. Is
my local Pharmacist covered by the plan? Drug plans must contract with pharmacies in your area. You should make sure the plan you’re interested in is contracted with the pharmacy you use. In addition, some plans allow you to obtain prescriptions through the mail as an added convenience. How
do the Medicare Part D plans differ from the Medicare Drug Discount
Card benefit? The Medicare approved “Drug Discount Card” that became available May 2004 provided a way for seniors to receive discounts on their prescriptions until the 2006 Medicare Prescription Drug Plans become available. Medicare Part D prescription drug plans will offer seniors traditional type prescription drug coverage. These plans work like other prescription insurance plans, where the enrollee will pay a monthly premium and a co-pay or co-insurance for each prescription they fill. Additional information can be found on http://www.medicare.gov/ |
