Medicare Drug Benefits
Medicare Prescription Drug coverage is coming…and you will have decisions to make. Because there are so many factors to consider, we are not recommending any particular decision. Instead, we encourage all patients with Medicare to make a careful evaluation of their choices. We hope the information below will be helpful.
- What is the Medicare prescription drug benefit?
- Who is eligible for Medicare prescription drug benefits?
- Do I have to do anything?
- When do I have to act?
- When would my benefits start?
- What exactly do I have to do?
- But I already have a plan that covers prescription drugs – what do I do?
- I don't use any prescription drugs. Why should I sign up?
- Tips for making the decision
- Resources to help you sort this out
What is the Medicare prescription drug benefit?
A new law expands Medicare benefits to include some coverage for prescription drugs.
This coverage will be made available as “insurance” and will be provided by various health plans. There will therefore be a monthly premium cost that you will pay for the prescription drug coverage. Some additional help is offered for those with very low incomes.
The benefits/coverage for prescription drugs will vary, depending on the type of Medicare prescription drug plan you choose.
Most people will save money on prescription drugs by joining a plan and should give this option careful consideration.
Who is eligible for Medicare prescription drug benefits?
Everyone who receives Medicare benefits – both Part A and Part B – is eligible to sign up for a plan and receive Medicare prescription drug coverage. There is no income restriction and no physical exams are required.
However, you will NOT be automatically enrolled in the plan.
Do I have to do anything?
If you already have a plan that includes a drug benefit, and your drug benefits are as good as – or better than - the benefits provided by Medicare Part D, then you don’t have to do anything.
However, if you don’t have this benefit, you must act if you wish to receive Medicare prescription drug benefits. You must choose a plan that is right for you and sign up for that plan.
When do I have to act?
Between November 15, 2005 and May 15, 2006
The initial enrollment period for Medicare prescription drug benefits begins November 15, 2005 and extends through May 15, 2006. It is important to act before May 15, 2006.
After May 15, 2006, you can sign up for a plan in future years, but you will pay more for the same amount of coverage.
When would my benefits start?
If you sign up before December 31, 2005, you will be covered beginning January 1, 2006.
If you sign up after December 31, 2005, but before May 15, 2006, your coverage would on the first day of the following month.
- Sign up between November 15 2005 - December 31, 2005, your benefits start January 1, 2006
- Sign up after December 31, 2005, your benefits start on the first day of the month following enrollment
For example: If you sign up April 2, 2006, your benefits would start May 1, 2006
What exactly do I have to do?
- Evaluate the options available for you (see resources below, to help)
- Decide if you want to keep current coverage, or sign up for a new plan
- Select a plan that is right for you
- Complete the application for that plan
But I already have a plan that covers prescription drugs – what do I do?
- If you are currently enrolled in a Medicare HMO plan:
Your HMO will automatically enroll you in its new prescription drug benefit program. You should be receiving information about this new benefit from your HMO. You should evaluate the costs and benefits of the coverage they offer against the new Medicare options.
If you have not received information from your health plan, you should contact them to ask for the comparison.
- If you currently have a Medicare supplement plan:
You have two options: You can purchase a drug prescription plan to have in addition to your current supplement plan. Or you may consider switching to a Medicare Advantage plan that includes a prescription benefit.
- If you have a retirement health benefit plan through your union or former employer:
You may already have a prescription drug benefit that is better than the new Medicare prescription drug benefits. In that case, you will want to stay with your existing plan. Your plan should be sending you information that provides a comparison of your current benefits with the new Medicare plans.
If you have not received information from your current plan, you should contact them and ask for the comparison.
I don't use any prescription drugs. Why should I sign up?
While you may not use prescription drugs now, there could come a day when you need an expensive prescription. Getting the coverage now will provide you with protection for the future. It will cost you more to sign up at a later date.
Tips for making the decision
Below are some things you can do to prepare yourself to make the best decision about Medicare prescription drug benefits.
- Make a list of all your current prescription medications, including brand names and doses.
- Estimate what you spend now, per year, paying for your prescription drugs.
- If you have prescription drug coverage now, via an employer-provided plan or a Medicare Advantage or supplement plan, write down what type of coverage you have – co pays, deductibles and premium cost.
- Save the printed material you should have received from your health plan, showing how your current coverage compares with the options available in Medicare D.
- Use the information you have gathered above as you visit the resource sites to learn what type of plan will be best for you.
- Even if you don’t need prescription drug coverage now, consider that you are likely to need some prescription drugs in the future.
Resources to help you sort this out
Provides information regarding available plans, the drugs on their formulary lists, and calculators to help you determine which plan is right for you.
- 1-800-MEDICARE (Open 24 hours per day, 7 days per week)
SOCIAL SECURITY OFFICE
Contact Social Security to learn about the financial assistance available to lower-income beneficiaries. This assistance helps to pay for co-payments, deductibles and premiums.
HICAP is a non-governmental agency that offers one-on-one counseling to determine the options that best meet your needs and how to enroll.