General
Information:
Between
now and January 1, 2006, seniors in South Dakota will be reviewing
the new Medicare Part D prescription drug program in order to
decide whether or not to sign up and if so, for which plan. Beneficiaries
have already received an overwhelming amount of information from
insurance companies that will provide the Part D benefit, as well
as from the federal government and other organizations. In order
to access the drug benefit, seniors must select either a Preferred
Provider Organization (PPO) or a prescription drug plan (PDP)
to receive drug coverage under the program. Each plan will be
different and will not necessarily cover the same drugs. Some
of the plans may even force beneficiaries to choose a new physician
if their current doctor is not covered under their particular
benefit plan.
The
initial enrolment period ends May 15, 2006. There are penalties
for failing to enroll in a plan right away. If you fail to sign
up for the Medicare benefit before that date, you will face a
penalty of at least 12% of the cost of your premium for every
year you waited. For example, if you wait three years, you would
pay almost 40% more for the same benefit. Furthermore, if you
are unhappy with the plan you choose, you may only switch plans
during a yearly open period to avoid a penalty. For these reasons,
Tim encourages seniors to carefully choose a plan that best fits
their needs and lifestyle. For some seniors, it may be better
to not sign up for the program at all.
While
Tim did not support final passage of the legislation that created
this program because of several concerns he has about how it will
impact South Dakotans, he still believes that it is important
for seniors to examine this program closely and decide for themselves
whether or not the new Medicare Part D drug benefit will be worthwhile
to them. Tim is diligently working to ensure that all South Dakotans
have sufficient information before they are expected to make a
decision.
Tim
has posted several weblinks and documents on his website about
the different plans offered in South Dakota. There is much more
to be said and to learn about this new program, and Tim will continue
to communicate with all South Dakotans in the coming months about
the program.
Return
to Top
For
more information on Medicare Part D:
If
you have questions, please contact Senator Johnson's office by
email, or
call Senator Johnson's toll-free number at 1-800-537-0025.
Click
here to read more about health related topics.
In
addition, the following resources may be helpful:
Medicare
Information Hotlines:
1-800-633-4227
1-877-486-2048
Medicare.gov
www.medicare.gov
Medicare
Part D information from the Social Security Administration
http://www.ssa.gov/prescriptionhelp/
South
Dakota Senior Health Information and Insurance Education (SHIINE)
http://www.state.sd.us/social/ASA/SHIINE/
1-800-536-8197
Assistance
for people of limited income and resources:
The
Centers for Medicare & Medicaid Services (CMS), the Administration
on Aging (AoA) and the National Council on the Aging (NCOA) recently
developed a new web-based service that will help Medicare beneficiaries
of limited income and resources gain access to the extra help
available to them through the Medicare Modernization Act of 2003.
The service, which will also help you enroll in other health care
and prescription drug assistance programs, is available at the
following address: http://www.BenefitsCheckUp.org/rx
Return
to Top
Approved
Providers in South Dakota:
In
September 2005, Centers
for Medicare and Medicaid Services (CMS) within the
U.S. Department of Health and Human Services (HHS) released
the names of approved providers in South Dakota that Medicare
beneficiaries will be able to seek service from.
Medicare
will be offering the new prescription drug benefit through two
types of programs. Each beneficiary will have to select to participate
in one of the following:
-
Stand
Alone Prescription Drug Plan (PDP):
Click here to view an
informational PDF file
Individuals signing up for the Stand Alone PDP will
not see any changes to their existing Medicare Part A or Part
B benefit. Medicare Part D will allow seniors to add prescription
drugs to their current Medicare by selecting a PDP which type
of insurance plan that will offer the drug benefit. Once a
beneficiary has selected a PDP, they will pay a deductible
co-payment and premium for their drugs through the selected
insurance provider. Certain drugs, as well as certain pharmacies,
may or may not be covered through a particular PDP.
| Stand-Alone
Prescription Drug Plan Organizations in South Dakota |
Offers
at Least 1 Prescription Drug Plan with a Premium <$20 |
| Aetna
Life Insurance Company |
N |
| Blue
Cross Blue Shield Northern Plains Alliance |
N |
| Connecticut
General Life Insurance Company |
N |
| First
Health Life and Health Insurance Company |
N |
| Fox
Systems, Inc. |
N |
| Humana
Insurance Company |
Y |
| Medco
Containment Life Insurance Company |
N |
| Memberhealth,
Inc. |
N |
| Pacificare
Life and Health Insurance Company |
N |
| Pennsylvania
Life Insurance Company |
N |
| RxAmerica,
LLC |
N |
| Silverscript
Insurance Company |
N |
| Sterling
Life Insurance Company |
N |
| Unicare |
N |
| United
American Insurance Company |
N |
| United
Health Care Insurance Company |
N |
| Wellcare
Health Plans |
N |
| Wellmark
Community Insurance, Inc. |
Y |
Data
as of September 18, 2005
-
Medicare
Advantage (MA) Plan:
Click
here to view an informational PDF file
Those who select a Medicare Advantage plan will see
many changes in the way their traditional Medicare Part A
and B benefits are administered. They will also be eligible
for Prescription drug coverage. Those who select to participate
in an MA plan will have to select an insurance company to
administer all of their Medicare benefits. Beneficiaries will
pay all of their co-payment, premiums and deductibles to that
plan. The MA plan will require a beneficiary to go to doctors,
hospitals and pharmacies that are participating in their insurance
network.
Medicare
Advantage Prescription Drug Plan (MAPDP) Organizations
in South Dakota |
Regional
Preferred Provider Organization? |
Percent
of Medicare Eligibles with Access to an MA PD Plan |
Offers
at Least 1 Plan in State with No Additional Premium for
Drugs |
Blue
Cross Blue Shield Northern Plains Alliance |
Y |
100% |
N |
Humana
Inc. |
N |
100% |
Y |
United
Healthcare |
N |
44% |
Y |
Data
as of September 18, 2005
The following Medicare Web site allows allow people to compare
drug plan options based on individual prescription drug needs:
https://www.medicare.gov/MPDPF/Public/Include/DataSection/Questions/Questions.asp
Return
to Top
