Who can join?
The Medicare prescription drug benefit is available to everyone who is either entitled to Medicare Part A hospital insurance or enrolled in Medicare Part B medical insurance:
-people age 65 and older
-people under age 65 with certain disabilities
-people of all ages with End-Stage Renal Disease (permanent kidney failure)
-people of all ages with ALS-Lou Gehrig's Disease

When can I sign up?
The enrollment period began on November 15, 2005 and will run through May 15, 2006. If beneficiaries sign up in November or December 2005, they will begin receiving the Medicare drug benefit on January 1, 2006. If beneficiaries sign up anytime between January 1, 2006 and May 15, 2006, their coverage will begin at the start of the following month. If beneficiaries do not sign up by May 15, 2006, they will not have another opportunity to sign up until November 15, 2006.

Beneficiaries who will not become eligible for Medicare until after May 15, 2006 will have an initial period of at least six months in which to enroll in the Medicare prescription drug benefit. Medicare will notify these beneficiaries of the dates of their six-month enrollment period when they first become eligible for Medicare.

What happens if I don't sign up?
If beneficiaries do not enroll in a Medicare drug plan before May 15, 2006, they will have to pay a higher premium if they decide to enroll later. If an individual enrolls in a Medicare prescription drug plan after May 15, 2006 after a period of 63 days or more without drug coverage that is as good as or better than Medicare coverage, his/her premium will increase at least 1% of the base beneficiary premium (a national number) per month for every month that s/he waited to enroll. The individual will have to pay this higher premium as long as the individual has a Medicare prescription drug plan.

Are there prescription drug plans that will meet my needs?
Medicare has contracted with private companies to offer a choice of at least two different drug plans in each region of the country. If you are an eligible individual, you should have received information from Medicare in October 2005 about the prescription drug plan options in your area. In Illinois, there are 42 stand-alone prescription drug plans, 46 Medicare Advantage prescription drug plans, and eight Medicare Advantage prescription drug plans for beneficiaries with special needs. These plans will offer a variety of choices, with different covered prescriptions, different costs, and different pharmacy networks.

Each prescription drug plan will have its own list of covered brand-name and generic drugs, called a formulary. Medicare drug plans can change their formulary at any time, as long as they give a 60-day notice. A Medicare drug plan will have to cover at least two drugs for each therapeutic class of drugs. For some drug classes, a drug plan will have to cover the majority of drugs.

Medicare beneficiaries should carefully review each of the drug plans offered in their area to determine which plans cover all of the prescriptions they take. A beneficiary's doctor or other health professional may be able to help the beneficiary obtain an exception if the medicine they need is not on the plan's formulary. Typically, the beneficiary's physician must determine that the preferred drug, formulary drug, or first-tier drug is not as effective for the beneficiary, harmful to the beneficiary, or both.

How much will my annual out-of-pocket cost for prescription drugs be? Will I save money by signing up for the new Medicare drug benefit?
The new Medicare prescription drug benefit will be similar to private insurance. Most individuals will have to pay annual deductibles, monthly premiums, and coinsurance or co-pays each time they fill a prescription. Each of the prescription drug plans will vary in terms of the costs, drugs covered, and list of in-network pharmacies.

Medicare has established national standards for minimum benefits that may be offered by each plan. If you choose to enroll in a Medicare prescription drug plan for 2006:

• You will pay a monthly premium averaging $32.20 per month, or $386.40 a year, per person. Monthly premiums could be higher or lower than $32.20, depending on the company you choose and the level of coverage it offers.
• Your annual deductible may not exceed $250 per person. Once you have paid the deductible each year, you will pay 25% of your next $2,000 in prescription drug costs per person, and Medicare will pay the remaining 75%.
• When your prescription drug costs have reached a total of $2,250 per person (the $250 deductible plus the next $2,000), Medicare will not provide additional assistance with your prescription drug costs, until you have paid the next $2,850 in prescription drug costs per person. Some sources refer to this period as the “doughnut hole.”
• After you have paid the next $2,850 in prescription drug costs per person, Medicare assistance will resume. For the rest of the year, you will pay either a flat co-payment of $2 for every generic drug prescription and $5 for every brand-name drug prescription, or 5% of the drug's cost, whichever is more.

Your total out-of-pocket costs will vary, depending on how many prescription drugs you use and how many times per year you must refill your prescriptions. You can obtain detailed information about the prescription drug plans that are available in your area, find out which plans cover the medications you use, determine the projected annual out-of-pocket costs of each plan, and find out which pharmacies are in each plan’s network by using the Plan Finder tool on the Medicare website
(link:http://www.medicare.gov/MPDPF).

NOTE: The Medicare Plan Finder website is updated with new prescription pricing data on an ongoing basis. You may wish to consult the Plan Finder more than once before enrolling in a particular plan to determine whether there has been any fluctuation in out-of-pocket costs for that plan or any other plans since you first used the Medicare Plan Finder website. For the most accurate information, you should directly contact the insurance company offering the prescription drug plan you wish to enroll in to verify your annual cost-sharing requirements before committing to that plan.

Will I qualify for extra help in meeting the premium and cost-sharing requirements of the new benefit?
Beneficiaries with limited incomes may be eligible for extra assistance. If you are eligible, you should complete a separate application for the extra subsidy. This extra help could cover between 85 percent and 100 percent of your drug costs.

Individuals who are eligible for both Medicare and Medicaid, individuals who are enrolled in the Medicare Savings Program, and individuals who are receiving SSI will automatically be enrolled in the Medicare prescription drug extra subsidy program.

Others will need to fill out an application to find out if they qualify for the extra subsidy, based on income guidelines. The Social Security Administration (SSA) has mailed applications to those who may qualify, which can be filled out and mailed back to SSA. You can also access and fill out an application online at http://www.socialsecurity.gov.

Beneficiaries who are dually eligible for Medicare and Medicaid will be automatically eligible for extra assistance. They will have no deductible and no premium (as long as they have selected a plan with a premium at or below the average for the drug plans offered in their area). Individuals with an income below $9,570 ($12,830 for a couple) will have to pay a $3 co-payment for a brand-name drug and $1 for a generic drug. Dual-eligibles with an income above $9,570 ($12,830 for a couple) will have to pay a $5 co-payment for a brand-name drug and $2 for a generic drug. These co-payments may represent an increase in what beneficiaries are paying now. The Medicare formularies may also be more restrictive than what the beneficiary was used to under Medicaid or at an SSA or State Medical Assistance Office.

Medicare beneficiaries who are not covered by Medicaid but have income below $12,920 for an individual and $17,321 for a couple, and assets below $6,000 for an individual and $9,000 for a couple will not be charged premiums and will have no deductible. Co-payments will be $5 for a brand-name drug and $2 for a generic drug. For beneficiaries with income between $12,920 and $14,355 (between $17,321 and $19,245 for a couple) and assets below $10,000 for an individual and $20,000 for a couple, their premium will be partially subsidized and their deductible will be $50. Their co-insurance will be 15 percent of their drug costs up to $5,100 in total drug spending; thereafter, the co-payment will be $5 for a brand-name drug and $2 for a generic drug.

How do I pay for Medicare prescription drug coverage?
In general, there are three ways you can pay your Medicare drug plan premiums:

1.) You can give permission to the company that offers the Medicare drug plan you choose to deduct the premium automatically from your bank account.

2.) You can have your premium deducted every month from your Social Security benefits, similar to your premiums for Medicare Part B.

3.) You can pay the prescription drug plan directly for your premium by mailing them a check or money order each month.

What if I want to change prescription drug plans once I've enrolled?
Once you have enrolled in the Medicare prescription drug benefit, you will have the opportunity to change from one Medicare prescription drug benefit plan to another once a year, between November 15 and December 31. You cannot change plans at any other time of the year.

What if I already have drug coverage through my former employer's retiree benefit plan?
You should speak with your former employer before deciding whether to enroll in a Medicare prescription drug plan. Your employer is suppose to notify you about whether your current drug coverage is as good as or better than the standard Medicare drug benefit. If it is, you will not have to pay a late-enrollment penalty if you decide to keep your employer drug coverage and later switch to a Medicare prescription drug plan. You should also ask your former employer if dropping your retiree drug coverage would cause you to lose any supplemental coverage for hospital and doctor services that your former employer provides to retirees. Some employers will choose to alter or drop existing retiree coverage as a result of the new Medicare drug benefit. Unfortunately, many of the beneficiaries will be left with lesser coverage under Medicare.

What if I already have prescription drug coverage through a Medicare HMO or other private plan?
You should examine what kind of drug coverage your current Medicare HMO or other private plan offers as well as the drug coverage offered by the other Medicare HMOs and other Medicare prescription drug plans in your area. Different plans are likely to cover different drugs and pharmacies and charge different premiums, deductibles, and co-insurance rates. Comparison information will be available at http://www.medicare.gov or 1-800-MEDICARE. If you are now enrolled in a Medicare HMO that includes drug coverage and you do not choose another plan, your HMO may automatically enroll you in one of its Medicare Advantage plans that offers drug coverage. But if you are now enrolled in a Medicare HMO that does not include drug coverage and you do not choose another plan, the HMO may not automatically enroll you in one of its Medicare Advantage plans that offers drug coverage. For the most accurate information, you should contact your Medicare HMO directly to find out how your existing drug coverage may change when the new Medicare prescription drug benefit takes effect.

What if I am already enrolled in a Medigap policy that includes drug coverage?
Medigap insurers are suppose to inform you about whether your Medigap coverage is as good as or better than the standard Medicare drug benefit. If it is, you will not have to pay a late-enrollment penalty if you later decide to switch to a Medicare drug plan. However, most Medigap coverage will not be as good as Medicare drug coverage. Beneficiaries who choose to enroll in a Medicare drug plan cannot also have Medigap coverage that includes drug coverage, but you could switch to a Medigap policy that does not include drug coverage.

What will happen to the prescription drug assistance I am currently receiving through the Illinois SeniorCare or Circuit Breaker programs once the Medicare drug benefit takes effect?
The Illinois General Assembly passed and Governor Rod Blagojevich signed into law the Illinois "Leave no Senior or Person With a Disability Behind" Act. This measure will help protect Medicare beneficiaries in Illinois from some of the shortfalls that have been created by the federal Medicare prescription drug benefit. Under this state program, individuals who are currently enrolled in Illinois SeniorCare or Circuit Breaker will have their current state pharmaceutical benefits maintained in a new state program named the "Illinois Cares Rx" program. These individuals will be able to receive assistance from the state of Illinois with increased prescription drug costs that will be imposed by the implementation of the Medicare prescription drug benefit. If you are presently enrolled in Illinois SeniorCare or Circuit Breaker, you should plan to enroll in a Medicare prescription drug plan, and you should also apply for the federal extra subsidy program using the application provided by the Social Security Administration. To find out more information about the new Illinois Cares Rx program and whether you may qualify for this state assistance with prescription drug costs, you should call the Illinois Senior Health Insurance Program (SHIP) at 1-800-548-9034, or contact the office of your State Senator or State Representative.

What will happen to the Medicare Prescription Drug Discount Card I signed up for in 2004 and 2005?
Medicare prescription drug plans are different from the Medicare-approved drug discount cards that were available in 2004 and 2005. You may use your Medicare-approved drug discount card until May 15, 2006, or until you join a Medicare prescription drug plan–whichever is first. Once you join a Medicare prescription drug plan, you may no longer use your Medicare-approved drug discount card.

Will I be able to have my prescriptions filled at any pharmacy?
Each Medicare prescription drug plan will contract with a network of pharmacies. Beneficiaries could be charged more if they do not fill a prescription at a pharmacy in the plan's network.

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