Frequently
Asked Questions
What is Medicare Prescription
Drug Coverage (Part D) and who can sign up?
How can I find out
about Part D plans in my area and learn the one that's best for me?
What drugs will Medicare
cover?
What if I already
have prescription drug coverage through my former or current employer?
What if I am enrolled
in a Medicare Advantage Plan?
How do I sign up for Medicare
Prescription Drug Coverage?
What does Medicare
Prescription Drug Coverage cost?
Can I get help paying for my
Medicare Part D premiums? How do I know if I qualify for assistance?
What happens if I
sign up late for Medicare Prescription Drug Coverage?
How does Medicare
Prescription Drug Coverage work if I already have Medicaid or get other
government prescription drug benefits?
What is Medicare Prescription
Drug Coverage (Part D) and who can sign up?
ü Anyone in Medicare can get the new drug coverage, known as Medicare Part D.
Being “in Medicare” means enrolled either in Medicare Part A (which
covers hospital and some home health care as well as skilled nursing
facility care) or Part B (doctor visit and other outpatient care). You
can sign up for Medicare Part D until May 15, 2006, without incurring a penalty.
ü If you do not want new Medicare drug coverage, you do not have to sign up for
it. But if you fail to sign up by 5/15/06, and later change your mind, you may have
to pay more for it. (See more about this late penalty below.)
How can I find out
about Part D plans in my area and learn the one that's best for me?
ü You
can get information about Medicare drug plans by going to www.medicare.gov online,
calling 800-MEDICARE, your local SHIP office or the Department of Aging
(California and Los Angeles information provided above). Before
you call any of these numbers, please make sure to have the following:
Your Medicare identification
number (this is on your Medicare card)
A list of the drugs
you currently take, the dosage, and how much you pay for them. You
may want to ask your doctor for help.
A list of the pharmacies you use regularly,
your refill schedule and preferred method of receiving prescriptions (pharmacy
or mail-order).
Your annual income
and a basic accounting of your personal assets (bank accounts,
checking accounts, cash, bonds, stocks, IRAs, 401(k)s),
if you think you may qualify for low-income assistance.
What drugs will Medicare
cover?
ü Each
different private plan has a different formulary, or list of drugs that it will
cover, as well as different pharmacies that it contracts with. This
is why it is important to compare plans and make sure you pick a plan
that covers your prescription drugs at the pharmacies you frequent.
What if I already
have prescription drug coverage through my former or current employer?
ü If
you already have a prescription drug plan offered by a private employer
or union, you may want to compare costs to see if Medicare will save
you money. This will depend on the premiums you pay in your current
plan, plus the cost of the drugs you purchase most frequently. You
may want to contact the benefits administrator of your current plan before enrolling
in Medicare Part D to determine which coverage is better for you.
ü Also,
if you already have prescription drug coverage through a former or
current employer, you may have received a letter from the employer
informing you if your current coverage is “actuarially equivalent” to
Part D coverage. If it is not, then you must sign up for
a Part D plan by the 5/15/06 deadline, or face potential penalties
if you decide to register later on.
What if I am enrolled
in a Medicare Advantage Plan?
ü You may be enrolled in one of California's 129 Medicare Advantage Plans. These
managed care plans may already offer prescription drug coverage,
or you may have been contacted by your provider indicating that
a drug benefit will soon be added to your current plan.
How do I sign up for Medicare
Prescription Drug Coverage?
ü You
can sign up online at www.medicare.gov. If
you need someone to help guide you through the process, call the
Center for Health Care Rights at (213) 383-4519 or
(800) 824-0780.
What does Medicare
Prescription Drug Coverage cost?
Costs will vary annually and will depend on the plan you choose. In
general, you will pay:
ü A
monthly premium
· This
will vary significantly according to which plan you select. In
California, there are 47 different stand-alone prescription drug plans,
most of which charge somewhere between $23 and $40 dollars a month.
ü A
yearly deductible ($250 in 2006).
· If
your drug expenses exceed the $250 deductible:
- For expenses above the $250 deductible, but under
$2,250, you pay 25% and the plan pays the other 75%.
- For expenses between $2,251 and $3,600,
you must pay all costs.
· Once
your drug expenses exceed $3,600, you pay 5% of the
cost and the plan pays the remaining 95% for the rest of the year.
ü All
costs mentioned above are in addition to the Part B premium for doctor
visits which will cost beneficiaries approximately $88.50 per month
in 2006. (You pay for Part B out of your Social Security check.)
Can I get help paying for my Medicare Part
D premiums? How do I know if I qualify for assistance?
ü If
your 2005 family income is below $14,355 (per individual) or $19,245 (per couple), you may
qualify for Medicare's low-income drug benefit. You can call Social
Security at 1-800-772-1213 or visit http://www.socialsecurity.gov/prescriptionhelp/ to
find out if you qualify and to sign up for the benefit.
ü When
you call, try to have documentation of your annual income
(like a tax return or a payroll slip) and your personal assets (bank
accounts, checking accounts, bonds, stocks, IRAs, 401(k)s). If
you don't have these documents, don't worry- representatives from
Social Security Administration should still be able to help you figure
out whether you qualify for assistance.
ü If
you receive Supplemental Security Income (SSI), you automatically qualify
for premium assistance.
What happens if I
sign up late for Medicare Prescription Drug Coverage?
ü Because
of a Medicare requirement to sign up by May 15, 2006, you will save
more on your monthly premiums if you sign up by this date. If
you choose to wait and enroll after May 15, 2006, you will pay a penalty
equal to 1% of the monthly premium for each month that you are covered
by Part D coverage. These fees can rack up quickly so be sure
to sign up before May 15th if you decide you want coverage.
How does Medicare
Prescription Drug Coverage work if I already have Medicaid or get other government prescription drug benefits?
ü If
you have Medicaid prescription drug coverage and Medicare, your Medicaid
drug coverage will end on December 31, 2005. You will
get your drugs through the Medicare prescription drug benefit starting
January 1, 2006. The rest of your Medicaid benefits will stay the
same.
o You
should choose a Medicare private drug plan through which to get your
Medicare drug coverage. If you do not sign up for a Medicare private
drug plan by December 31st, 2005, you will
be automatically enrolled in one that may not cover the drugs you need.
ü If
you receive Supplemental Security Income (SSI), you will automatically
be enrolled in a prescription drug plan after May 1st,
2006. If you do not sign up for a Medicare private drug
plan, you will be automatically enrolled in one that may not cover
the drugs you need.
|