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You are at: Home >> Constituent
Services >> Assistance >>
Medicare
Medicare Prescription Drug
Resource Center
Access to affordable prescription drugs continues to pose a
mounting challenge to Long Island seniors. Unfortunately, the cost
of prescription drugs is increasing at double-digit rates. The Medicare
Modernization Act of 2003 (MMA) included provisions intended to
decrease the cost of prescription drugs for Medicare recipients.
Along with the new prescription
drug savings card, the MMA establishes a new, voluntary prescription
drug benefit for all Medicare recipients.
Although I believe the drug plan could be much improved, I
want my constituents to have all the information they need to make
their decisions and get the best deal they can from this program.
Please note that the details of the individual plans that will be
offered will not be released until later this year. I will continue
to update this page as more information becomes available. In the
meantime, I hope that you, my constituents, will find the tools
you need to determine the usefulness of the plan for your prescription
drug needs. Please know that I will continue fighting to ensure
that all of our community’s seniors have access to safe, affordable
prescription drugs.
--Rep. Steve Israel
Who Can Enroll in Medicare’s New Prescription Drug Benefit?
• Drug coverage will be provided for all people with Medicare
• All beneficiaries will have access to at least two Medicare
prescription drug plans
• Extra help is available for
people with limited resources • Most Medicare beneficiaries
must choose and enroll in a Medicare prescription drug plan to get
drug coverage When to Enroll?
• Join between November 15, 2005, and December 31, 2006 and
coverage will begin on January 1, 2006
• Join between January 1, 2006, and May 15, 2006 and coverage
will begin the first day of the month after the month joined
- If you enroll after May 15, 2006, you will pay a penalty
in the form of an increased premium (the cost of your premium
will increase 1% for each month that you wait to enroll)
- Your future opportunities to enroll may be limited to November
15–December 31 of each year
What is the Cost of the New Prescription Drug Benefit?
• Plans will vary in cost and coverage, but must provide
standard coverage
• Generically, standard coverage works so that beneficiaries
pay a premium, a yearly deductible and part of the cost of covered
prescription drugs:
• Pay a premium of about $37 each month (this is in addition
to the Part B premium; the enhanced benefit may cost more)
• Pay a yearly deductible up to $250
• Pay part of the cost of covered prescription drugs
- You pay 25% of drug costs from $250 to $2,250; Medicare will
pay 75 percent
- You pay 100% of drug costs from $2,250 to $5,100
- After your total drug costs reach $5,100 and you have
paid $3,600 in out-of-pocket costs, you pay only 5% of any costs
above $5,100; Medicare will pay the other 95 percent
Things You Should Consider
• Look over your current health insurance coverage (you may
not be able to re-enroll if you leave your current program)
- Are prescription drugs covered?
- What are the out-of-pocket costs?
• Is there prescription drug coverage available to you through
a former employer or union?
• Do you have limited resources that would qualify you for
extra assistance?
- People with limited resources can get extra help with their Medicare drug plans costs
- Those with lowest incomes will pay no premiums or deductibles and pay small or no copayments
- Those with slightly higher incomes will pay a reduced deductible
• Are your prescriptions covered by the plan that you select?
To Get Help Paying for the Cost of Prescription Drug Plans
If you have Medicare and have limited income and resources, you
may qualify for extra help paying for prescription drugs.
What do I need to know?
• If your annual income is below $14,355 for a single person
(or $19,245 if you are married and living with your spouse), you
may qualify for extra help
• And if your resources (including your savings and stocks,
but not counting your home or car) are under $11,500 (for a single
person) or under $23,000 (for a married couple) you may qualify
for extra help paying for your Medicare prescription drug costs
• You can apply for this extra help through the Social Security
Administration or your State Medical Assistance Office
• The amount of extra help you get depends on your income
and resources
• You still need to join a Medicare prescription drug plan
for Medicare to pay for your drug costs
• If you qualify for extra help, you will have continuous
drug coverage and will pay only a small amount for your prescriptions
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