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Medicare Prescription Drug Benefit: Online Resource

The new drug benefit will go into effect January 1, 2006.  It is available to everyone with Medicare, regardless of income or health status.

For information about the plans available in Utah, go to Medicare's website and click on "Compare Medicare Prescription Drug Plans" or go directly to the Prescription Drug Guide. Additional information is also available in the new "Medicare and You 2006" handbook.

You may also want to ask a family member, friend, or other caregiver to help you decide what drug coverage meets your needs.  Personalized assistance is also available by calling a Medicare customer service representative at 1-800-Medicare, or through the State Health Insurance Information Program (SHIIP) at 1-800-541-7735. 

Have the following information available when you are ready to sign up for a plan:

  • Medicare identification number and effective date
  • Zip Code
  • Information about your current prescription drug coverage
  • List of medications including name, exact dosage, frequency and cost
  • Names of preferred pharmacies

Summary of Prescription Drug Benefit

Beginning in 2006, Medicare beneficiaries will have access to the standard drug benefit described below. Although drug plan sponsors may change some of the specifications below, the benefit offered must at least be equal in value to the standard benefit. Standard coverage includes:
  • A monthly premium of about $35
  • A deductible of $250
  • Coinsurance of 25 percent up to an initial coverage limit of $2250
  • Protection against high out-of-pocket prescription drug costs, with copays of $2 for generics and preferred multiple source drugs and $5 for all other drugs, or 5 percent of the price, once an enrollee's out-of-pocket spending reaches a limit of $3,600

Additional Provisions for Low Income Seniors

Beneficiaries with limited savings and incomes below 135 percent of the federal poverty line ($12,123 for individuals, $16,362 for couples) will receive:
  • A $0 deductible
  • A $0 premium
  • No gap in coverage
  • Copays of $2 for generics and preferred multiple source drugs and $5 for all other drugs, up to the out-of-pocket limit (NOTE: For full dual eligibles under 100% of poverty, the copayment is reduced to $1 and $3 and for those full dual eligibles who are residents of nursing homes there is no copay)
  • $0 copay for all prescriptions once the out-of-pocket limit is reached

Beneficiaries with limited savings and incomes below 150 percent of the federal poverty level ($13,470 for individuals; $18,180 for couples) will receive:

  • A sliding scale monthly premium that would be about $35 for beneficiaries with incomes of 150 percent of the federal poverty level
  • A $50 deductible
  • No gap in coverage
  • Coinsurance of 15 percent up to the out-of-pocket limit
  • Copays of $2 or $5 once the out-of-pocket limit is reached

New Preventive Benefits

Beginning in 2005, all newly enrolled Medicare beneficiaries will be covered for an initial physical examination, and all beneficiaries will be covered for cardiovascular screening blood tests, and those at risk will be covered for a diabetes screen. These new benefits can be used to screen Medicare beneficiaries for many illnesses and conditions that, if caught early, can be treated, managed, and can result in far fewer serious health consequences.

Prescription Drug Resources

Detailed reports prepared by the Congressional Research Service (CRS) at the Library of Congress:

 *Medicare Drug Benefit Overview and Bill Summary


 *Medicare Health Care Provider Reforms


 *Guide to Calculating Eligibility for Low-Income Assistance


*About PDF File Documents
To read pdf file documents, you will need Acrobat Reader 3.0 (or higher) or a pdf viewer. You can download a free copy of Acrobat® Reader® throught the Adobe Website.

Medicare vs. Social Security Administration (SSA) Questions?

If you have a question about:
  • Eligibility for Medicare Part A and B
  • The difference between Part A and Part B benefits
  • How to apply for Medicare
  • When to apply for Medicare benefits
  • Medicare monthly premium amounts
  • Replacing a Medicare card
  • Changes of address
  • SSA benefits
  • Reporting a death
  • How to find the local SSA office
Please call the SSA at 1-800-772-1213 from 7:00 a.m. - 7:00 p.m. on business days.

If you have a question about:
  • General Medicare information
  • Medicare Part A and Part B coverage
  • Medicare health plan choices in the local area including cost, benefits, quality, and other information
  • Medicare patients' rights and appeal rights
  • Nursing homes in the local area
  • Medicare events and activities in the local area
  • How to obtain the most up-to-date Medicare booklets and phone numbers for Medicare bills and services
Please call Medicare at 1-800-MEDICARE or go to www.medicare.gov.


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