Resources
If you have questions about the program or need help deciding whether the Medicare prescription drug program is right for you, there are many resources available to help you. Places to get help with Medicare Part D:
• The SHINE Program: The SHINE Program is Massachusetts' State Health Insurance Program that provides free, one-on-one health insurance information, counseling and assistance to Medicare beneficiaries of all ages.
• The Access to Benefits Coalition: The nonprofit Access to Benefits Coalition can help you learn about and enroll in the new prescription coverage. Our help is available online or in person. It’s free, fast and confidential.
• The Centers for Medicare and Medicaid Services: Runs a website and the 1-800-Medicare hotline which is staffed by customer service representative 24 hours a day, seven days per week.
• Contact Your Medicare Part D Plan: If you have enrolled in a Medicare Part D plan or if you have questions about a specific private plan you may have to contact your plan directly. If you need to contact your private plan and you don’t have the company’s phone number 1-800-Medicare can give you that information.
• Rep. Ed Markey’s District Office: If you still have questions, need more information or would like to suggest changes to this site, please call the Medford District Office at 781-396-2900.
The SHINE Program
The SHINE Program: The SHINE Program is Massachusetts' State Health Insurance Program that provides free, one-on-one health insurance information, counseling and assistance to Medicare beneficiaries of all ages.
• Toll Free State-wide Number: 1-800-AGE-INFO 1-800-243-4636
• SHINE Website
• The Shine Program has 3 offices that serve the 7th District:
North Shore, Mystic Valley, Chelsea, Revere & Winthrop SHINE Program: Mystic Valley Elder Services
300 Commercial Street
19 Riverview Business Park
Malden, MA 02148
781-324-7705
Metro West Shine Program: Callahan Senior Center
Framingham COA
154 Pearl St
Framingham, MA 01701
508-620-6569
Northern Middlesex County including Cambridge & Somerville SHINE Program: Minuteman Senior Services, Inc.
24 Third Avenue
Burlington, MA 01803
781-272-7177
The Access to Benefits Coalition
The Access to Benefits Coalition: The nonprofit Access to Benefits Coalition can help you learn about and enroll in the new prescription coverage. Our help is available online or in person. It’s free, fast and confidential.
• Access to Benefits Coalition Website
• Local Partner: Action for Boston Community Development, Inc. (ABCD):
178 Tremont Street
Boston, MA 02111
(888) 489-7744
The Centers for Medicare and Medicaid Services
1-800-Medicare (1-800-633-4227)
• 1-800-Medicare is a service run by the Centers for Medicare and Medicaid Services. You can talk with a customer service representative 24 hours a day, seven days per week to Get help with your Medicare questions, order information on Medicare health plans, listen to recorded questions and answers on topics such as Medicare health plan choices, order Medicare publications. (Some are available in large print, Spanish, audio-tape, and Braille.)
• If the pharmacy won't fill your prescription, or charges you more than you know you should have to pay because it can't confirm you are enrolled in a Medicare Prescription Drug Plan, here's what to do: If you don't have a membership card yet, you can show the pharmacist the letter you received from the plan that confirms you have enrolled. If you don't have a letter, ask your pharmacist to call 1-800-MEDICARE (1-800-633-4227).
• If you are hearing impaired or speech impaired, call the TTY/TDD line toll-free at 1-877-486-2048.
The Medicare Prescription Drug Website: www.medicare.gov
• The Medicare Prescription Drug Website is run by the Centers for Medicare and Medicaid Services. It will help you learn about the new Medicare prescription drug program, find and compare prescription drug plans to see if they meet your personal needs, and if you choose to enroll, help you enroll in a prescription drug plan.
Background on the Medicare Prescription Drug Program
Seniors now have the option of selecting a new prescription drug plan to accompany their traditional Medicare coverage. This new Medicare Part D program is part of the Medicare reform legislation passed by Congress in 2003. I voted against this program because I believe that it is too confusing, gives too much money away to the drug companies and does not provide a strong enough benefit for seniors. I have co-sponsored legislation to improve and simplify this program. However, the program has been implemented and seniors now have to decide whether Medicare Part D is right for them. To help you make this decision I have provided answers to some frequently asked questions about the program.
How will the new drug benefit work?
If you have Medicare, you can get new prescription drug coverage beginning January 2006 in one of two ways:
1. A prescription drug plan (PDP), from a private company. You will continue to get coverage for your other medical services (such as doctor visits and hospital stays) through traditional Medicare.
2. A Medicare private plan, like an HMO or PPO, that offers medical and hospital benefits in addition to drug coverage. You can enroll between November 15, 2005 and May 15, 2006 and change plans once a year between November 15 and December 31.
Will all my drugs be covered?
Each drug plan will have its own list of prescription drugs that the plan will cover. You will have to pay approximately 25 percent of the cost of drugs on the list and the full cost for drugs not on the list. You must also fill your prescription at a pharmacy in your plan's network.
How much will I pay for drug coverage?
It depends on which plan you choose. You will pay a monthly premium, annual deductible and coinsurance, all of which may vary by plan. Be aware, however, that seniors must pay out of pocket for any annual drug costs between $3,600 and $5,100.
Do I have to get the Medicare prescription drug benefit?
No, joining a private drug plan offered by Medicare is your choice and you shouldn’t join a plan until you are sure how it would affect your retiree coverage. In some cases, if you join a private drug plan offered through Medicare, you could lose your retiree health coverage as well as your prescription drug coverage. However, keep in mind that unless you have drug coverage that is at least as good as Medicare's (your current drug plan will let you know) you need to enroll between November 15, 2005 and May 15, 2006 to avoid a premium penalty for late enrollment.
How will the benefit work with the drug coverage I now have?
That will depend on your current coverage. Some drug insurance plans, like retiree plans and State Pharmaceutical Assistance Programs, will supplement your Medicare drug coverage. Call the company that provides your current drug coverage to find out how it will work with the Medicare drug benefit.
How do I find out about different drug plans?
You can visit www.medicare.gov or call 800-MEDICARE (633-4227) to access a list of all available prescription drug plans.
For answers to more questions, please visit the Frequently Asked Questions section on the Medicare Website
Low-Income Benefit
If your 2005 income is below $14,355 ($19,245 for couples) and your resources are less than $11,500 ($23,000 for couples) you may qualify for extra help with your Medicare drug costs. If you qualify for the low income benefit, the government will pay 85 to 100 percent of your prescription drug costs.
How do I know if I am eligible for extra assistance?
1. If you have Medicaid or a Medicare Savings Program (MSP), or you receive Supplemental Security Income (SSI), you automatically qualify for help--you do not have to apply.
2. If you do not have Medicaid, an MSP or SSI, you should apply for help through the Social Security Administration (SSA) using the agency's print or online application (www.ssa.gov).
How do I apply?
If you have not received an application through the mail, click here to submit an application online.
When you submit your application through SSA, you can simply state that your income and assets qualify you; you will not have to provide proof. This application will not enroll you into a plan. You will have to choose a Medicare drug plan through which to get your drug coverage.
What if I have drug coverage through Medicaid?
You will lose your Medicaid drug coverage on December 31, 2005 and get your drug coverage through Medicare as of January 1, 2006. You will still keep your other Medicaid benefits. You will automatically get extra help paying for your Medicare drug costs, but you should enroll in the Medicare drug plan that best meets your needs or you will be automatically enrolled in a randomly selected plan. The randomly selected plan may not cover your drugs.
What if I have coverage through my state's pharmaceutical assistance program?
If you are enrolled in your state's pharmaceutical assistance program, call your program to find out how it will work with the Medicare drug benefit. Some states will continue to offer coverage as they always have; others will help you fill gaps in your Medicare drug coverage.
Rep. Markey’s Work on Cleaning Up the Medicare Prescription Drug Mess
Seniors now have the option of selecting a new prescription drug plan to accompany their traditional Medicare coverage. This new Medicare Part D program is part of the Medicare reform legislation passed by Congress in 2003. I voted against this program because I believe that it is too confusing, gives too much money away to the drug companies and does not provide a strong enough benefit for seniors. Since the passage of this legislation, I have been working with other Democrats to improve and simplify this program.
Medicare Part D as been accepting enrollments since November, but many seniors are confused by the wide variety of private plans, experiencing difficulty navigating the program and having trouble getting the drugs that they need. I want to hear about your experiences with the new Medicare Prescription Drug Program. To tell your story, click here.
In response to problems with Medicare Part D, Rep. Markey has cosponsored:
• The "Medicare Prescription Drug Emergency Guarantee Act" (HR4685). Introduced Rep John Dingell on February 1, 2006) this bill will preserve access to medications and prevent beneficiaries from being penalized as a result of poor program design or problems created by the agency or the private drug plans.
o For the text of this bill go to http://thomas.loc.gov
• The “Medicare Prescription Drug Savings and Choice Act” (HR 752). This bill was introduced by Rep Marion Berry on February 10, 2005 and will create a Medicare-administered prescription drug plan and require the Secretary of Health and Human Services to negotiate for lower prices.
o For the text of this bill go to http://thomas.loc.gov
• The “Medicare Informed Choice Act,” (HR3861). Introduced by Rep Fortney Pete Stark on September 22, 2005, this bill was will give seniors an additional six months to enroll in a plan and give Medicare beneficiaries the opportunity to make a one-time change in prescription drug plan enrollment at any point in 2006.
o Read Rep. Markey's Statement
o For the text of this bill go to http://thomas.loc.gov.
o This bill has been endorsed by: Alliance for Retired Americans, American Federation of Teachers, American Nurses Association, California Health Advocates, Center for Medicare Advocacy, Consumers Union, Families USA, Medicare Rights Center, National Committee to Preserve Social Security and Medicare