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Over
the years, Medicare has offered relief to
millions of seniors in need of health
care. But in recent years, it has become obvious that Medicare simply cannot
sustain the demands we are placing on it;
reform is necessary.
On December 1, 2003, President Bush
signed into law the first major overhaul
of the Medicare program since its
inception in 1965. While not perfect,
this bill made major changes to your Medicare coverage.
In 2006, the Prescription Drug Benefit
will be added to Medicare. All people
with Medicare will be able to enroll in plans that cover prescription drugs.
People
with Medicare will pay a premium
estimated to be $35 a month and there
will be a $250 deductible. Medicare
will pay 75% of drug costs between the
deductible and $2250. Medicare then pays 95%
of drug cost above $5100. The
Prescription Drug Benefit includes
additional assistance for people with low
income and limited assets.
Most significantly, people
with Medicare who are also
fully eligible for Medicaid with incomes
below 100% of the federal poverty
level (and with no separate asset
test) will receive:
- Full premium subsidy
- Full subsidy of deductible
- Minimal co-pays
Other beneficiaries with low income
and limited assets will receive premium
and deductible assistance and have limited cost sharing. |
Who
can join?
Anyone with Medicare Part A and/or Part B can join a Medicare prescription
drug plan offered in their area. If you are in a Medicare Advantage Plan
(like an HMO or PPO), your plan may also offer drug coverage.
When
can I join?
If you currently have Medicare Part A and/or Part B, you can join a
Medicare prescription drug plan between November 15, 2005 and May 15,
2006. If you join by December 31, 2005, your Medicare prescription drug
plan coverage will begin on January 1, 2006, and you won’t miss a day of
coverage. If you join after that, your coverage will be effective the
first day of the month after the month you join. If you join a Medicare
prescription drug plan after May 15, 2006, you are likely to pay a higher
monthly premium unless you currently have a drug plan that covers at least
as much as a Medicare prescription drug plan. You will have to pay this
higher premium as long as you have a Medicare prescription drug plan.
How
much does it cost?
Like other insurance, if you join, you will pay a monthly premium
(generally around $37 in 2006) and a yearly deductible (up to $250 in
2006). You will also pay a part of the cost for your prescriptions,
including a copayment or coinsurance. Costs will vary depending on which
drug plan you choose. Some plans may offer more coverage and additional
drugs for a higher monthly premium. If you have limited income and
resources, and qualify for extra help, you may not have to pay a premium
or deductible.
When
can I get more information?
Detailed information about Medicare prescription drug plans in your area
will be available in the fall of 2005. Throughout 2005, Medicare will
provide general information to help you get ready, including how to choose
and join a plan that meets your needs. In the fall of 2005,
- you will get the "Medicare
& You 2006" handbook in the mail. It will list the
Medicare prescription drug plans available in your area.
- you will be able to get free
personalized information at www.medicare.gov
on the web, or by calling 1-800-MEDICARE (1-800-633-4227) to help you
choose the plan that meets your needs.
- you can get free personalized
counseling from your State Health Insurance Assistance Program (SHIP),
and other local and community-based organizations. Call 1-800-MEDICARE
to get the telephone number of the SHIP nearest you.
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