Medicare Part D Is Here! Enrollment opened last month for the Medicare Part D prescription drug program that was created by Congress in 2003. For those senior citizens enrolled in the program by Dec. 31, 2005, coverage will begin Jan. 1, 2006. If you join after that, your coverage will be effective the first day of the following month. The initial enrollment period ends May 15, 2006. If you join a Medicare prescription drug plan (plan) after May 15, you are likely to pay a higher monthly premium (penalty added for each month you delay). You may avoid a penalty if you currently have a drug plan from another source that covers at least as much as a Medicare drug plan.
In order to get this prescription coverage, you must choose and enroll in a plan that meets your needs. Coverage is not automatic. Here’s how you can get ready to take advantage of this new option. ∙
Look over your current health insurance coverage. Does it cover prescription drugs? What are your current out-of-pocket drug costs?∙Keep a list of the name, dosage, and cost of the prescriptions you use. Since different plans will cover different drugs, this will help you choose a plan that meets your prescription needs.∙
If you have a limited income ($14,355 or less for a single person with assets below $11,500; $19,245 or less for a couple with assets below $23,000), you should have received an Application for Help with Medicare Prescription Drug Plan Costs (SSA-1020) to get extra help paying for a Medicare prescription drug plan from the Social Security Administration (SSA). Generally, assets are anything that can be turned into cash in 20 days which would include your savings and stocks. Your home would not be counted. Millions of people will qualify for a Medicare prescription drug plan with little or no premiums or deductibles, and low co-payments. You might be one of them. If you have not received an application and your income and resources are below what was mentioned above, please call SSA at 1-800-772-1213 and request an application or drop by the local SSA office. Also, you can contact them by email at www.socialsecurity.gov. There is no deadline for this application to be completed. The sooner you find out if you are eligible, the more money you can save.∙
If you have prescription drug coverage through a former employer or union, check with your benefits administrator. Medicare prescription drug coverage may be different for you. If you decide to keep this other coverage, please do not enroll in a Medicare Part D plan. It may cancel your coverage with your former employer or union (could also include medical, vision and/or dental benefits).
If your income is not below the above-stated amounts, your costs for a plan will vary depending on which plan you choose. The premiums range from around $10 to $65 a month and a yearly deductible of up to the first $250 may apply (some plans have waived the deductible). You will also pay a share of your prescription drug costs up to $2,250. After that, you may have a coverage gap and have to pay all of the drug costs yourself until you reach out-of-pocket costs for drugs of $3,600. When you have paid $3,600 in out-of-pocket covered drug costs, you will then pay 5% of the costs and Medicare pays 95% of the costs for the rest of the year.
If you have not joined a plan, PLEASE CONTACT ONE OF THE AGENCIES LISTED BELOW TO GET A COMPARISON OF PLANS. You will need to have your Medicare number, effective date of Medicare coverage, date of birth, pharmacy you would like to use, and list of medications, along with name of drug and dosage on hand before you call or email. A few of our local pharmacies have told me they can or will provide the same assistance. It is likely that all pharmacies will not be enrolled as providers with all plans. Providers are encouraged to alert recipients to check with their preferred pharmacy to assure the pharmacy is a member of the network of the plan in which they are enrolling.
●Medicare: 1-800-633-4227 or www.medicare.gov
●CLAIM/Primaris, Inc.: 1-800-390-3330 or www.primaris.org
●Northwest Area Agency on Aging: 1-888-844-5626 or nwmoaaa.albanymo.net
After you have given them the above information, they will use a plan finder tool to process your personal information. Plan selection will be narrowed down to the three most advantageous plans for you and enrollment information will be provided. They will mail you this information; remember they are helping many folks, so it may take a few weeks. These agencies cannot tell you which plan to choose. Once you have decided which plan to enroll in, contact that plan and request an enrollment packet. You can also enroll through that plan’s website or through www.Medicare.gov. You can pay for the plan one of three ways:
1) Deduction from your Social Security check.
2) Automatic withdrawal from your checking account.
3) Direct payment to the insurance plan.
Important Notice to Medicaid Recipients and Providers: The Division of Medical Services has been notified that Medicare has mailed an auto-enrollment notice on yellow paper to people with Medicare and Medicaid coverage which informs them about the change in their drug coverage from Medicaid to Medicare. The notice explains the following:
▸starting Jan. 1, 2006, Medicare will provide their prescription drugs through the Prescription Drug Plans instead of Medicaid;
▸recipients with Medicare and Medicaid coverage have been randomly auto-enrolled in a plan. They may change that plan anytime prior to Jan. 1, 2006, and every month thereafter if they choose. The plan you are auto-enrolled in may not be the best plan for you. There may be another plan that covers your prescription drugs better;
▸the name of the plan in which Medicare has auto-enrolled them; and
▸their costs in the plan (which, for dual eligible individuals, should be the co-pay associated with the prescription).
Recipients who have additional questions may call the Medicaid Recipient Services Unit at 1-800-392-2161, Option 2.
If you have any questions regarding the above information, please contact Medicare, CLAIM/Primaris, Inc., or the Northwest MO Area Agency on Aging (numbers listed above). I realize this is a very complex situation, however, I sincerely hope you can work through it or get someone to assist you.
