Medicare Part D

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Medicare :

Forty years after Medicare began providing coverage for hospital stays and doctor visits for those 65 and older, part of the cost of prescription drugs can also be paid for beginning January 1, 2006. In the coming weeks, Medicare recipients will begin receiving extensive information from Medicare and from insurance companies offering this new coverage.

During the month of October, each Medicare recipient will receive the official government handbook “Medicare & You 2006” in the mail. This book contains important information about all aspects of Medicare coverage, including the Medicare drug plans.

Medicare recipients should understand that, except for very low income individuals, enrollment in a prescription drug plan will not be automatic. Several decisions will need to be made: whether or not to enroll in a plan, how much you are willing or able to pay out of pocket for prescription drugs, and how much you are willing or able to pay for the prescription drug insurance coverage. Decisions made now could affect your costs for years to come, so it is important to gather as much information as possible.

Enrollment in any Medicare drug plan will not be allowed until November 15, 2005. Those who enroll by December 31, 2005 will have coverage beginning January 1, 2006. If you do not opt for prescription drug coverage by May 15, 2006, you will have to pay a late enrollment penalty to get drug coverage later.

In an effort to help Medicare recipients, their children and caregivers understand the options available and the consequences of prescription drug coverage decisions, Maury River Senior Center and Valley Program for Aging Services are working to provide information as quickly as it is available. Pharmacist Brian Morris will speak on “Medicare Part D From a Pharmacist’s Point of View” at noon on Friday, October 21 at the Senior Center located at 2137 Magnolia Avenue in Buena Vista.

MRSC is seeking volunteers willing to participate in a two-hour training session and to meet with Medicare recipients at the Senior Center by appointment to help individuals understand their options in this new program. To volunteer, call Jeri Schaff at the Senior Center, 261-7474. Watch for upcoming announcements about availability of one-on-one and group educational assistance.

The basic facts about Medicare prescription drug coverage include:

• It is insurance that covers both brand-name and generic prescription drugs at participating pharmacies. However, not all medications will be covered by every plan.
• Different insurance companies will offer different plans. Some plans will have very low monthly premiums, with higher deductibles and co-payments. Others will have higher premium costs and lower out-of-pocket expenses.
• If you receive medications from your doctor’s office, the Free Clinic, or a discount drug care already, you may still need to join a Medicare drug plan.
• Joining a Medicare plan that covers prescription drugs is voluntary. If you want coverage, you must choose to join a plan to receive it.
• If you choose not to join a plan when you are first eligible and later change your mind, you may have to pay a late enrollment penalty.

If you choose to join a Medicare drug plan, you should be aware that some key factors will vary among the plans available to you. These factors are coverage, cost, convenience and peace of mind. Some of these factors might be more important to you than others, depending on your situation and your drug needs. 

Coverage :

The list of drugs that a Medicare drug plan covers is called a formulary. Formularies include generic drugs and brand-name drugs. Each Medicare drug plan will offer different formularies, but must include at least two drugs in categories and classes of the drugs most commonly prescribed to people in Medicare.

Some drugs are more expensive than others, may have certain side effects, or have restrictions on how long they can be taken. To be sure that certain drugs are used correctly and only when truly necessary, plans may require a “prior authorization.” This means before the plan will cover these prescriptions, your doctor must first contact the plan and show there is a medically-necessary reason why you must use that particular drug for it to be covered.

Cost :

The monthly cost you will pay to join a Medicare drug plan is called the premium. For the plans being offered to Virginia residents, monthly premiums will range from just under $10 to nearly $60. In addition, you may be required to pay for some of your prescriptions in full before your plan starts to share in the costs. The amount you are required to pay is called an annual deductible. The deductible amount ranges from $0 (usually for a higher monthly premium) to a maximum of $250 per year, depending on the plan.

The amount you will pay for your prescriptions after you have paid the annual deductible is called a co-payment (a set amount) or coinsurance (a percentage of the cost). In some plans you will pay the same co-payment or coinsurance for any prescription. In other plans there might be different costs to you depending on whether the prescription is for a generic or brand-name drug. In many plans your share of the cost can increase when your prescription drug costs reach a certain limit.

The Medicare drug plan includes a coverage gap that begins when the total cost of your prescriptions in one calendar year, whether paid for by you or your drug plan reaches $2,250. Until the total paid by you reaches $3,600, most plans offer limited or no coverage for your prescriptions.

For those Medicare recipient with limited income and assets, extra help may be available to pay the monthly premiums, and in some cases, the annual deductible and co-payments. Many lower income Medicare recipients have already received a mailed application for extra help. If you received this application, fill it out and send it back to the Social Security Administration as soon as possible. If you did not receive an application but think you might qualify, call 1-800-772-1213 to request one. Extra help applications are also available at Maury River Senior Center.

Convenience :

Medicare drug plans must contract with pharmacies in your area. Check with the plan to make sure your pharmacy or a pharmacy in the plan is convenient to you. Some plans may offer a mail-order program that will allow you to have your prescriptions sent directly to your hope. You should consider all of your options in determining what is the most cost-effective and convenient way to have your prescriptions filled.

Peace of Mind :

Even if you don’t take a lot of prescription drugs now, you should still consider joining a drug plan in 2006. As we age, most people need prescription drugs to stay healthy. For most people, if you do not join a drug plan when you are first eligible to do so, you may have to pay a penalty if you choose to join later. You will have to pay this penalty as long as you have a Medicare drug plan.

Enrollment in any Medicare drug plan will not be allowed until November 15, 2005. Those who enroll by December 31, 2005 will have coverage beginning January 1, 2006. If you do not opt for prescription drug coverage by May 15, 2006, you will have to pay a late enrollment penalty to get drug coverage later.

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