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QUESTIONS AND ANSWERS ABOUT MEDICARE DRUG COVERAGE
(1) What is Medicare
Prescription Drug Coverage?
(2) Am I eligible
for the Medicare Prescription Drug Plan Benefit?
(3) Should I enroll
in a Medicare Prescription Drug Plan?
(4) When can I enroll?
(5) What if I choose
not to enroll?
(6) Is there help
available if I can't afford a Medicare Prescription Drug Plan?
(7) When can I change
plans?
(8) Is the plan I
am on the best option for me?
(9) Is there anything
I can do to avoid the Coverage Gap (donut hole)?
(10) Where can I get
more information?
(1) What is Medicare
Prescription Drug Coverage? The Medicare Prescription Drug Benefit offers coverage for
brand name and generic drugs to anyone eligible for Medicare. Coverage is provided through private insurance plans, and you
can choose a plan that is right for you. You must enroll to get coverage. (2) Am I eligible
for the Medicare Prescription Drug Plan Benefit?
To be eligible for the Medicare Prescription Drug Plan benefit, an individual must be:
Entitled to Medicare Benefits under Part A and/ or enrolled in Part
B,
a resident
in the prescription plan's service area, not be enrolled in more than one Medicare Part D plan at a time during the Annual Enrollment Period of November 15 through
December 31 of each year, anyone eligible for Medicare Prescription Drug coverage may either enroll or switch their current
Medicare Part D plan. (3)Should I enroll in a Medicare Prescription Drug Plan?
Enrolling in a Medicare Prescription Drug Plan can save you money and
offer peace of mind, should your prescription drug costs rise in the future. You should enroll in a Medicare Prescription
Drug Plan unless your current drug coverage is as good or better than the Medicare prescription drug coverage available to
you. This is called "creditable" coverage. It's important that you join a plan when you are first eligible. You
should contact your current plan provider to determine if you have creditable coverage. If you are eligible for Medicare and
have Medicaid, you may be automatically enrolled in a prescription drug plan. Check with your State Medicaid Department for
more information. There
is a penalty for each month you delay in enrolling in a Part D plan once becoming eligible. (4) When can I enroll?
You have the opportunity to obtain
drug coverage when you become eligible for Medicare, during your Initial Medicare Enrollment Period. You can join a Medicare
drug plan: During your initial 7 month Medicare Enrollment Period (three months before and three months after
your 65th birthday) During the three months before and the three months after your 25th month of
disability , 63 days after your creditable insurance coverage ends or during the Annual Enrollment Period which
runs November 15th through December 31st each year. (5) What if I choose
not to enroll?
If
you're eligible, and don't sign up when you're first eligible, you may pay more. If you don't join a Medicare drug plan when
you're first eligible to join (during your Initial Enrollment Period), and there is a period of 63 continuous days or more
during which you don't have creditable prescription drug coverage, you may have to pay a late enrollment penalty when you
do join. This amount changes every year, but is approximately 1% of the plan's premium price for each month you delay in enrolling
for a plan. You will have to pay a penalty as long as you have Medicare Prescription Drug Coverage. (6) Is there help
available if I can't afford a Medicare Prescription Drug Plan? Some
people with limited income and resources will qualify for. If you qualify, Social Security will help you pay for premiums
and/or the cost of prescriptions. You can apply for at any time, and there's no risk to submitting an application. To determine
if you qualify, contact your local Social Security office, or visit .www.ssa.gov for more details. To qualify
for this subsidy in 2009, Medicare-eligible seniors must meet the following income guidelines:
Total assets
are not worth more than $11,990 for single persons Your combined savings, investments, and real estate are
not worth more than $23,970, if you are married and living with your spouse, or $11,990 if you are not currently married or
not living with your spouse. (7) When can I change
plans? The Medicare Prescription Drug Program has an Annual Enrollment
Period from November 15th - December 31st every year. You may change plans during this time. Dual eligible individuals with
both Medicare and Medicaid may change plans monthly, at any time throughout the year. (8) Is the plan I
am on the best option for me? If you are currently enrolled in a Medicare
Part D plan, you should think about a few things to decide if you are in "the right plan". Each year, plan premiums,
deductibles, prescription copayments, and annual out of pocket expense may change. Therefore, these costs, as well as the
list of covered drugs, vary from plan to plan and from region to region. You also need to remember that only the cost of Part
D covered drugs that are included on a plan's formulary count towards the deductible and out of pocket limits. You should take time to review the various plans available to you in your current and anticipated prescription
needs and financial resources. You may want to consider if there is a different plan available, other than your current plan,
which may be more suitable to your needs. (9) Is there anything
I can do to avoid the Coverage Gap (donut hole)? If
your drug plan has a coverage gap and you're concerned that you might have trouble meeting your prescription needs as a result,
the following are ways that might help you to avoid or delay in entering the gap and continue to save money on medications
while in the gap: Keep using your Medicare drug plan card, even while in the coverage gap. Using
your drug plan card ensures that you'll get the drug plan's discounted rates and that the money you spend is counted towards
your catastrophic coverage. Consider switching to generics, over-the-counter (OTC), or other lower-cost
drugs. Ask your doctor about generic or less-expensive brand-name drugs that would work just as well as the ones you're taking
now. Explore national and community-based charitable programs that might offer assistance. Comprehensive
information on Federal, state, and private assistance programs in your area. Look into Pharmaceutical Assistance
Programs that may be offered by the manufacturers of the drugs you take. Look at State Pharmaceutical Assistance
Programs (SPAP) to see if you qualify. Apply for the Extra Help benefit by contacting the Social Security
Administration at 1-800-772-1213. Additionally, the Annual Enrollment Period may be a good opportunity to seek whether an
alternate plan that provides gap coverage should be considered. (10) Where can I get more information? Every
October, Medicare recipients receive the Medicare & You handbook in the mail with more detailed information. This is a
good place to start.
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