Medicare Part D Patient Information
Medicare’s new prescription benefit also called Medicare Part D will begin on January 1, 2006. As the enrollment process progresses, you may have questions regarding which plans will best cover your therapy needs. Hopefully we are able to provide you with answers to questions that you may have.
Q: Can I have my prescription filled at Hapeth if I haven’t had them filled there before?
A: Yes. New patients are always welcome. We will ask you several questions about your address, phone number, date of birth, drug allergies, medications you're currently taking and your health insurance information.
What is Medicare prescription drug coverage?
A: It is an insurance provided by private companies that have been approved by Medicare. Starting Jan. 1, 2006, new Medicare prescription drug coverage will be available to anyone eligible for Medicare. It is important to note that joining a plan is your choice. What if I already have prescription coverage?
A: Talk to your plan, benefits administrator, or insurer before making any changes. You will be notified about any changes in you current coverage so you can compare plans and decide if you should join a Medicare drug plan.
Should I join a Medicare drug plan even if I don’t take many prescription drugs?
A: You should consider joining a Medicare drug plan in 2006. For most people, joining now means you will pay the lowest possible monthly premium.
When can I sign up for a Medicare drug plan?
A: The first time to sign up for is November 15, 2005 to May 15, 2006. If you sign up before Dec. 31, 2005, your coverage will start Jan. 1, 2006. If you sign up after Jan 1, 2006, you coverage starts the first day of the month following the month you sign up. If you sign up after May 15, 2006, your coverage may not start until 2007. In most cases, if you don’t sign up by May 15, 2006, and you don’t currently have a plan that covers, on the average, at least as much as standard Medicare prescription coverage, you will have to wait until November 15, 2006 to sign up. When you do sign up, your premium cost will go up at least 1% per month for every month that you waited to sign up. You must pay this penalty as long as you have Medicare prescription drug coverage.
When can I join if I miss the May 15, 2006 deadline?
A: You can join Nov. 15 – Dec. 31 of each year. Your coverage would begin Jan 1 of the following year. If you choose not to join when you are first eligible and later change your mind, you may have to pay a penalty.
How do I join a Medicare prescription drug plan?
A: You will receive information from Medicare, as well as Medicare approved drug plans. Compare these plans carefully. Check if your prescription drugs are covered. Compare the level of coverage and your monthly premiums. This information will help you choose a plan.
By paper application – Contact the company offering the drug plan you choose and ask for an application. Once you fill out the form, mail it or fax it back to the company.
On the plan’s Web site – Visit the drug plan company’s Web site. You may be able to join online.
By phone – You can join a drug plan by calling 1-800-MEDICARE (1-800-633-4227)
and talking to a Medicare customer service representative. TTY/TDD users should call 1-877-486-2048. Or call LinkAge Line at 1-800-333-2433. How much will prescription drug coverage cost me?
A: When you receive Medicare prescription drug coverage, you will pay part of the costs and Medicare pays part of the costs. You will pay a premium every month to join the drug plan. If you have Medicare part B, you will also have to pay your monthly Part B premium. Your costs will vary depending on which plan you choose. Your plan must, at a minimum, provide a standard level of coverage as shown below. Some plans offer more coverage or lower premiums.
What is standard coverage (the minimum coverage drug plans must provide)?
A: If you join in before May 15, 2006 for covered drugs you will pay:
1. A monthly premium (varies depending on the plan you choose, but estimated $32 to $37 per month in 2006),
2. A deductible, the first $250.00 of your covered drug costs each year.
3. After you meet the deductible, you pay 25% of the next $2000 of drug costs (you pay $500 and the government pays $1500)
4. You then pay 100% of the next $2850 of your drug costs. This is known as the “coverage gap”.
5. After you have paid a total of $3,600 out of your pocket ($250 + $500 + $2,850), you pay only 5% of your prescription costs through the end of the year and the plan pays the rest.
What happens if I choose not to join a Medicare drug plan by May 15, 2006? Can I join later?
A: If you don’t join a plan by May 15, 2006 and you don’t currently have a drug plan that, on average, covers at least as much as standard Medicare prescription drug plan coverage, you will have to wait until Nov. 15, 2006 to join. When you do join, your premium cost will go up at least 1%per month for every month that you wait to join the plan. Like any other insurance, you will have to pay this penalty as long as you have Medicare prescription drug coverage. If you join after May 15, 2006, the next open enrollment period is Nov. 15, 2006 to Dec. 31, 2006. However coverage for people who enroll during this period will not take effect until Jan. 1, 2007.
How do I pay for the coverage?
A: You can give permission to the company that offers the Medicare drug plan you choose to deduct the premium automatically from your bank account, or
You can have your premium deducted every month from your Social Security benefits, similar to your premiums for Medicare Part B, or
You can pay the prescription drug plan directly for your monthly premium by mailing them a check or money order each month.
Will Medicare drug plans cover drugs that treat mental illness?
A: Yes. Medicare drug plans will include drugs in all disease categories. They must also have an appeals and exceptions process. That process must include ways to help individuals who have trouble handling the process themselves.
Are any drug categories not included in Medicare prescription drug coverage?
A: Certain drugs are excluded, which means that they can’t be provided as part of standard Medicare prescription drug coverage, however, a plan may choose to cover excluded drugs if the plan offers more than standard coverage. Some examples of excluded drugs include benzodiazepines, barbiturates, drugs for weight loss or gain, drugs to promote fertility, drugs used for cosmetic purposes or for hair growth, and non-prescription drugs.
What if I have current drug coverage?
A: Medicare will help employers and unions continue to provide retiree drug coverage that meets Medicare standards. Your (or your spouse’s) former of current employer or union will send you information about how your current coverage compares to the Medicare standard prescription drug coverage by November 15, 2005. This information is important because it can effect the decision you will need to make this fall about if and when you sign up for Medicare prescription drug coverage.
If your (or your spouse’s) employer or union has determined that your current coverage,
on the average, is at least as good as the Medicare standard prescription drug coverage (called creditable prescription drug coverage): you can keep it as long as it is still offered by your employer or union, and you don’t have to pay a penalty if you employer or union stops offering prescription drug coverage as long as you join a Medicare drug plan within 63 days after the coverage ends – even if you join after May 15, 2006.
If the current coverage has been determined to be, not at least as good as, the standard Medicare prescription drug coverage, if you want to join a plan, you must join by May 15, 2006 to avoid a penalty.
CAUTION: If you drop your employer or union coverage, you may not be able to get it back. You also may not be able to drop you employer or union drug coverage without also dropping your employer or union health coverage. If your employer’s union plan is not as good as Medicare prescription drug coverage, find out about your options from your benefits administrator. You may be able to keep your current employer or union drug plan and join a Medicare drug plan to give you more complete prescription drug coverage, or only keep your current employer or union drug plan. But, if you join a Medicare drug plan after May 15, 2006, you may have to pay a penalty. What do I need to know if I have coverage from TRICARE, the Department of Veteran’s Affairs (VA), or the Federal Employee Health Benefits Program (FEHB)?
A: As long as you still qualify, your TRICARE, VA, or FEHB prescription drug coverage is not changing. Contact your benefits administrator before making any changes. If you lose your coverage you have 63 days to join a Medicare plan without penalty.
What do I need to know if I have full coverage from my state Medicaid program?
A: Your Medicaid prescription drug coverage is changing. Medicare, not Medicaid will start paying for your prescription drug coverage starting Jan. 1, 2006. Medicaid will still cover other care that Medicare doesn’t cover. You will have continuous Medicare prescription drug coverage and in most cases, will pay a small amount out of your pocket. Compare coverage and choose a plan. Medicare will let you know the plan it has picked for you in October 2005, but you can still compare plans and choose another plan by Dec. 31, 2005. Medicare will enroll you in the plan it has picked to ensure that you don’t miss a day of coverage. If you decide you want another plan you can switch to another plan without a penalty.
What do I need to know if I have Medicare Part A and B and don’t have prescription drug coverage?
A: To have Medicare help pay for your medication you must join a plan that has Medicare prescription drug coverage. You can choose and join a plan that fits your needs. If you don’t use a lot of prescription drugs now, you should still consider joining.
Information for people with limited income and resources:
People with limited income and resources may qualify for extra help paying for Medicare prescription drug costs. The amount of extra help you get is based on your income and resources. You may qualify if your income is less than $14,355 if you are single and $19,245 if you are married living together and your assets are less that $11,500 if you are single and $23,000 if you are married.
The size of your family can also affect whether you qualify based on income. If you think you qualify and need as application contact the Social Security Administration at 1-800-772-1213 or visit www.socialsecurity.gov on the Web, visit the local Social Security office or contact Senior LinkAge Line at
1-800-333-2433. How do I know if the drugs that I am currently taking are covered?
A: Each Part D plan will provide its own formulary or list of covered drugs. This information will be available through the plan’s Web site, customer service center or through marketing materials. All Part D plans must meet formulary requirements set by Medicare. The formulary will include both generic and brand name drugs.
Each plan must use a Pharmacy and Therapeutics Committee which includes doctors and pharmacists to establish its formulary. This process assures you that you’ll have access to a number of drugs, although not necessarily all drugs. To help compare plans
Part D information can be found on the official Medicare web site at www.medicare.gov . Select “Search Tools” at the top of the screen. Then choose “Learn More About Your Medicare Prescription Coverage Options.” Or call 1-800-MEDICARE (1-800-633-4227). Follow the instructions to speak to a customer service representative who can help you get personalized information. TTY/TDD users should call 1-877-486-2048.
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