Medicare Part D- Prescription Drug Coverage
Effective January 1, 2006, Medicare prescription drug coverage will begin. This new plan is complicated and NAMI of Greater Chicago is attempting to provide simplified information and offer educational materials and programs for those who are affected to get the information they need to make the best choices. Below find a brief summary of this new program and on the back of this paper find a timeline. Please don’t hesitate to contact our office with questions at 312-563-0445.
(Sources: Mental Health Choices: Medicare, Spring 2005, Vol. 1/Issue 1 and Medicare Rx)
What will Medicare modernization mean to mental health consumers?
In December 2003, President Bush signed a new Medicare law. Before this, Medicare offered insurance for doctors and hospitals, but didn’t cover drugs. The new law says Medicare must offer prescription drug coverage to everyone who uses the program. Medicare will cover drugs through a permanent insurance benefit that begins in January 2006.
Private plans will provide the coverage for the program. Those who want to be covered will need to choose a plan. Those who now get Medicaid and Medicare (“dual eligibles”) will be automatically enrolled into a program and can change monthly if so desired. Other participants can change their plans only once each year.
Eligibility/Enrollment
· Must have Medicare Part A and/or Part B. (This is not for people with just straight Medicaid.)
· Enrollment in drug coverage is voluntary. (except for dual eligibles as noted above)
· Enrollment begins November 15, 2005, and continues through May 15, 2006.
Is this program right for you?
If you have no coverage for your medicines now, and do not sign up during the initial enrollment period, you may have to pay higher premiums if you enroll later on.
If you have drug coverage through a retiree plan, your spouse’s work, a union, or other program, you may keep that if you wish. If you decide to keep the plan you have, it is VERY IMPORTANT that you make sure your drug plan covers as much or more than a Medicare drug plan. If it does not, and then later you want to sign up for a Medicare drug plan, you may have to pay higher premiums. In October 2005, you can call Medicare (1-800-633-4227) to see if the plan you have now is as good as a Medicare drug plan. You will also get a notice from your employer or union that tells you your plan’s coverage.
If you have Medicare, but now get your medicines through Medicaid, you will also be asked to sign up for one of the new Medicare drug plans. If you don’t choose a plan this fall, you will be signed up for the new Medicare drug coverage automatically and a plan will be chosen for you. To learn more, call your local Medicaid office or call Medicare (1-800-633-4227).
Key Messages
· Medicare prescription drug coverage is available to all people with Medicare.
· There is additional help called “extra help” (see below) for those who need it most.
· Medicare prescription drug coverage pays for brand-name as well as generic drugs. (available drugs may vary depending on the chosen carrier)
· Look for a Medicare prescription drug plan that meets your needs.
· Medicare prescription drug coverage helps you pay for the prescriptions you need.
Extra Help (for Beneficiaries with Lower Incomes)
· Available to people with limited income and resources.
· Extra Help will help pay for all or most of the premium, deductible, and copayments (depends on income and resources).
· Full benefit “dual eligibles” (both Medicare and Medicaid) are “deemed” eligible for extra help and do not need to apply.
· Other limited income individuals will have to apply for the extra help.
· Those in long-term-care (LTC) facilities will have no cost-sharing.
· Apply through the Social Security Administration (SSA) 1-800-772-1213.
Choosing a Plan
Information from Medicare comparing available drug plans and coverage options will be distributed via mail, 1-800-MEDICARE, and the Plan Comparison Web Tool and Medicare Personal Plan Finder on www.medicare.gov in Mid-October.