Medicare Part D Prescription Drug Plans

Article submitted by Advanced Pharmacy Services,
For more information, they can be reached at 866-751-5797.

If you are confused --you are not alone. There is some good news... help is available! CMS (Centers for Medicare & Medicaid Services) has allocated $400 million to educate seniors on the prescription drug program.

What do I need to know...?

Who can join?

Anyone with Medicare Part A and/or B can join a Medicare prescription drug plan offered in their area. If you are in a Medicare Advantage Plan (like an HMO or PPO), your plan may also offer drug coverage.

When can I join?

If you have Medicare Part A and/or Part B, you can join a Medicare prescription drug plan between November 15, 2005 and May 15, 2006. Your Medicare prescription drug coverage will begin the first day of the month after the month you join. If you do not join a Medicare prescription drug plan by May 15, 2006, you will have to wait until November 15, 2006 to join and will most likely pay a higher premium. You will have to pay this higher premium as long as you have a Medicare prescription drug plan.

How much does it cost?

If you join, your costs will vary depending on which plan you choose. In general, you pay a monthly premium (generally $37 in 2006) and a yearly deductible (up to the first $250 in 2006). You will also pay a share of your prescription drug costs, and your plan pays a share. Medicare helps pay for costs up to a limit ($2,250 in total). From $2,251 - $5,100 you pay 100%. Above $5,100 you pay 5% of the costs and Medicare pays 95% of the costs for the rest of the year.

Drug Costs	What Beneficiaries Pay	What Medicare Pays	Cost for Beneficiary (Total)
First $250 (Deductible)	100%	Nothing	$250 ($250)
$251 - $2,250	25%	75%	$500 ($750)
$2,251 - $5,100	100%	Nothing	$2850 ($3,600)
Above $5,100	$2 for generic drugs, $5 for brand name, or 5% of the drug cost (whichever is greater)	95%	$3,600 plus $2 for generic drugs, $5 for brand name, or 5% of the drug cost (whichever is greater)

What if I already have prescription drug coverage?

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.

Extra help my be available 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 for a single person or $19,245 for a married couple living together, and your resources are less than $11,500 for a single person or $23,000 for a married couple living together.
You can apply for this extra help through the Social Security Administration or your State Medical Assistance Office. Social Security is mailing the application for extra help to people with limited incomes and assets whom they believe may qualify. If you receive an application, fill it out and return it in the enclosed postage paid envelope.
After you apply, Social Security will review your application and send you a letter to let you know if you qualify for extra help.

How can I get more information?

For information on how you can get extra help with prescription drug costs and how to apply call SSA at 1-800-772-1213 or visit www.socialsecurity.gov. You can also call 1-800-Medicare (1-800-633-4227) or visit www.medicare.gov. TTY users should call 1-877-486-2048.You can also get free personalized counseling from your State Health Insurance Assistance Program (SHIP), and other local and community-based organizations. Call 1-800-Medicare to get the telephone number of the SHIP nearest you.

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