Medicare Rx Info
Frequently
Asked Questions
How
does the Model 2009 Medicare Part D Plan Work?
Most basic or model Medicare Part D plans are broken down
into six main parts:
- Part 1 - The
initial $295 deductible - Some plans do not have an initial
deductible
and provide "first dollar coverage" -
- Part 2 - Coverage
- The plan provides the Medicare Part D Beneficiary with
co-insurance or medication co-payment.
Usually,
coverage
extends to a point where the total retail cost
of the medication
reaches $2,700 - however, some plans lower
this limit to $2,000 or even $1,850 (lower limits are used
to lower
monthly
premiums
for people with minimal medication needs.
- Part
3- The Coverage Gap or Donut Hole - Here is where the
Beneficiary pays 100% of their
Medication costs - Some
plans do provide partial or complete coverage for this gap in the
Medicare Part D coverage.
- Part 4 - Catastrophic
Coverage - When a person has spent more than $4,350 for
prescription
medications, they will be
protected by Catastrophic Coverage - here the cost of medications
is substantially reduced.
- Part 5 - Minimum Cost-sharing
in the Catastrophic Coverage Portion of the Benefit:
from $2.25 for generic or preferred drug that is a multi-source
drug and
$5.60 for all other drugs in 2008 to $2.40 for generics
and $6.00 for other drugs in 2009
- Part 6 - Maximum Co-payments below the Out-of-Pocket Threshold for certain Low Income Full Subsidy Eligible Enrollees: from $2.25 for generic or preferred drug that is a multi-source drug and $5.60 for all other drugs in 2008 to $2.40 for generics and $6.00 for other drugs in 2009
Who is eligible for Medicare prescription
drug coverage? All individuals with Medicare Part
A (Hospital Insurance) or Medicare Part B (Medical Insurance)
are eligible to enroll regardless of age, income or health
conditions. By looking at the front of your Medicare card,
you can verify if you have either or both Medicare Part
A and Part B.
How are the new Medicare drug plans that are starting in 2006 different from the Medicare-approved drug discount cards that are already available?
Medicare prescription drug plans are a new type of insurance
that can give you prescription drug coverage from Medicare.
These plans work like other insurance you may already have.
If you join one of these plans, you will pay a monthly premium,
and you will have to pay a copayment or coinsurance for each
prescription you fill. You will first be able to sign up
for one of these new plans beginning November 15, 2005.
How do I get a quote for Medigap (Medicare Supplement Coverage)?
Simply click here to request your quote! One of our Medigap
specialists will contact you at your convenience, or for
faster service call us toll free in Washington at 1-800-562-1399.
How will I benefit from this Medicare Prescription Drug Coverage?
• It provides you with insurance coverage for prescription
drugs.
•
It pays for both brand name and generic drugs.
•
It offers a choice of plans.
•
There is extra help for those who need it most.
As with other types of insurance, your monthly premium and
out-of-pocket costs may be different in different plans.
Drug plans can also vary based on:
•
What prescription drugs are covered;
•
How much you pay; and
•
Which pharmacies you can use.
All drug plans will provide a standard level of coverage,
which Medicare will set.
However, for a higher monthly premium, some plans may offer
more coverage and additional medications.
What should I consider when selecting a plan that’s right for me?
• Look over
your current health insurance coverage. Are prescription
drugs covered?
• Find out which pharmacies are available in your area to make
sure the pharmacies are convenient to you.
• Determine if the monthly fees work for you. What are your
out-of-pocket drug costs now?
• Keep a list of the name, dosage, and cost of the prescriptions
you use. Since different plans will cover different drugs,
this will help you choose a plan that meets your prescription
needs.
All these things are important to help you choose a plan.
What
happens if I don’t enroll in a prescription drug plan?
For most people, joining by May 15, 2006 means they will
pay a lower monthly premium than if they wait to join until
later.
Even if you do not use many prescription drugs now, you still
should consider joining a plan. Prescription drugs can heal,
cure, comfort, and even prevent. As we age and our medical
conditions change, our need for prescription drugs may increase.
Medical practice has come to rely more and more on new drug
therapies to treat chronic conditions and out-of-pocket spending
on prescription drugs has increased dramatically. Medicare
Prescription Drug Coverage makes it easier to pay for the
prescription drugs you need to stay healthy.
When can I enroll in a Medicare prescription drug plan?
If you currently have Medicare Part A (Hospital Insurance)
and/or Medicare Part B (Medical Insurance), you can join
a Medicare prescription drug plan between November 15, 2005,
and May 15, 2006. In general, you can join or change plans
once each year between November 15 and December 31.
If you join a Medicare prescription drug plan:
•
By December 31, 2005, your coverage will begin on January
1, 2006; and
•
After December 31, 2005, your coverage will be effective
the first day of the month following the month you join.
What
if I cannot pay for a Medicare prescription drug plan?
Some people with an income at or below a set amount and with
limited assets (including their savings and stocks, but not
counting their home) will qualify for extra help. People
who qualify will get help paying for their drug plan’s
monthly premium, and/or for some of the cost they would normally
have to pay for their prescriptions.
The Social Security
Agency (SSA) should have sent people with certain incomes
information about how to apply for extra help in paying
for their prescription drug costs in mid-2005. Those who
qualify,
should have received a notice to let them know that Medicare
prescription drug coverage is coming and that they will
get extra help without needing to apply for it. If you think
you may qualify for extra help, you can sign up with the
SSA or your local Medicaid office.
The Social Security
Administration
will mail a different letter to other people who do not
automatically qualify for the extra help but may be potentially
eligible
for it. The letter will include an application that people
can fill out and return to find out if they qualify for
extra help paying for a Medicare prescription drug plan.
What if I am currently getting prescriptions from Medicaid? What do I need to know?
• Your Medicaid prescription drug coverage is changing.
•
Medicare will start paying for your prescription drugs beginning
January 1, 2006.
•
The last day that your State will pay for your prescription
drugs is December 31, 2005.
•
You will have continuous drug coverage and pay a small amount
out of your own pocket.
•
You must compare your drug plan options and join a Medicare
prescription drug plan for Medicare to pay for your prescription
drugs.
•
You can join a Medicare prescription drug plan starting November
15, 2005.
•
If you don’t join a plan by December 31, 2005, Medicare
will enroll you in a plan to make sure that you don’t
miss a day of coverage.
•
Medicaid will still pay for your other health costs.
Will this new Medicare prescription drug plan work with other Medicare coverage that I may have?
Yes, Medicare prescription drug plans work with all types of
Medicare health plans, and there will be:
•
Medicare prescription drug plans that add coverage to the Original
Medicare Plan (these plans will be offered by insurance companies
and other private companies); and
•
Medicare prescription drug plans that are a part of Medicare
Advantage Plans (like PPOs, Private Fee-for-Service and HMOs,
etc.),in some areas.
What if I have a Medigap policy with drug coverage or prescription drug coverage from an employer or union?
You will get a detailed notice from your insurance company
or the employer or union informing you whether or not your
policy covers as much or more than a Medicare prescription
drug plan.
This notice will explain your rights and choices. If your
employer or union plan covers as much as or more than a Medicare
prescription drug plan, you can:
•
Keep your current drug plan. If you join a Medicare prescription
drug plan later, your monthly premium won’t be higher;
or
•
Drop your current drug plan, and join a Medicare prescription
drug plan. However, you may not be able to get your employer
or union prescription drug plan back.
If your employer or union plan covers less than a Medicare prescription drug plan, you can:
• Keep your current drug plan, and join a Medicare prescription drug plan
to give you more complete prescription drug coverage; or
•
Keep your current drug plan. However, if you join a Medicare prescription drug
plan later, you will have to pay more for the monthly premium; or
•
Drop your current drug plan and join a Medicare prescription drug plan. However,
you may not be able to get your employer or union drug plan back.
What if I live in a Nursing Home or a Long-term Care Facility?
• If you are not able to enroll on your own, an authorized representative
can enroll you in a plan that meets your needs.
• Some nursing homes and other long-term care facilities have their own
pharmacy.
• If you move into a nursing home or other long-term care facility, you
can switch Medicare prescription drug plans at that time if you choose to.
• If you are in a skilled nursing home getting Medicare-covered skilled
nursing care, your prescriptions generally will be covered by Medicare Part A.
• There is extra help for people with limited income and resources, including
people who have Medicaid health coverage and people who receive Supplemental
Security
Income.
• If you have full coverage from Medicaid, your prescription drugs stop
being covered by Medicaid, and start being covered by Medicare on January 1,
2006. You will
have continuous coverage.
• If you have full coverage from Medicaid and live in a nursing home, you
will pay nothing out of your own pocket.
• If you have full coverage from Medicaid and live in an Assisted Living
or Adult Living Facility, or a Residential Home, you will pay a small co-payment
for each
covered prescription drug.
How will I know if the drugs I currently take will be covered?
Each Medicare Prescription Drug plan will provide its own formulary or list of
covered drugs. This information will be available through the plan's website,
customer service center, and through marketing materials.
What
is a formulary?
A formulary is a list of medicines that any Medicare Prescription Drug plan covers.
Will
Part D cover drugs purchased from Canada?
No. Only drugs sold in the United States are eligible for Medicare Prescription Drug coverage.
Can premiums be deducted from Social Security checks?
Yes, you will have the option to have the premium deducted from your Social Security
check (just like your Part B premium). Or, you or your former employer can
pay your premium directly to your plan.
I
have drug coverage through the Veterans' Administration (VA).
Can I continue to get my prescriptions through the VA in 2009?
The introduction of Medicare prescription drug plans in January 2006 will have
no impact on Veterans' Administration benefits. If you currently have prescription
drug benefits through the VA, you will be able to continue to obtain your prescriptions
through the VA.
Where can I get more information?
Click here to go to our Medicare Supplement Resource Center. You
can review the informative guides “Medicare and You” and
Choosing a Medigap Policy, or Click here to go directly to our
Quote Request page. |
