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 This special "primer" provides updated information regarding the Medicare Prescription Drug Plans that will be available to your Medicare beneficiaries in 2006. You and your staff may want to take advantage of this “teachable moment” and help your Medicare patients!
This new benefit was established by the Medicare Modernization Act (MMA), which was enacted in 2003.
This new drug coverage requires every Medicare beneficiary to make a decision this fall. As a trusted source, your patients may turn to you for information about this new coverage. Help can be as simple as referring them to CMS beneficiary educational resources such as 1-800-MEDICARE and http://www.medicare.gov. It is important to encourage your patients to learn more about the new coverage as it may save them money on prescription drug costs.
The Basic Plan
Beginning January 1, 2006, new Medicare prescription drug plans will be available to all people with Medicare. Insurance companies and other private companies will be working with Medicare to offer these drug plans and negotiate discounts on drug prices. These plans are different from the Medicare-approved drug discount cards that phase out by May 15, 2006, or when a beneficiary’s enrollment in a Medicare prescription drug plan takes effect, if earlier. The cards offered discounts, while the plans offer insurance coverage for prescription drugs.
Medicare prescription drug plans provide insurance coverage for prescription drugs, and like other insurance plans, participating beneficiaries will pay:
• A monthly premium (generally around $37 in 2006), and
• A share of the cost of their prescriptions (with costs varying depending on the drug plan chosen by the beneficiary).
In addition, drug plans can vary depending on the following:
• What prescription drugs are covered,
• How much the beneficiary pays, and
• Which pharmacies the beneficiary can use.
All drug plans will provide a standard level of coverage which Medicare will set. However, for a higher monthly premium, some plans might offer more coverage, and additional medications.
When a Medicare beneficiary joins a drug plan, it is important that they choose one that meets their prescription drug needs. The following Qs and As provide key information that might be of interest to you, your staff, or your patient.
When can your patients enroll in this new plan?
If a beneficiary currently has Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance), the beneficiary can join a Medicare prescription drug plan between November 15, 2005, and May 15, 2006.
In general, a beneficiary can join or change plans once each year between November 15 and December 31. If they join a Medicare prescription drug plan:
• By December 31, 2005, their coverage will begin on January 1, 2006, and
• After December 31, 2005, their coverage will be effective the first day of the month after the month they join.
Even if a beneficiary does not use many prescription drugs now, they still should consider joining a plan. If they don’t join a plan by May 15, 2006, and they don’t have a drug plan that covers as much or more than a Medicare prescription drug plan, they will have to pay more each month to join later.
What if the Medicare beneficiary can not 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. The exact income amounts will be set in early 2005. 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 type of extra help received will be based on income and assets. If they think they may qualify for extra help, they can sign up with the Social Security Administration (SSA) or their local Medicaid office as early as the summer of 2005.
Will this new plan work with other Medicare coverage that your patients 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 HMOs), in some areas.
If a Medicare beneficiary has 1) a Medigap policy with drug coverage or 2) prescription drug coverage from an employer or union, they will get a detailed notice from their insurance company or the employer or union informing them whether or not their policy covers as much or more than a Medicare prescription drug plan. This notice will explain their rights and choices.
If a Medicare beneficiary’s employer or union plan covers as much as or more than a Medicare prescription drug plan, they can:
• Keep their current drug plan. If they join a Medicare prescription drug plan later, their monthly premium won’t be higher, or
• Drop their current drug plan, and join a Medicare prescription drug plan. However, they may not be able to get their employer or union drug plan back.
If a Medicare beneficiary’s employer or union plan covers less than a Medicare prescription drug plan, they can:
• Keep their current drug plan, and join a Medicare prescription drug plan to give them more complete prescription drug coverage; or
• Keep their current drug plan. However, if they join a Medicare prescription drug plan later, they will have to pay more for the monthly premium, or
• Drop their current drug plan and join a Medicare prescription drug plan. However, they may not be able to get their employer or union drug plan back.
Further Information
• In mid-2005, SSA will send people with certain incomes information about how to apply for extra help in paying for their prescription drug costs.
• The information contained in this article is based on a fact sheet for beneficiaries. To obtain a copy of this fact sheet for your patients, visit:
http://www.medicare.gov/Publications/Pubs/pdf/11065.pdf
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