Illustration by Christoph Niemann
|
Medicare Medicine: The Basics
By Karen Reyes, November & December 2005
Here's a handy tutorial to help you get the most out of the new prescription-drug benefit
|
Taken as a whole, the new Medicare prescription-drug benefit (also known as Medicare Part D) may seem a bit daunting. But if you break it down into its parts and decide which apply to you or your family members, the rest becomes a whole lot easier. First, you need to know what's going to happen when—and what you have to do now to make sure you choose a plan that works for you.
Key Questions to Answer
1. Are you eligible for Medicare Part D? This is the most basic question, and if you're currently receiving Medicare, the answer is yes. It doesn't matter how much money you make, where you live, or why you're receiving Medicare (for instance, you may have a long-term disability). The Medicare Part D benefit is voluntary and you cannot be denied coverage for any reason.
2. Is Medicaid paying for your prescriptions? If so, after December 31, 2005, your drugs will no longer be covered by Medicaid. Instead, your prescription benefits will be under Part D. Choose a Part D plan by that date, or Medicare will choose one for you.
3. Are you receiving Supplemental Security Income (SSI)? You'll also be covered by Medicare Part D. Your deadline for choosing a plan is May 15, 2006; otherwise, one will be assigned. (More key dates below.)
4. Do you have a Medigap plan that pays for prescriptions? If so, you can (1) choose another Medigap plan that doesn't cover drugs so you can sign up for Part D, (2) drop your Medigap plan's prescription coverage and sign up for Part D, or (3) keep your current Medigap plan with its prescription coverage. That's probably not the best choice, though, because your premiums will almost certainly increase as the Medigap prescription plans are phased out. And you'll probably be subject to a late-enrollment penalty if you go back to Medicare Part D later.
5. Do you have a Medigap plan that doesn't pay for drugs? Then don't worry, you can keep it. It won't change. You can sign up for Medicare Part D, if you choose.
6. Do you get help paying for prescriptions from a former employer or union? They'll be letting you know how the Medicare Part D benefit will work with their coverage.
7. Are you receiving prescriptions from the Department of Veterans Affairs (VA)? If so, you don't have to do anything. Your VA prescription benefits remain the same.
8. Are you a single Medicare beneficiary with income of $14,355 or less or a couple making $19,245 or less a year? Then you're probably eligible to get help paying for some of the Medicare Part D costs. Your assets must be less than $10,000 for an individual or $20,000 for a couple. (This does not include the value of your home, car, some earned income, or certain property related to burial expenses.) Higher incomes are allowed if you have dependent relatives living with you. If you received an application for limited-income help, fill it out. If you didn't and you think you might qualify, go (or send someone) to apply at your local Social Security Administration office, which manages the limited-income benefit. Or call 800-772-1213 or go to www.socialsecurity.gov. Note: if you're now receiving Medicaid or SSI, you'll automatically be signed up.
Things to Consider
- Make your choice There'll be national plans that'll provide coverage to people in all the states. And there'll be regional ones that will be available in only certain areas. Premiums and other costs will vary. Choose a plan that covers the drugs you use. Also make sure the drugstores and pharmacies that are part of the plan are convenient for you, or that you're able to order your prescriptions by mail, if you prefer. If the plan you like doesn't cover all of the drugs you use, talk to your doctor about changing prescriptions. If the doctor decides there's no substitute, he or she can request that the plan cover it.
- Consider the bottom line Individual Medicare Part D premiums will range from around $20 to $35 a month in 2006. You can have your premiums automatically deducted from your Social Security check, or you can be billed each month. Prescriptions aren't free. You'll pay some of the cost. It's not until you've paid about $3,600 out of pocket that the plans pay 95 percent of the costs. Before that they pay varying amounts, depending on the plan.
- Note the expiration date All Medicare-approved discount drug cards with the Medicare seal on them will expire when your Part D plan coverage begins, or on May 15, 2006, whichever happens first.
- Avoid the penalty With some exceptions, the penalty for late enrollment in Part D is a higher premium. An extra 1 percent of the average premium for each month that you delay is added to your premium, and it's permanent for as long as you have Part D coverage.
Dates to Remember
October 2005 Medicare starts mailing its official booklet, "Medicare & You 2006," to Medicare beneficiaries.
October 1, 2005 Companies begin advertising their Medicare-approved plans. To compare the plans you're eligible to sign up for, go to www.medicare.gov or call 800-633-4227.
November 15, 2005 First day you can enroll in a Medicare Part D plan.
January 1, 2006 First day you can use a Medicare Part D prescription-drug plan that you enrolled in before December 31, 2005. Otherwise, you can start using your plan on the first day of the month after you enroll.
May 15, 2006 The last day you can sign up for a Part D plan without a stiff penalty, unless you qualify for an exception. After that, you'll have to wait for the next open-enrollment period (November 15-December 31, 2006). If you're forced to change plans before that (for instance, you move out of the area), you can choose another plan.
For more information: Order AARP's booklets "The New Medicare Prescription Drug Coverage: What You Need to Know" (English D18350; Spanish D18352) and "The New Medicare Prescription Drug Coverage: Extra Help for People With Limited Incomes" (English D18351; Spanish D18353) by calling 888-687-2277. Log on to www.aarp.org. Call Medicare at 800-633-4227 or go to www.medicare.gov. And be sure to check out the November AARP Bulletin for additional articles about Medicare Part D.
Additional reporting by Brenda Casale.
|
