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Click here for Blue Cross of California Medicare Part D plan information
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So you have heard about the new Medicare Prescription Drug Plan, called Medicare Part D, and now you need more information. The information contained on this page will help jump start your knowledge on this new plan so that you can make an informed decision on how to proceed. When and who is eligible The new Medicare Prescription Drug coverage begins on January 1, 2006. It is available to everyone who has Medicare. The type of coverage you get depends on your income.
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How the Part D
Plan Works
If your income is more than $14,355/individual or $19,245/couple With the new Medicare drug coverage, you will have:
The Coverage Gap (No Coverage - AKA "donut hole") Once your total drug cost is $2,250 (the amount you pay plus the amount the plan pays), you will have to pay the full price for your drugs until you spend $3,600 out of your own pocket (not including your monthly premium). This means that if you do not have any other drug insurance, you will pay approximately $5,100 out of your own pocket each year (this price includes your deductible, monthly premiums, your co-insurance and the money you spend after you reach $2,250 in drug costs). Catastrophic Coverage Once you spend more than $3,600, you will be eligible for what is called catastrophic drug coverage and will pay only 5% of prescription fees, or a $2 co-pay for generic drugs (whichever cost more). You will also have $5 co-pay for brand name drugs. |
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Important Dates
Medicare beneficiaries with yearly incomes between $12,920 and 14,355/year for an individual and $17,321 and 19,245/year for a couple in 2005, and with assets between certain limits, may qualify for one of the limited income partial subsidy programs. These programs will cover some of the out-of-pocket costs that Medicare beneficiaries with higher incomes will have to pay. Under the new Medicare drug coverage you will have:
**If you pay more than $3,600 out of your own pocket before the end of the year, your co-payment (the amount you pay for each drug) for any drugs you purchase will be no more than a $2 co-pay for generic drugs and $5 co-pay for brand name drugs. (Your premium payments are not included in the $3600.)
Medicare beneficiaries with annual incomes below $12,920/year for an individual and $17,321/year for a couple in 2005, and with assets below specified limits, may qualify for one of the limited income subsidy programs. These programs will cover most of the out-of-pocket costs that Medicare beneficiaries with higher incomes will have to pay. Under the new Medicare drug coverage you will have:
***Once you have spent $3,600 in annual drug costs, you will no longer have a co-pay. You will have to pay a premium each month for the Part D benefit. The premium for Part D is approximately $35-$37 a month. Each enrollee wishing to participate will have to elect the part D coverage and choose a corresponding Prescription drug plan (PDP) or a Medicare Advantage Plan (MA-PD).
FREQUENTLY ASKED QUESTIONS - Part D I have NO prescription coverage now, how do I enroll in Medicare Part D? The initial enrollment period will be November 15, 2005 to May 15, 2006, for people who are currently eligible or will become eligible in November and December of 2005 and January of 2006. You should receive an enrollment package from United States Social Security Agency in the early fall. For eve ryone else, the Initial Enrollment Period is similar to the Initial Enrollment Period for Part B.
Presently I am under a Medicare + Choice program (Part C). What changes can I expect with the new Medicare Part D Prescription plan? Medicare Pa rt C is being restructured to Medicare Advantage (MA) Plans. Medicare Advantage Plans are made available through private health care companies. Medicare Advantage Plans may be a HMO (Health Maintenance Organization), POS (Point of Service) plan, PFFA (Private Fee-For-Service) plan or PPO (Preferred Provider Organization). Each MA will offer varied benefits, depending on the plan you select. If you choose a MA that does not offer prescription drug coverage, you may participate in the Medicare Part D program.
I have prescription coverage through my employer -sponsored retirement plan. Do I need to enroll in Medicare Part D? This decision will have to be made once your former employer decides whether or not they are going to maintain coverage for retirees. Companies have the option to either maintain their current drug benefits, or to reduce or eliminate prescription drug coverage for Medicare-eligible beneficiaries. Employers must notify their Medicare eligible retirees prior to November 10, 2005 of their decision to discontinue, reduce or maintain drug coverage. Beneficiaries must compare the benefits available to them and select the option that best suits their needs.
I have both Medicare and Medicaid (with prescription coverage). Do I need to enroll in Medicare Part D? Beneficiaries who are dually eligible for both Medicare and Medicaid must enroll in Medicare Part D by December 31st, 2005. After that date, the Medicaid program will no longer provide prescription drugs for dual-eligibles. All other health related services you receive under Medicaid will continue. You will need to select a prescription drug plan (PDP) under Part D that best suits your medication needs. You will now have a co-payment on every prescription drug, which will be based on your income. There will be premium assistance available for low income beneficiaries. ■ Beneficiaries that are dually eligible for Medicare and Medicaid with assets of less than $2,000 for a single person and $3,000 for couples-
■ Beneficiaries below 135% of the poverty with higher assets ($6,000 for a single person and $9,000 for couples)-
■ Beneficiaries below 150% of pove rty level, not eligible for above programs, and have assets, excluding the home you live in, below $10,000 for a single person or $20,000 for couples-
Will I be penalized for not enrolling in Part D? If the beneficiary enrolling in Part D does not have credible drug coverage (defined as at least as good as Part D), then they will be penalized for not enrolling by May 15, 2006. Penalties take the form of increased monthly premium charges. Rates will be determined by the length of your delayed enrollment. If the enrollee does have credible coverage, he/she will be able to enroll in Part D at a later date with no penalty.
What about my current Medigap coverage? Will it continue to cover my prescription drugs? Medigap policies that include a prescription drug benefit will NOT be sold, issued or renewed as of 1/1/06. You will need to enroll in Medicare Part D or one of the Medicare Advantage Plans to have prescription drug coverage. Medigap will have plans K & L that will remain available, but will not provide prescription drug coverage. |
