Return to non-screen reader version
Skip to Global Site Links
Start Content
TIPS AND TOOLS FOR PEOPLE WITH MEDICARE AND THOSE WHO CARE FOR THEM
For the first time ever, everyone with Medicare, regardless of income,
health status, or prescription drug usage, will have access to prescription
drug coverage. This new coverage begins on January 1, 2006. While information
is available now and educational sessions are taking place in communities
across the country, you can't enroll until November 15 th. By now, you
should have received your Medicare & You 2006 handbook which
explains in detail what prescription drug coverage means to you and which plans
are available in your area.
Medicare Advantage and Prescription Drug Plans have started their
advertising across the country.You may want to find out more about some of
these options. It might be a good idea to save these materials for review when
it gets closer to November 15, 2005.
America, Pull up a Chair
We've Got Something Good to Talk About.
Because this new coverage is so important, the Centers for Medicare &
Medicaid Services (CMS) wants to promote a national conversation to make sure
that all people with Medicare, and those who care for them, understand this new
coverage. This conversation will take place in many different places and in
many different ways – it will occur across the kitchen table, in senior
centers, at churches, between friends, neighbors, parents and their children,
pharmacists and their customers. Because this new coverage is a vital addition
to Medicare that will help people save money and live better, healthier lives,
it's important to have information about it. It will extend the promise of
modern drug treatment to everyone with Medicare. If you have Medicare, we
strongly urge you to learn more about this new coverage. Right now, you can
talk about this with many different people and start thinking about the
coverage you want. And, if you have family and friends with Medicare, we ask
that you help them learn more about it, too.
People are talking about Medicare prescription drug coverage right now in
many different settings. To provide additional help and places for these
conversations to occur, the Centers for Medicare & Medicaid Services (CMS)
has created more than 140 community-based education networks and is working
with nearly 10,000 local partners including the State Health Insurance Programs
(SHIP) and Area Offices on Aging all across the country. These networks and
partners provide a variety of services, from distributing materials to
educational meetings to personalized counseling for people with Medicare. To
help these groups and to help you, CMS has developed a variety of resources
such as consumer brochures, on-line tools, and educational materials.
All of the CMS materials and on-line tools are available now. They are
listed below as part of a four-step process to help you understand the process
of choosing Medicare prescription drug coverage. For each step in the process,
there's an on-line tool that can help you. Remember that Medicare
is here for you – 24/7 – at 1-800-MEDICARE. Our customer service
representatives will provide information and answers to your questions. Also,
visit www.medicare.gov , or contact 1-800-MEDICARE or www.eldercare.gov to find out about local
counseling and assistance available in your area.
Four Steps to Get Medicare Prescription
Drug Coverage
To help people with Medicare take advantage of the new Medicare prescription
drug coverage, there are four steps you can think about while making a
decision:
1. Getting Started
The decision to get Medicare prescription drug coverage depends on how you
pay for your drugs now and how you get your Medicare coverage. Most people with
Medicare pay for drugs and get their Medicare in one of five ways:
- Original Medicare only, or Original Medicare and a Medigap
(‘Supplement') Policy without drug coverage. The new Medicare drug
coverage will cover half of the costs for you if you have this kind of coverage
now. Enhanced options are available that provide more coverage.
- Original Medicare and a Medigap (‘Supplement') Policy with drug
coverage. The new Medicare drug coverage will generally provide much more
comprehensive coverage at a lower cost.
- Retiree or union coverage. In most cases, people with good retiree or union
coverage can continue to get it, with new financial support from Medicare.
- Medicare Advantage Plan (like an HMO or PPO) or other Medicare Health Plan,
which already include drug coverage and other extra benefits.
- Dual coverage from Medicare with Medicaid drug coverage. These people will
automatically get comprehensive prescription drug coverage from Medicare,
starting on January 1.
NOTE: If you have limited income and resources, but you don't have
Medicaid, you may qualify for extra help that may pay for about 95% of your
drug costs. Visit Extra Help for People with
Limited Income and Resources for more information.
Because the way that Medicare drug coverage works depends on your current
coverage, Medicare has specific information available to help you no matter
what type of coverage you have. These resources include the CMS brochure
What Medicare Prescription Drug Coverage Means to You: A Guide to Getting
Started and the Medicare & You 2006
Handbook that you got in the mail this fall. You can get the brochure
and other free Medicare publications by visiting www.medicare.gov or calling 1-800-MEDICARE. You should also look for
and review information from your current insurer about how your current
coverage will work with the Medicare prescription drug coverage.
2. Determining what matters most and reviewing plan
options
Once you decide that you want prescription drug coverage, think about what
matters most to you. There are a range of plan options available, so you can
focus on the kind of coverage you prefer. There are two ways you can get your
Medicare drug coverage.You can add drug coverage to the traditional Medicare
plan through a “stand alone” prescription drug plan. Or you can get
drug coverage and the rest of your Medicare coverage through a Medicare
Advantage plan, like an HMO or PPO, that typically provides more benefits at a
significantly lower cost through a network of doctors and hospitals. No matter
what type of plan you choose, you can choose a plan that reflects what you want
in terms of cost, coverage and convenience.
- Cost: What you pay for the coverage, including premiums,
deductible, and payments for your drugs.
- Coverage: What benefits are provided (like coverage in the
“coverage gap” and other coverage enhancements), which drugs are
covered and the rules (like prior authorization) for getting those drugs.
- Convenience: Which pharmacies are part of the plan and
whether the plan has a mail-order option.
The Centers for Medicare & Medicaid Services has created an online
resource, Landscape of Local
Plans . This resource helps you find Medicare prescription drug plans
by state or Medicare Advantage plans with prescription drug coverage by county.
It lets you see the plans in your area that offer drug coverage, including
basic information to help you find ones that meet your needs based on cost,
coverage, and convenience.
This is the first week that you can see drug plan data. Some of the features
of the Medicare Prescription Drug Plan Finder are not yet available. These
features will allow you to further personalize your search for a drug plan that
meets your needs. These features will be available well before you can choose
to enroll in a plan on November 15. Right now, it is important to get ready to
choose a plan by making a note of the drugs you take, the coverage features
most important to you, and any specific pharmacies you prefer to use. The
Landscape of Local Plans is a good resource for finding out about the plans in
your area to get ready to make a choice.
3. Choosing a plan
Beginning on November 15, people with Medicare can choose a prescription
drug plan. There are many ways to choose a plan. You may rely on advice from
people you know or trust, or choose a plan you are already familiar with, or
use the Landscape of Local Plans
located on medicare.gov to find a plan that meets your needs. All of the
plan options must meet or exceed Medicare's standards for coverage,
including coverage for medically necessary drugs.
If you want to make more specific plan comparisons based on what matters to
you, you can get personalized information from the Medicare
Prescription Drug Plan Finder . The Medicare Prescription Drug Plan Finder
can be accessed at www.medicare.gov , or through a customer
service representative at 1-800-MEDICARE, or through the many organizations
working with Medicare to help people take advantage of the new drug
coverage.
This is the first week that you can see drug plan data. Some of the features
of the Medicare Prescription Drug Plan Finder are not yet available. These
features will allow you to further personalize your search for a drug plan that
meets your needs. These features will be available well before you can choose
to enroll in a plan on November 15. Right now, it is important to get ready to
choose a plan by making a note of the drugs you take, the coverage features
most important to you, and any specific pharmacies you prefer to use. The
Landscape of Local Plans is a good resource for finding out about the plans in
your area to get ready to make a choice.
Once the Medicare Prescription Drug Plan finder is fully operational, it
will help you to personalize your search for a drug plan, and look at a
side-by-side, personalized comparison of up to three plans at a time so you can
find one that meets your needs. This list of plans provides a view of important
plan information so you can compare plans based on cost, coverage and
convenience.
- Cost: The Medicare Prescription Drug
Plan Finder will show you a list of drug plans in your area, sorted by the
plan with the lowest total cost for the drugs you take now. It can also help
you narrow down the choices based on deductibles or premiums.
- Coverage: The Medicare Prescription Drug
Plan Finder makes it easy for you to see what kind of coverage each plan
offers and it gives you personalized information on plans that might meet your
needs for you based on the coverage they offer and their other features.
- Convenience: The Medicare Prescription
Drug Plan Finder can identify plans that are accepted by your preferred
pharmacy and other nearby pharmacies, and plans that provide mail-order
prescriptions.
The Medicare Prescription Drug Plan Finder will also
help you if you aren't sure whether:
- You qualify for extra help paying for a Medicare drug plan,
- Your employer/union is continuing your current coverage with a Medicare
subsidy, or
- You are already enrolled in a Medicare Advantage Health Plan or in a
Medicare drug plan.
4. Enroll
You can enroll in a plan starting November 15. Medicare will have an online
Enrollment Center available on that date at www.medicare.gov. You can also
enroll by calling the plan's toll free number, by mailing in an application
to the plan, or by visiting the plan's website. Coverage begins January 1,
2006 if you join a plan by December 31, 2005. The deadline to enroll to get
coverage next year is May 15, 2006.
Other important information: If you work on behalf of a
group of people with specific drug needs (like people with Lupus), Medicare has
another tool that can help you. The Formulary Finder lets you enter a typical
combination of drugs used by people with a certain condition to find out which
plans in an area have formularies that cover these drugs.
Introducing Medicare’s New Coverage for Prescription Drugs (PDF 623.9 KB)
To view this fact sheet in another language, please choose from the list below:
For more information on partner resources and training, visit our Partner Center on
www.cms.hhs.gov.
|
|
|
The Official U.S. Government Site for People with Medicare
|
|
|