Medicare.gov - Information on the Medicare Prescription Drug Coverage

Start Content

WANT TO LEARN MORE ABOUT THE NEW MEDICARE PRESCRIPTION DRUG COVERAGE?

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: