About
Medicare Benefits
What Is the Medicare prescription drug coverage benefit?
Beginning January 1, 2006, new Medicare prescription drug
plans will be available to people with Medicare. Insurance
companies and other private companies will work with Medicare
to offer these drug plans. They will negotiate discounts
on drug prices. These plans are different from the Medicare-approved
drug discount cards, which phase out by May 15, 2006, or
when your enrollment in a Medicare prescription drug plan
takes effect, if earlier.
Medicare prescription drug plans provide insurance coverage
for prescription drugs. Like other insurance, if you join
you will pay a monthly premium (generally around $35 in
2006) and pay a share of the cost of your prescriptions.
Costs will vary depending on the drug plan you choose.
Drug plans may vary in what prescription drugs are covered,
how much you have to pay, and which pharmacies you can
use. All drug plans will have to provide at least a standard
level of coverage, which Medicare will set. However, some
plans might offer more coverage and additional drugs for
a higher monthly premium. When you join a drug plan, it
is important for you to choose one that meets your prescription
drug needs.
When can I join a Medicare prescription drug plan?
If you currently have Medicare Part A (Hospital Insurance)
and/or Medicare Part B (Medical Insurance), you can join
a Medicare prescription drug plan between November 15,
2005, and May 15, 2006. If you join by December 31, 2005,
your Medicare prescription drug plan coverage will begin
on January 1, 2006. If you join after that, your coverage
will be effective the first day of the month after the
month you join. In general, you can join or change plans
once each year between November 15 and December 31.
Even if you don't use a lot of prescription drugs now,
you still should consider joining a plan. If you don't
join a plan by May 15, 2006, and you don't have a drug
plan that covers as much or more than a Medicare prescription
drug plan, you will have to pay more each month to join
later.
What if I can't pay for a Medicare prescription drug
plan?
Some people with an income at or below a set amount and
with limited assets (including your savings and stocks,
but not counting your 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 will be based on your income and assets.
Look for details in the mail from Medicare and the Social
Security Administration (SSA). If you think you qualify
for extra help, you can sign up with SSA or your local
Medicaid office as early as the summer of 2005.
Do Medicare prescription drug plans work with all types
of Medicare health plan?
Yes. 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. There will also be other drug plans that are
a part of Medicare Advantage Plans (like HMOs), in some
areas.
What if I already have prescription drug coverage from
a Medigap (Supplemental Insurance) Policy?
If you have a Medigap policy with drug coverage, you will
get a detailed notice from your insurance company telling
you whether or not your policy covers as much or more than
aMedicare prescription drug plan.This notice will explain
your rights and choices.
What if I have prescription drug coverage from an employer
or union?
If you have prescription drug cov04/14/2005ou will get a notice from your employer or union
that tells you if your plan covers as much or more than
a Medicare prescription drug plan.
If your employer or union plan covers as much
as or more than a Medicare prescription drug plan you
can…
- keep your current drug plan. If you join a Medicare
prescription drug plan later your monthly premium won't
be higher, or
- drop your current drug plan and join a Medicare prescription
drug plan, but you may not be able to get your employer
or union drug plan back.
If your employer or union plan covers less than
a Medicare prescription drug plan you can…
- keep your current drug plan and join a Medicare prescription
drug plan to give you more complete prescription drug
coverage, or
- just keep your current drug plan. But, if you join
a Medicare prescription drug plan later, you will have
to pay more for the monthly premium, or
- drop your current drug plan and join a Medicare prescription
drug plan, but you may not be able to get your employer
or union drug plan back.
When will I get more information?
Throughout 2005, Medicare will provide you more information
about Medicare prescription drug plans, including how to
choose and join a drug plan that best meets your needs.
In the fall of 2005, the "Medicare & You 2006" handbook
will list the Medicare prescription drug plans available
in your area.
In mid-2005, SSA will send people with certain incomes
information about how to apply for extra help paying their
prescription drug costs.
How can I get help choosing a Medicare prescription drug
plan?
In the fall of 2005, you will be able to get personalized
information at www.medicare.gov on the web, or by calling
1-800-MEDICARE (1-800-633-4227) to help you make your best
choice. TTY users should call 1-877-486-2048. Your State
Health Insurance Assistance Program (SHIP), and other local
and community-based organizations, will also provide you
with free health insurance counseling. |