MEDICARE NEWS

If you take prescribed medication AND are
Medicare-eligible, we have some information for you…

What is Medicare Part D?
Known as the most significant change to Medicare since its creation in 1965, the Medicare Part D program provides prescription drug coverage for Medicare-eligible beneficiaries. Insurance and private companies are working with Medicare to offer this program.

Who can participate?
Beginning January 1, 2006, all individuals with Medicare became eligible for prescription drug coverage. The annual election period begins November 15 and ends December 31 each year. During the annual election period, beneficiaries can select a health plan with or without prescription drug coverage. Beneficiaries do have one more chance to change their plan during the open enrollment period which runs January 1 through March 31 each year. There are enrollment rules and restrictions during both periods.

How will the program work?
Medicare-eligible individuals who wish to participate must choose a plan offering coverage that meets their needs, and then enroll. The Medicare Part D insurer will provide beneficiaries with a card to present to pharmacies. When filling a prescription, a pharmacist will review the card to determine the type of coverage the customer has and how much the out-of-pocket cost will be.

How much will it cost to participate?
While costs vary from plan to plan and income levels, the monthly premium national average is $27.35 per month, with varying annual deductibles. In general, participants can expect the program to work like typical health insurance coverage: beneficiaries pay a monthly premium, deductible and copayments. Customers will also pay a portion of the drug costs. Each plan offers varying costs on each, so it is important to review available plans carefully. For those who qualify, Extra Help is available with plans that pay substantial portions of expenses.

How many drug plans are there to choose from?
Medicare-eligible individuals have a variety of plans from which to choose. All plans offer varying monthly premiums, deductibles and copayments. Some plans offer prescription drug coverage only, while others offer coverage on a full range of Medicare services.

If I already have prescription coverage do I still need to enroll?
The Medicare Part D program is optional. Many individuals eligible for the program are already covered under health plans as part of retirement benefits. If current coverage is just as good as that offered by the Medicare drug plan, then retirees do not need to participate in the open enrollment period. If individuals lose their coverage later, they may enroll in Medicare Part D without a late penalty.

However, even if you have coverage as part of retirement benefits, it is wise to compare current coverage to what is offered by Medicare Part D. This program could save you money.

I heard about a late penalty. How much is it and when would it be applied?
The penalty is in the form of a higher premium for those who opt out of enrolling in a prescription drug plan, and then decide to pick up coverage later. Any individual who decides to participate in the drug program must enroll once they’re eligible to avoid a penalty. Otherwise, a late fee of one percent per month will be added to the monthly premium, should enrollment occur at a later date. There is no maximum for this penalty, and the beneficiary would continue to pay this late fee for as long as he or she continues to receive coverage.

For example: a five-year delay in enrollment would result in a 60 percent increase in the monthly premium at the time of enrollment.

What if I have limited income and can’t afford to pay the monthly premiums and out-of-pocket costs? Is there any Extra Help for me?
Absolutely. Extra Help will be available through Social Security for those with limited income and resources. In fact, those with Medicare who have incomes below certain levels will pay a lower or no premium or deductible for prescription drugs. It is important to remember, however, even if an individual qualifies for Extra Help, beneficiaries must still enroll in Medicare-approved prescription drug plans to obtain coverage and Extra Help. Social Security Extra Help applications are available online at www.socialsecurity.gov. Premium and copay assistance is also available from Illinois Cares Rx. Call the Senior HelpLine for program information.

How do I determine which plan is best for me?
It is important to make careful comparisons among the available plans. Yet before you begin comparisons, it is recommended to make a list of all prescriptions you currently take. Then review the plans to compare monthly premiums, deductibles and what drugs are covered.

I have a government-issued discount card. Can’t I just keep using it?
Discount cards issued by the government were a temporary measure provided while gearing up for Medicare Part D. The discount drug cards expired at the end of 2005 for those who enrolled in the prescription drug plan. For those who choose not to enroll in Medicare Part D, the card expired on May 15, 2006.

Where can I turn for more information?

• Health Alliance Medical Plans holds several informational meetings for the public. To learn more about the meetings, or to have questions answered, please call Health Alliance Medicare Services at
  (800) 965-4022 or visit www.HealthAllianceMedicare.org 

• Call 1-800-Medicare or visit www.medicare.gov

• Senior HelpLine at (800) 252-8966

• Senior Health Insurance Program at (800) 548-9034