Medicare Prescription Program: Answering Your Questions

Janell Downing, PharmD
Published Online: Sunday, January 1, 2006

As shown in the box below, the deadline for enrolling in the Medicare Part D Prescription Drug Program for this year is May 15, 2006. For some people, however, the big issues still are "Should I enroll in Medicare Part D?"and "If so, how do I enroll?"The following questions and answers will guide you in understanding whether the program is right for you and how to enroll in it.

Do you currently have prescription drug coverage through your employer or through a retirement plan?

If the answer is yes, then the program you currently have most likely gives you better coverage than Medicare Part D can offer?unless you fall into one of the low-income categories. If you do, then Medicare Part D may be a good option for you. You must compare the monthly premiums and copays for your current plan with the monthly premiums and copays offered by the Medicare Part D low-income plan.

Your current plan must send you a letter that states whether its prescription coverage is "creditable"or "not creditable."Creditable means that your current prescription coverage is at least as good as the minimum benefit that Medicare has to offer. If your current coverage is creditable and you do not fit in the Medicare low-income category, you do not need to sign up for the new Medicare benefit. Be sure to keep this letter for your records, because you may need it in the future.

Although your current coverage may be much better than what Medicare can offer, you also must keep in mind that your insurance company may choose not to cover you in the future because you can be covered by the Medicare prescription drug program. At that point, when Medicare Part D is your only option, you may be faced with premium penalties for waiting to enroll. (The penalties are a 1% increase in the monthly premium for every month you delay in enrolling after you are eligible, unless you are still working and are covered by your employer's program.)

You will not be penalized as long as you have creditable coverage from your current insurance carrier. Your letter from your insurance company that describes your current coverage as creditable will be your proof to avoid any penalties from Medicare.

If you do not now have prescription drug coverage, then Medicare Part D is a great option for you. Your cost savings for drugs will vary, based on your income status and the number of medications you are taking.

Some people who are eligible for Medicare Part D may choose not to participate in the plan because they are currently not taking any prescription drugs. By not enrolling when they are eligible, however, they run the risk of much higher premiums if they have to take these drugs in the future.

Also, some people who are eligible for Medicare Part D presently receive prescription assistance through state programs or through pharmaceutical company programs. These programs are no longer offered to people who are eligible for Medicare Part D, starting in January 2006.

Now that you have decided to enroll, how do you enroll?

If you are eligible for both Medicaid and Medicare, you are automatically enrolled in the new program. Because you are automatically enrolled, you will not know what plan you have been assigned to. You will not have to know your new plan to receive coverage. Your pharmacy can look up your plan and process your prescription coverage for you. There should be no difference between your current Medicaid coverage and the new Medicare coverage.

For everyone else, enrollment began on November 15, 2005. Enrollment forms were sent out to all eligible people sometime in October. The forms also are posted on the Web at www.Medicare.gov.

To enroll in the program for 2006, you must fill out your enrollment form and send it back as soon as possible. If your income falls within certain limits and you have savings (or assets) of less than $10,000 (for single people) and less than $20,000 (for couples), then you qualify for the low-income assistance. You must complete the application for this benefit. If you are eligible for the standard benefit (with no limit on income or assets), you will have to complete the standard application.

The most difficult part of enrolling is deciding which plan within the Medicare Part D program to choose. The plans differ in the drugs that are on their list, or formulary. (Formulary means the drugs that the plan will cover.) To find the best fit, you must match the medications you are currently taking with a plan that covers the majority of your medications.

You will have to look at different plans individually. Then choose the plan that fits your budget, while also covering most of the medications that you are taking.

This part of enrolling can be very confusing. You should use any resources available to you to help you in this process.

Please contact any of the agencies listed below for further information about enrollment. Also, remember that your local pharmacist is a great resource for answers to questions about Medicare Part D.

Dr. Downing is a clinical pharmacist with Kerr Drug.




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