Medicare Part D
Medicare started offering insurance
coverage for prescription drugs through Medicare prescriptions drug
plans and other health plan options. Medicare's prescription drug
coverage will typically pay over half of your drug costs, for a monthly
premium. It will also provide peace of mind because it protects you
once your out-of-pocket drug spending is more than $4,050 in 2008 and
$4,350 in 2009. Even if you don't use a lot of prescription drugs now,
you should consider joining.
Important points you need to know:
- Medicare prescription drug coverage helps you pay for the prescriptions you need.
- Medicare prescription drug coverage is available to all people with Medicare.
- There is additional help for those who need it most.
- Medicare prescription drug coverage pays for brand name as well as generic drugs.
Your Medicare Prescription Drug Coverage
Basic Information
What is Medicare prescription drug coverage?
Who can get Medicare prescription drug coverage?
When can I get Medicare prescription drug coverage?
How does Medicare prescription drug coverage work?
Why should I get Medicare prescription drug coverage?
What if I have a limited income and resources?
Things to Consider
Cost
Coverage
Convenience
Peace of mind now and in the future
What is Medicare prescription drug coverage?
Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription
drugs at participating pharmacies in your area. Medicare prescription drug coverage provides protection for
people who have very high drug costs or from unexpected prescription drug bills in the future.
Who can get Medicare prescription drug coverage?
Everyone with Medicare is eligible for this coverage, regardless of income and resources,health status, or current
prescription expenses.
When can I get Medicare prescription drug coverage?
You
may sign up when you first become eligible for Medicare (three months
before the month you turn age 65 until three months after you turn age
65). If you get Medicare due to a disability, you can join from three
months before to three months after your 25th month of cash disability
payments. If you don't sign up when you are first eligible, you may pay
a penalty. If you didn't join when you were first eligible, your next
opportunity to enroll will be from November 15, 2009 to December 31,
2009.
How does Medicare prescription drug coverage work?
Your
decision about Medicare prescription drug coverage depends on the kind
of health care coverage you have now. There are two ways to get
Medicare prescription drug coverage. You can join a Medicare
prescription drug plan or you can join a Medicare Advantage Plan or
other Medicare Health Plan that offers drug coverage.
Whatever plan you
choose, Medicare drug coverage will help you by covering brand-name and
generic drugs at pharmacies that are convenient for you.
Like other insurance, if you join, generally you will pay a monthly
premium, which varies by plan, and a yearly deductible. You will also
pay a part of the cost of your prescription, including a copayment or
coinsurance. Costs will vary depending on which drug plan you choose.
Some plans may offer more coverage and additional drugs for a higher
monthly premium. If you have limited income and resources, and you
qualify for extra help, you may not have to pay a premium or
deductible. You can apply or get more information about the extra help
by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or
visiting www.socialsecurity.gov..
Why should I get Medicare prescription drug coverage?
Medicare
prescription drug coverage provides greater peace of mind by protecting
you from unexpected drug expenses. Even if you don't use a lot of
prescription drugs now, you should still consider joining. As we age,
most people need prescription drugs to stay healthy. For most people,
joining now means protection from unexpected prescription drug bills in
the future.
What if I have a limited income and resources?
There is extra help for people with limited income and resources.
Almost 1 in 3 people with Medicare will qualify for extra help. If you
qualify for extra help, Medicare will pay for almost all of your
prescription drug costs. You can apply or get more information about
the extra help by calling Social Security at 1-800-772-1213 (TTY
1-800-325-0778) or visiting www.socialsecurity.gov..
Cost
Premium
There is a monthly cost you pay to join a Medicare drug plan. Premiums vary by plan.
Deductible
This is the amount you pay for your prescriptions before your plan starts to share in the costs.
Deductibles vary by plans. Some plans may not have any deductible.
Copayment/Coinsurance
This is the amount you pay for your prescriptions after you have paid
the deductible. In some plans, you pay the same copayment (a set
amount) or coinsurance (a percentage of the cost) for any prescription.
In other plans, there might be different levels or "tiers," with
different costs. (For example, you might have to pay less for generic
drugs than brand names. Or, some brand names might have a lower
copayment than other brand names.) Also, in some plans your share of
the cost can increase when your prescription drug costs reach a certain
limit.
Coverage
Formulary
A list of drugs that a Medicare drug plan covers is called a formulary.
Formularies include generic drugs and brand-name drugs. Most
prescription drugs used by people with Medicare will be on a plan's
formulary. The formulary must include at least two drugs in categories
and classes of most commonly prescribed drugs to people with Medicare.
This makes sure that people with different medical conditions can get
the treatment they need.
Prior Authorization
Some drugs are more expensive than others even though some less
expensive drugs work just as well. Other drugs may have more side
effects, or have restrictions ono how long they can be taken. To be
sure certain drugs are used correctly and only when truly necessary,
plans may require a "prior authorization." This means before the plan
will cover these prescriptions, your doctor must first contact the plan
and show there is a medically-necessary reason why you must use that
particular drug for it to be covered. Plans might have other rules like
this to ensure that your drug use is effective.
Coverage Gap
If you have high drug costs, you may consider which plans offer
additional coverage until you spend $4,050 in 2008 and $4,350 in 2009
out-of-pocket. In some plans, if your costs reach an initial coverage
limit, then you pay 100% of your prescription costs. This is called the
coverage gap. Some plans might offer some coverage during the gap. Even
in plans where you pay 100% of covered drug costs after a certain
limit, you would still pay less for your prescriptions than you would
without this drug coverage.
Convenience
Drug
plans must contract with pharmacies in your area. Check with the plan
to make sure your pharmacy or a pharmacy in the plan is convenient to
you. Also, some plans may offer a mail-order program that will allow
you to have drugs send directly to your home. You should consider all
of your options in determining what is the most cost-effective and
convenient way to have your prescriptions filled.
Peace of mind now and in the future
Even
if you don't take a lot of prescription drugs now, you still should
consider joining a drug plan. As we age, most people need prescription
drugs to stay healthy. For most people, joining now means you will pay
a lower monthly premium in the future since you may have to pay a
penalty if you choose to join later. You will have to pay this penalty
as long as you have a Medicare drug plan. If you reach the point where
you have spent $4,050 in 2008 and $4,350 in 2009 out-of-pocket for drug
costs during the year, the plan will pay most of your remaining drug
costs. This protection could start even sooner in some plans.