Effective January 1, 2006, private companies will offer Medicare prescription drug coverage (Medicare Part D), insurance that covers brand name and generic prescription drugs at participating pharmacies in your area. Everyone who has Medicare is eligible.
How can you get Medicare prescription drug coverage?
If you want coverage, you must choose to join a Medicare prescription drug coverage plan. The first day you can join is November 15, 2005. If you join between November 15, 2005 and December 31, 2005, the Medicare prescription drug coverage begins January 1, 2006.
What is the last day you can join a plan and have Medicare prescription drug coverage in 2006?
The last day you can join a plan and still have Medicare prescription drug coverage in 2006 is May 15, 2006.
What if you do not join a Medicare prescription drug plan by May 15, 2006?
If you want to join after May 15, 2006, the next open enrollment period is November 15, 2006 to December 31, 2006. Coverage for people who enroll during this period will not take effect until January 1, 2007. November 15 to December 31 will be the open enrollment period each year.
If you do not currently have a drug plan that, on average, covers at least as much as standard Medicare prescription drug coverage, and you decide to join after May 15, 2006, your premium cost will go up at least 1% per month for every month that you wait to join. You will have to pay the penalty as long as you have Medicare drug coverage.
Are all drugs covered?
Medicare drug plans do not have to cover every drug that is included in Medicare prescription drug coverage. They only have to cover every type of drug. You should review what drugs are covered by the Medicare drug plans available in your area and try to join one that covers the same prescriptions you take now.
If the plan does not cover your exact prescriptions, the plan is required to have a transition period where your current drugs may be covered for a certain length of time while you work with your doctor to find an alternative prescription drug to take that is covered by the plan.
If your doctor believes you need to take your current prescription drug and should not switch to a covered prescription drug, you or your doctor can contact your plan and ask for an exception. If the plan refuses to give you an exception, you can appeal the decision.
How will you know what Medicare prescription drug plan options are available in your area?
In October 2005 you received the Medicare & You handbook in the mail and information about plans in your area. Community events will also be scheduled to help familiarize you with your options.
You can look under the Search Tools option on the Medicare website for detailed information about the plans available in your area.
Will you be able to switch your Medicare prescription drug plan?
If you join a Medicare prescription drug plan, you can only change plans under certain circumstances:
All Medicare prescription drug plans must offer what is called "standard coverage". What is standard coverage?
If you join a plan which is effective in 2006, you will pay the following for covered drugs if you have standard coverage:
Are the Medicare prescription drug cards the same as the Medicare-approved drug discount cards that became available in May 2004?
No, the Medicare-approved drug discount cards were offered as a transition step to help people with Medicare save money on prescription drugs until Medicare prescription drug plans became available.
If you are still confused about Medicare prescription drug plans where can you get more information?
You can call 1-800-MEDICARE or go to Medicare. Take into consideration your current drug regimen and current insurance coverage when choosing. Do you have Original Medicare, Medicare Advantage Plan, Medigap? Do you have other drug coverage? Do you have low income which may qualify you for extra help?
Related Resources
Sources: Medicare.gov, Medicare Rx Education Network
