Medicare Prescription Drug Coverage is a complicated program, and counseling for patients is beyond the ability of any doctors' office to provide.  (We have trouble understanding it ourselves)

 

Instead, Medicare and it's Center for Medicare and Medicaid Services (CMS) recognizes that Medicare itself must provide the one-on-one counseling participants will need to make good decisions.  To that end, Medicare and CMS have asked doctors to give their patients the information below to determine the right plan for their needs. 

 

Included is information from several different Medicare publications, so there is some repetition.

 

                                                           Your Providers at Deer Park Family Doctors

 

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Information from Medicare:
Medicare Prescription Drug Coverage

When can patients enroll?

Enrollment begins on November 15, 2005 and runs until May 15, 2006.  Similar to other insurance, if patients enroll after May 15, 2006, they will need to pay more for the Medicare benefit.     

Is this plan just for people who are low-income?

No. While the insurance will be especially helpful for people with low-incomes, or those who have modest means (most seniors donít see themselves as low-income), this plan is for everyone. Some people will be enrolled automatically in a Medicare plan if they need extra financial assistance, e.g. if they are enrolled in Medicaid and Medicare, the so-called ìdual eligibles.î Others who may be eligible for extra help will get a letter from the Social Security Administration this summer telling them how to apply, or, they can contact the SSA themselves by calling 1-800-772-1213.   

How will patients choose a Medicare drug plan? 

Starting October 13, patients can compare all of the Medicare insurance plans.  Information is available on the CMS Web site www.medicare.gov and at 1-800-MEDICARE (1-800-633-4226). They will also receive a Medicare & You handbook in the mail.
 
State Health Insurance Assistance Programs (SHIP) will be another place to get information. Patients can call 800-MEDICARE for information. 

The number for the Kentucky SHIP is 877-293-7447. 

And, local and community groups are also working together to help seniors pick the right plans. 

How will the Medicare drug plans be different?

Private companies are setting up the insurance plans for Medicare, and, as a result, each plan will have slightly different characteristics. Some plans may use only certain pharmacies and others may cover only certain drugs. The cost also may vary slightly by plan.     

How much will this new insurance cost patients?

The monthly insurance fee will be about $32. There is also a $250 deductible each year and a small co-pay for each drug.

Does this insurance cover all of my drug costs each year?

No. After patients pay the deductible, Medicare will pay 75% of all drug costs, up to $2,250. Then, there is a gap in coverage, commonly referred to as the ìdonut hole.î Specifically, this means that when a patientís total drug costs reach $2,250, they will need to pay the next $2,850 themselves until they reach $3,600. At that point, Medicare will pay 95% of all drug costs; this is the ìcatastrophic benefit.î 

What if patients have a Medigap policy?

If patients receive drug coverage through Medigap, they will get detailed information from their insurance company in September. This information will help them decide what to do.

What if patients already get drug coverage through their employer or through a union?

Patients will receive information from their employer or union that tells them if their current plan covers less, the same, or more than Medicare drug insurance.

If their current plan covers less than Medicare drug insurance, patients can:

• Keep their current plan AND join a Medicare plan for complete coverage.
• Keep their current plan. (However, if they join a Medicare plan later, they will need to pay more.)
• Drop their current plan and join a Medicare plan. (However, they may not be able to get their current plan back.)

If their current plan covers the same or more than Medicare drug insurance, patients can:

• Keep their current plan. (If they join a Medicare plan later, they wonít need to pay more.)
• Drop their current plan and join a Medicare plan. (However, they may not be able to get your current plan back.)

What about drug formularies?

The specific plans, including their formularies, are now available. Formulary information will be updated monthly on the CMS Web site:

http://plancompare.medicare.gov/formularyfinder/selectstate.asp

5 Questions to Help You Get Ready for the New Drug Benefit

1. Write down the names and dosages of all prescription drugs that you are taking. This information will be important to decide on the right plan for you.
2. Do you have drug coverage through a former employer; union; or Medigap? If so, you should have gotten a letter explaining the drug coverage. Make sure you keep the letter so that you can compare the current coverage to the new plans.
3. List the cost and what you currently pay for drugs (if you have drug coverage through the above organizations).
4. List the name, address and phone number for pharmacies you like to use.
5. If you have a limited income or modest means, you can call the Social Security Administration at 1-800-772-1213 to apply for extra help.  You may also have gotten a letter from the SSA asking you to apply.

Quick Facts

Starting January 1, 2006, Medicare will offer prescription drug plans to help you pay for the prescriptions you need. If you donít join a Medicare prescription drug plan by May 15, 2006, you will pay a higher premium unless you have drug coverage that, on average, is at least as good as standard Medicare prescription drug coverage (such as from a former employer or union). Your insurer will notify you before fall to let you know if your coverage, on average, is at least as good as standard Medicare prescription drug coverage.

What do I need to know?

To get Medicare prescription drug coverage, you must choose and enroll in a Medicare prescription drug plan.

You can first enroll in a Medicare prescription drug plan from November 15, 2005 through May 15, 2006.

If you join by December 31, 2005, your coverage will begin January 1, 2006.

If you join, your costs will vary depending on which plan you choose. In general, you pay a monthly premium (generally around $37 in 2006) and a yearly deductible (up to the first $250 in 2006). You will also pay a share of your prescription drug costs, and your plan pays a share. Medicare helps pay for drugs up to a limit ($2,250 in total) and once your total out-of-pocket costs for drugs reach $3,600, you pay 5% of the costs and Medicare pays 95% of the costs for the rest of the year.

Many people with limited income and resources will get extra help paying for their prescription drug coverage. People with the lowest incomes and resources will get the most help. If you are in this group, you will get information in the mail this summer from the Social Security Administration (SSA) or from Medicare telling you what to do.

What if I already have prescription drug coverage?

If you already have prescription drug coverage through your Medicare private health plan or other insurance, check with your current plan to see if this coverage is changing.  Unless you have other drug coverage that is, on average, at least as good as standard Medicare prescription drug coverage, itís important for you to join a Medicare prescription drug plan when you are first eligible. For most people, joining when you are first eligible means you will pay a lower monthly premium than if you wait to join until later.

How can I get more information?

Detailed information will be available in October 2005. You can look at the "Medicare & You 2006" handbook, visit www.medicare.gov on the web or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. For more information on who can get extra help with prescription drug costs and how to apply, call SSA at 1-800-772-1213 or visit www.socialsecurity.gov on the web.

Quick Facts for People with Limited Income

Starting January 1, 2006, Medicare will offer prescription drug coverage for all people with Medicare. If you have Medicare and have limited income and resources, you may qualify for extra help paying for prescription drugs.

What do I need to know?

• If your annual income is below $14,355 for a single person (or $19,245 if you are married and living with your spouse), you may qualify for extra help. Slightly higher income levels may apply if you provide support to other family members living with you, or if you work or reside in Alaska and Hawaii.
• And if your resources (including your savings and stocks, but not counting your home or car) are under $11,500 (for a single person) or under $23,000 (for a married couple) you may qualify for extra help paying for your Medicare prescription drug costs.
• You can apply for this extra help through the Social Security Administration or your State Medical Assistance Office. Social Security is mailing the application for extra help to those who may qualify. If you receive an application, fill it out and return it in the enclosed postage paid envelope.
• The amount of extra help you get depends on your income and resources.
• You still need to join a Medicare prescription drug plan for Medicare to pay for your drug costs.
• You can join a Medicare prescription drug plan from November 15, 2005 through May 15, 2006. If you join by December 31, 2005, your coverage begins January 1, 2006. If you join after January 1, 2006, your coverage starts the first day of the month after the month you join.
• If you qualify for extra help, you will have continuous drug coverage and will pay only a small amount for your prescriptions.

How do I get more information?

For more information on who can get extra help with prescription drug costs and how to apply, call the Social Security Administration at 1-800-772-1213, or visit www.socialsecurity.gov on the web. TTY users should call 1-800-325-0778.

You will receive detailed information from Medicare about your choice of Medicare prescription drug plans in October 2005. You can look at the "Medicare & You 2006" handbook, visit www.medicare.gov on the web or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

People with Medicare Need To Know:

• Everyone with Medicare can get Medicare prescription drug coverage.
• Coverage starts January 1, 2006.
• You must join to get coverage.
• You can join from November 15, 2005ñMay 15, 2006.
• If you donít join by May 15, 2006, you may have to wait until November 15, 2006, and you may pay a penalty
• Thereís extra help for those who need it most.
• Medicare prescription drug coverage covers brand name and generic drugs.
• Compare and join a Medicare prescription drug plan that meets your needs.
• Youíll get a list of plans and their costs mailed to you in the Medicare & You handbook this October.

People with Employer or
Union Drug Coverage Need to Know:

• Medicare is working with employers and unions to help you keep the coverage you have.  Contact your benefits administrator to decide whether you should keep your current coverage.  You may be able to keep your current coverage and not pay a penalty if you join a Medicare prescription drug plan after May 15, 2006.
• If you drop your employer or union coverage, your eligibility for your employer/union plan may be affected. You also may not be able to drop your employer or union drug coverage without also dropping your employer or union health coverage. You may qualify for extra help paying for your prescriptions.

People with the Original Medicare Plan
and Medigap Need to Know:

• You can't have both Medigap prescription drug coverage and Medicare prescription drug coverage at the same time.
• You will get a detailed notice in the mail from your Medigap insurance company describing your choices for prescription drug coverage in the fall.  Read it carefully before making any decisions.
• Most prescription drug coverage offered by Medigap policies, on average, is not as good as standard Medicare prescription drug coverage. This means, in most cases, if you keep your Medigap prescription coverage, and donít join a Medicare prescription drug plan by May 15, 2006, you will have to pay a penalty for joining later.

People in a Managed Health Plan Need to Know:

• If you currently have drug coverage, you can stay in your plan and have Medicare prescription drug coverage.
• If you donít have drug coverage, you can stay in your plan and add a Medicare prescription drug plan.

Those Who Automatically Qualify for Extra Help
(People with Both Medicare and Medicaid)
Need to Know:

• You automatically qualify for extra help. You donít need to apply.
• If you get your prescription drugs from Medicaid, Medicare will begin paying for your prescription drugs starting January 1, 2006.
• Your coverage will come from a Medicare prescription drug plan starting January 1, 2006.
• If you donít join a plan by December 31, 2005, Medicare will enroll you in a drug plan to make sure your coverage continues.

Those Who Automatically Qualify for Extra Help
(People with Both Medicare and
a Medicare Savings Program or who Receive SSI)
Need to Know:

• You automatically qualify for extra help.
• You must join a Medicare prescription drug plan to get coverage.
• If you donít join a plan by May 15, 2006, Medicare will enroll you in a drug plan for coverage effective June 1, 2006, to make sure you get help paying for your prescription drug costs.

Those Who Must Apply for the Extra Help
(People with Medicare with Limited Income and Resources)
Need to Know:

• You must apply to SSA or your state agency for the extra help paying for the yearly deductible, monthly premium, and coinsurance and/or copayments.
• You must join a Medicare prescription drug plan to get coverage.
• If you qualify for extra help and you donít join a plan by May 15, 2006, Medicare will enroll you in a drug plan so that your coverage is effective June 1, 2006, to make sure you get help paying for your prescription drug costs.

Other Links:

Medicare:  http://www.medicare.gov, the official site for people with Medicare.

http://www.medicare.gov/medicarereform/drugbenefit.asp

KY Medicare Advantage Plans:  http://www.medicare.gov/medicarereform/mapdpdocs/MALandscapeky.pdf

KY Standalone Plans:    http://www.medicare.gov/medicarereform/mapdpdocs/PDPLandscapeky.pdf

Find a Medicare Prescription Drug Plan:    http://www.medicare.gov/MPDPF/Public/Include/DataSection/Questions/MPDPFIntro.asp

The Medicare Rx Education Network, http://www.medicarerxeducation.org a coalition of 40 organizations including the American Academy of Family Practice, which was established to educate America's seniors about the new drug benefit  

Getting Started Brochure:  http://www.medicare.gov/Publications/Pubs/pdf/11146.pdf

Kentucky is in Medicare's Region IV, head-quartered in Atlanta:

• Centers for Medicare & Medicaid Services 404-562-7150
• Social Security Administration 404-562-5500

Info for Providers