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Facts about Medicare Part D prescription program

November 06, 2005|Compiled By BOB MAGINNIS

Correction

Due to a source's error, a fact sheet on the Medicare Part D prescription program printed in The Herald-Mail opinion section on Sunday, Nov. 6, contained two mistakes. The correct information is as follows:

· Medigap plans H, I and J will not be sold after Dec. 31. However, if you decide to stay with any of these plans, your coverage is not creditable and if you are eligible for Medicare and do not enroll in a plan by the end of the Initial enrollment period (Nov. 15, 2005 through through May 15, 2006), you will pay a 1 percent per month penalty if you enroll in a Medicare D plan.

If you decide to enroll in a Medicare drug plan, the drug coverage will not continue in your H, I or J Medigap plan and you will have the option of enrolling in some other type of Medigap policy with equal medical coverage offered by the same insurance company.

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· The Maryland Senior Prescription Drug Program is not a CareFirst program, but is administered by CareFirst. It will become the Maryland Senior Prescription Assistance Program, helping members transition into a new Part D Plan by subsidizing their premium by $25 per month, no matter what drug plan that they choose.

The Herald-Mail apologizes for the errors.




By now you should have received the booklet "Medicare & You 2006" in the mail. It contains instructions for signing up for the Part D program and a list of the 47 approved plans.

What follows are a list of questions answered by Katrina Eversole, an insurance advocate who works out of the offices of the Washington County Commission on Aging.

Which plan is right for me?



It depends on a number of things. Your pharmacy probably won't participate in every plan, so a good first step would be to talk to your pharmacist and find out which drug plans they will accept.

What do all the plans have in common?



All plans must offer brand-name and generic drugs. Each plan will have a network of pharmacies for its members. Each plan must allow its members to obtain at least some prescriptions in an out-of-network pharmacy, if, for example, you're on vacation and need medicine.

Each plan must include at least two drugs in a therapeutic or diseases class, so your doctor has some choice. If a pharmacy decides to withdraw a drug that has been on its list, it must notify the beneficiaries in writing.

How much will it cost?



Every plan is different, but if you meet income guidelines, you will be eligible for financial help, and application forms are available through the local Social Security office. Those who qualify include individuals with less than $14,355 in gross annual income who have less than $11,500 worth of assets. Your home and car don't count as assets. Couples qualify if they have a gross annual income of less than $19,245 and less than $23,000 worth of assets. Again, your car and home don't count in the asset total.

What if I don't qualify for assistance?



The Part D program is not just for low-income people. Every Medicare recipient is eligible. There are various premiums and deductibles, depending on the plan that you choose. But whether you have to sign up depends on whether the prescription drug plan you have now is "creditable."

In other words, if it is as good or better than Part D program, you can stick with what you have now.

How will I know whether my present plan is "creditable"?



You may already have been notified by mail or will be notified by Nov. 14, 2005. You may want to call your former employer to see if drug coverage will continue and whether it will be as good or better than what the federal government is offering.

How do I know whether my present plan will continue?



Again, you should have been notified by mail. Three plans we know for sure will continue are: Federal Employee Health Benefits Program (FEHBP), the Veterans Administration (VA) program and Tri-Care.

Which plans are closing for sure?



Medigap plans with H, I and J coverage are not creditable and the prescription part of this supplemental medical coverage will not continue after Dec. 31 - you will be offered a choice of Medigap plans (with comparable medical coverage) without prescription coverage.

Maryland Pharmacy Assistance Program, as well as the Maryland Pharmacy Discount Program, will end Dec. 31. CareFirst Senior Rx Plan will also end on Dec. 31, and members will receive help transitioning to new plans; namely a $25 per-month subsidy for the plan of the member's choosing. CareFirst members are receiving information in the mail now about trade shows and seminars in Washington County.

What if my employer decides to discontinue the Rx coverage to retirees at a future date?



Then you will have 63 days to enroll in a Medicare Part D plan with no penalties (if it is after the May 15, 2006 deadline.)

Will the Part D program affect my medical coverage under Medicare?



No.

What if I'm on Medicare and medical assistance?



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