Q: What is Medicare Part D, and who is eligible? A: Part D is the new prescription-drug benefit that the federal Medicare program is offering...
Q: What is Medicare Part D, and who is eligible?
A: Part D is the new prescription-drug benefit that the federal Medicare program is offering starting Jan. 1. Private companies will provide coverage. In Washington, there are more than 70 plans to choose from, differing by cost, which drugs or other services they cover, and how they deliver those drugs to the consumer.
Anyone who is eligible for Medicare is eligible for Part D: people over 65, people with disabilities and people with end-stage renal disease.
Q: What kind of plans are offered?
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A: There are two basic options. Participants can keep their existing Medicare plan for doctor and hospital visits and join a stand-alone plan that provides prescription-drug coverage only. Or they can join a comprehensive plan that includes coverage for doctor and hospital visits as well as prescription drugs.
Q: How much does a Medicare prescription-drug plan cost?
Choosing a Part D drug plan:
When the enrollment period begins on Nov. 15:
Make a list of all the medications you are currently taking, or may need to take in the near future.
Decide how much you can afford to pay in monthly premiums.
Read the “Medicare and You, 2006” handbook, sent this fall, to see which drug plans are available in Washington. Go to the Medicare Web site or call the toll-free Medicare number, 800-MEDICARE (800-633-4227), to find out which drugs are covered by each plan.
Narrow the list to plans that you can afford and cover the drugs you need to take.
Check which of those plans use pharmacies nearest to your home or offer delivery through the mail.
Fill out an application either in print or online. To get a print application, contact the company that offers your drug plan. Phone numbers are listed in the “Medicare and You” booklet. Return the completed application by fax or by mail.
To get an application online: An online application may be available through the company’s Web site. Otherwise, go to www.medicare.gov, where you can join a plan through Medicare’s online enrollment center.
A: It depends on the plan. But most people with stand-alone plans will pay a monthly premium ranging from $7 to $65, depending on how much coverage they want. Premiums are expected to increase every year.
Some participants will be responsible for a yearly deductible, up to $250 in 2006. Many plans require a co-payment for prescriptions.
Q: What happens if I can’t afford the premiums or deductibles?
A: Some participants may be eligible for extra help from the government. For example, an individual whose income is less than $14,355 a year, with assets less than $11,500, may qualify for that help.
Medicare recipients who also receive Medicaid, a Medicare Savings Program or receive Supplemental Security Income (SSI) automatically qualify and do not have to apply for this extra assistance. But they will be automatically enrolled in a plan if they don’t choose one by the deadline.
Others can apply for extra help through the Social Security Administration (800-772-1213, or www.socialsecurity.gov) , or through a local Medicaid office.
Q: When is the open-enrollment period?
A: The initial enrollment period begins Nov. 15 and ends May 15. For people who join by Dec. 31, coverage will begin Jan. 1. After that, coverage will begin on the first of the month after they sign up.
There is a penalty to join after May 15: Participants will pay at least 1 percent of the average monthly premium — which is $20 this year. The penalty increases for every month after May 15 that you wait to join, and will last for the duration of coverage.
Q: Why not sign up for Part D?
A: It may not make good financial sense for some. For example, for those who don’t take a lot of medicine, the premiums may total more than the cost of the drugs.
A former employer or union may already offer prescription-drug coverage. They are supposed to issue letters by Nov. 15 explaining how their coverage compares to the new Part D plans.
If the coverage is at least as good as Part D, keeping an existing plan may make sense. In that case, signing up for Part D later will not incur a penalty.
Q: If I sign up now for Part D coverage, will it pay for every medication I am taking now?
The Statewide Health Insurance Benefits Advisors: 800-562-6900
The Medicare administration: 800-MEDICARE (800-633-4227).
The Senior Rights Assistance Program: 206-448-5720 or 888-435-3377 (ask for Senior Rights Assistance)
The National Asian Pacific Center on Aging offers information and assistance in several languages.
English and Chinese: 800-582-4218; Korean: 800-582-4259; Vietnamese: 800-582-4336
The Medicare Web site: www.medicare.gov
MedicareRxConnect, a coalition of nonprofit health organizations, has a comprehensive Web site to walk people through the process: www.maprx.info.
A: Not necessarily. Some plans do not cover certain kinds of drugs, such as weight-loss pills and sexual-performance drugs. Other plans may cover those drugs, but the premiums are usually higher.
Each plan has a list of drugs that it will cover, but the companies may remove drugs from the lists, or change the cost of them, at any time. If so, they must provide 60 days’ notice, and patients and doctors may appeal.
Q: How easy is it to switch plans within Part D?
A: Between Nov. 15 and Dec. 31 of each year, participants can change plans freely. People who move or change nursing homes can switch plans during other specified periods. Medicaid recipients can change plans at any time.
Q: How does this affect the Medicare drug-discount cards that were sent out last year?
A: The Medicare-approved drug-discount cards were introduced in 2004 to help people save on their prescription drugs until the new prescription-drug coverage starts next year. Medicare recipients can still use the cards until May 15, or until they join a drug plan, whichever comes first.
Cara Solomon: 206-464-2024 or firstname.lastname@example.org