 | Information About the Medicare Drug Coverage Plan |
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Sign-up deadline is May 15, 2006 During Thanksgiving 2003, Medicare legislation passed in Congress and was signed into law what is commonly referred to as the Medicare Drug Coverage Plan. When we first wrote about this we stated: “There is no doubt that the large and complex bill that has become law is the most major change in Medicare since the law was originally passed in 1965. It will have a major impact just as did the original law.” The Prescription Drug Benefit offers all Medicare and Medicaid eligible patients two basic plans to help cover prescription drug costs and to maximize the amount a person could pay ($3,600 out-of-pocket). The two types of plans are: 1) a Medicare prescription drug plan or 2) a Medicare Advantage Plan or other Medicare Health Plans that offer drug coverage through private insurers. Either plan will help you by covering brand-name and generic drugs at convenient pharmacies. There is a $35 monthly payment to participate in the Medicare plan and a $250 annual deductible. Most analysts believe that people who need prescription drugs will experience a cost savings. As most of us age, we will require prescription drugs for our health.
National Sign-up
Enrollment began Jan. 1, 2006, and all eligible people have until May 15, 2006, to enroll in a plan or risk a financial penalty if you join later. The next time to sign up after May is Nov. 15, 2006, through Dec. 31, 2006. This means that if you want maximal advantage of this revolutionary governmental plan without possible penalty, now is the time to act. Sign-up has been slow, partly due to the complexity and confusion about such a big and comprehensive plan that involves federal and state governments and private insurance. Nevertheless, 5.4 million people have signed up. An additional 20 million Medicaid, unions, employers and other eligible people also have signed up for the plan. A total of approximately 26 million people have enrolled, and the rate of enrollment is approximately 400,000 per week as the May deadline approaches.
Key Issues
Who is eligible? Everyone with Medicare and Medicaid is eligible. What will it cost me? As with any insurance, a monthly premium applies. The premium varies by the chosen plan, and the Medicare plan is $25 per month. If a drug prescription is used, a yearly deductible applies (no more than $250 during 2006). Enrollees are entitled to discounted drugs termed a copayment, which varies depending on the plan used. Prescription costs could be reduced by an estimated 50 percent. Some people with low annual incomes are entitled to considerably more assistance, which could cover most expenses. Are all drugs covered? No, not all drugs are in the formularies. Two drugs in every major class are covered. If your drugs are not covered, your physician can justify your medical need for a drug. Generic and trade-name drugs are covered. Are retirees with retirement drug plans covered? Yes, if you are Medicare eligible, you can enroll even if you are covered by your employer. I already have a Medicare Supplement (Medigap) plan. Why should I join? The new Medicare drug benefit will provide significant savings compared to copayments for drugs under the Medigap plan. The Medicare drug benefit should provide better coverage against unexpected drug expenses. Other Questions? Questions and answers can be found at the Medicare Web site: www.medicare.gov/pdphome.asp Bottom Line Despite the complexity and almost chaotic introduction of the Medicare plan this year, it should become easier to understand and access. Healthy aging often requires prescription drugs, and most elderly people are on fixed incomes. Therefore, it is important that you enroll in one of the Medicare plans before May 15, 2006, if you are eligible. Additional Online Resources outside MUSCHealth.com:
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