Everyone Needs to Make a Decision This Year
Beginning January 1, 2006, Medicare will offer insurance coverage for
prescription drugs through Medicare Prescription Drug Plans and other health plan
options. Insurance companies and other private companies work with Medicare to offer these plans. If you join by December 31, 2005, you won't miss a day of coverage.
Because of changes in the Medicare Program, everyone with Medicare has to make a decision
about prescription drug coverage this year. To learn more about these changes.
Even if you don't use a lot of prescription drugs now, you should still read
the information about Medicare prescription drug coverage in this handbook and consider joining. As we age, most people need prescription drugs to stay healthy. For most people, joining now means you will pay a
lower monthly premium in the future since you may have to pay a penalty if you choose to join later
Medicare & You 2006 Centers for Medicare & Medicaird Services Handbook.
This is the main hand book on the new Prescription Drug and Health Plan options
Here are the steps I took to determin the best plan for my mother.
- Click on "Find a Medicare Prescription Drug Plan."
Follow the steps and it will walk you through each step you need to
make an informed decession. You will need your Social Security Card to complete this
- Search Options
- Current Coverage Information
- Review Plan Results & Options
- Medication & Pharmacy Selection
- Review Plan Details & Enroll
If you don't have all the Personal Medicare Information, at least prepare a list of drugs
you are using and look at what percentage each plan has.
Prescription Drug Coverage: Basic Information
What is Medicare prescription drug coverage?
Medicare prescription drug coverage is insurance that covers both
brand-name and generic prescription drugs at participating pharmacies in your area. Medicare prescription drug coverage provides protection for people who have very high drug costs.
Who can get Medicare prescription drug coverage?
Everyone with Medicare is eligible for this coverage, regardless of income and
resources, health status, or current prescription expenses.
When can I get Medicare prescription drug coverage?
You may sign up from November 15, 2005 to May 15, 2006. If you join by
December 31, 2005, your coverage will start January 1, 2006, and you won't miss a day of coverage. If you don't sign up when you are first eligible or by May 15, 2006, you may pay a penalty. Your next
opportunity to enroll is from November 15, 2006 to December 31, 2006.
How does Medicare prescription drug coverage work?
Your decision about Medicare prescription drug coverage depends on the kind of
health care coverage you have now. There are two ways to get Medicare prescription drug coverage. You can join a Medicare prescription drug plan or you can join a Medicare Advantage Plan or other Medicare Health
Plans that offer drug coverage.
Whatever plan you choose, Medicare drug coverage will help you by covering brand-name and generic drugs at pharmacies that are convenient for you.
Like other insurance,
if you join, you will pay a monthly premium, which varies by plan, and a yearly deductible (no more than $250 in 2006). You will also pay a part of the cost of your prescriptions, including a copayment or
coinsurance. Costs will vary depending on which drug plan you choose. Some plans may offer more coverage and additional drugs for a higher monthly premium. If you have limited income and resources, and you qualify
for extra help, you may not have to pay a premium or deductible.
Why should I get Medicare prescription drug coverage?
Medicare prescription drug coverage provides greater peace of mind by
protecting you from unexpected drug expenses. Even if you don't use a lot of prescription drugs now, you should still consider joining. As we age, most people need prescription drugs to stay healthy. For most
people, joining now means protecting yourself from unexpected prescription drug bills in the future.
What if I have a limited income and resources?
There is extra help for people with limited income and resources. Almost 1 in 3
people with Medicare will qualify for extra help and Medicare will pay for almost all of their prescription drug costs.
Prescription Drug Coverage: Things to Consider
To get Medicare coverage for your prescription drugs, you must choose and join a Medicare drug plan. Regardless of how a Medicare drug plan
decides to offer this coverage, there are some key factors that may vary. Some of these factors might be more important to you than others, depending on your situation and drug needs. These factors are:
This is the monthly cost you pay to join a Medicare drug plan. Premiums vary by plan.
the amount you pay for your prescriptions before your plan starts to share in the costs. Deductibles vary by plans. No plan may have a deductible more than $250 in 2006.
the amount you pay for your prescriptions after you have paid the deductible. In some plans, you pay the same copayment (a set amount) or coinsurance (a percentage of the cost) for any prescription. In other plans,
there might be different levels or "tiers," with different costs. (For example, you might have to pay less for generic drugs than brand names. Or, some brand names might have a lower copayment than other
brand names.) Also, in some plans your share of the cost can increase when your prescription drug costs reach a certain limit.
A list of drugs that a Medicare drug plan covers is called a formulary. Formularies include generic drugs and
brand-name drugs. Most prescription drugs used by people with Medicare will be on a plan's formulary. The formulary must include at least two drugs in categories and classes of most commonly prescribed drugs to
people with Medicare. This makes sure that people with different medical conditions can get the treatment they need.
Some drugs are more expensive than others even though some less
expensive drugs work just as well. Other drugs may have more side effects, or have restrictions on how long they can be taken. To be sure certain drugs are used correctly and only when truly necessary, plans may
require a "prior authorization." This means before the plan will cover these prescriptions, your doctor must first contact the plan and show there is a medically-necessary reason why you must use that
particular drug for it to be covered. Plans might have other rules like this to ensure that your drug use is effective.
If you have high drug costs, you may consider which plans offer
additional coverage until you spend $3,600 out-of-pocket. In some plans, if your costs reach an initial coverage limit, then you pay 100% of your prescription costs. This is called the coverage gap. This
"gap" in coverage is generally above $2,250 in total drug costs until you spend $3,600 out-of-pocket. Some plans might offer some coverage during the gap. Even in plans where you pay 100% of covered drug
costs after a certain limit, you would still pay less for your prescriptions than you would without this drug coverage.
Drug plans must contract with pharmacies in your area. Check with the plan to make sure your pharmacy or a pharmacy in the plan is
convenient to you. Also, some plans may offer a mail-order program that will allow you to have drugs sent directly to your home. You should consider all of your options in determining what is the most cost-effective
and convenient way to have your prescriptions filled.
Peace of Mind Now and in the Future
Even if you don't take a lot of prescription drugs now, you still should consider joining a drug plan in 2006. As we age, most people
need prescription drugs to stay healthy. For most people, joining now means you will pay a lower monthly premium in the future since you may have to pay a penalty if you choose to join later. You will have to pay
this penalty as long as you have a Medicare drug plan. If you reach the point where you have spent $3,600 out-of-pocket for drug costs during the year, the plan will pay most of your remaining drug costs. This
protection could start even sooner in some plans.
Prescription Drug Coverage: Common Situations
Click on this to get answers to common questions