Starting January 1, 2006 Medicare will offer for the first
time in its 40-year history coverage for prescription drugs.
The coverage, which is called Medicare Part D and is voluntary,
will be available to all people with Medicare, regardless
of income level and resources, pre-existing conditions, or
current prescription expenses, according to the Centers for
Medicare & Medicaid Services (CMS).
Open enrollment for 2006 Part D coverage, which may cost
less than $20 per month for some plans, begins in November
and runs through May 15, 2006. Companies that were approved
by CMS in late September to offer such plans along with consumer
advocacy and other institutions began a massive information
blitz starting in October.
In essence, the Medicare Part D plan is insurance provided
by private companies. According to CMS, eight insurance companies
will offer coverage nationwide, while other insurers will
offer coverage regionally. Beneficiaries will have at least
11 plans to choose from and those in larger states, such
as New York and Texas, will have a choice of about 20 plans.
The eight companies offering nationwide coverage are Aetna
Life Insurance Company, Connecticut General Life Insurance
Company, Memberhealth, Pacificare Life and Health Insurance
Company, Silverscript Insurance Company, Unicare, United
Health Care Insurance Company and Wellcare Health Plans.
As with any insurance program, the plans offered by CMS-approved
companies may differ in terms of costs and coverage so it's
important that you comparison shop. For instance, each Part
D drug plan will have a government-approved list of drugs
it covers, often called a formulary or a preferred-drug list.
But the formulary will vary from plan to plan so you should
compare plan formularies to see which one fits your needs
best. Another difference might be what pharmacies you can
use. If you join a Part D plan and you use the plan's
network of pharmacies, you will likely receive discounted
prices on prescription drugs. Medicare prescription drug
coverage can help you by covering both brand name and generic
prescription drugs at participating pharmacies.
Given the vast choice in plans, consumers are well advised
to seek out the help of trusted advisers, including physicians,
pharmacists and financial planners. Purchasing Medicare Part
D is as much a financial decision as it is a health-care
decision. You will be able to change plans once per year.
Medicare beneficiaries should also take note of the fact
that the new prescription drug plan is open to all people
with Medicare. But Medicare Part D prescription drug coverage
will work differently from Medicare Part A and Part B. To
get coverage, you'll choose a plan from a private company
approved by CMS. And you will have to pay a monthly premium,
over and above any premiums you pay for Medicare Part B coverage
or Medigap insurance plans, to participate in the plan.
The Medicare Part D plans come in two basic types: the most
simple is the prescription drug benefit or PDP plan, which
covers only drugs and can be used with your traditional Medicare
and or Medicare supplement plan. The other type combines
a prescription drug plan with a Medicare Advantage plan which
includes medical coverage for doctor visits. If you already
have good drug coverage through a retiree plan or Medicare
Advantage Plan, Medicare can provide help for its cost.
If you already have prescription drug coverage, you will
likely want to compare the plan you have now with the new
plans being offered under Part D. If you don't have
coverage now, it's important for you to look at Part
D plans.
A typical person with Medicare could see his or her total
drug expenses drop by about 50 percent, according to CMS.
Don't, however, expect free drugs. For each prescription
you'll pay a portion of the cost. Qualified people
with limited income and resources will, however, have almost
no drug expenses. And, if you have high out-of-pocket prescription
drug costs, Medicare will pay 95 percent of your prescription
drug costs, after you pay $3600.
Of note, if you don't sign up with a plan by May 15,
you may have to pay a penalty. The late enrollment fee is
about 1 percent of your premium for each month you delay
and you'll pay it for as long as you stay in a Part
D program. Your next chance to enroll will be November 15
through December 31 of each year. Even if you do not need
a lot of prescription drugs now, it's still good to
consider joining. As people age, they need prescription drugs
to stay healthy.
You can learn more about this historic addition to Medicare
at the following Web sites: AARP, www.AARP.org;
Medicare, www.Medicare.gov;
Social Security, www.SocialSecurity.gov;
Kaiser Family Foundation, www.KFF.org;
State Health Insurance Assistance Program, www.shiptalk.org;
Medicare Rights Center, www.Medicareinteractive.org;
and National Council on Aging, www.benefitscheckup.org.
CMS recommends keeping an eye out for community meetings on
the subject of Medicare Part D. Also, CMS notes that more detailed
information about Medicare Part D is being mailed to beneficiaries.