Medicare / Medicaid

Medicare / Medicaid

• What is Medicare Part D?

• When is the Medicare Part D medication benefit supposed to start?

• Is the Medicare Part D Prescription benefit mandatory?

• When is the enrollment period?

• How many plans are there?

• Is enrollment in Medicare Part D free?

• What if a beneficiary does not have Medicaid, but has limited income and cannot afford to purchase a Part D Prescription Plan?

• What if I already have prescription drug coverage through a private supplemental plan?

• Will I have to change my medications when the new Medicare Part D medication benefit starts?

• Where can I find further information about the Medicare Part D Prescription benefit?

What is Medicare Part D?
Medicare Part D is the name of the new prescription benefit that Congress and the President passed as part of the Medicare Modernization Act. This will provide coverage for prescription medications for anyone on Medicare, including those in nursing homes. Although it is a Medicare benefit, it will be provided by private insurance companies. This is the most fundamental change in the Medicare program since its inception in 1965.

When is the Medicare Part D medication benefit supposed to start?
The Medicare Part D medication benefit is scheduled to begin January 1, 2006. Enrollment for the plans begins on November 15, 2005. Medicare beneficiaries have already begun receiving information about the new benefit, along with the “Medicare and You 2006” handbook.

Is the Medicare Part D Prescription benefit mandatory?
Enrollment in a Medicare Part D Prescription Benefit Plan is voluntary for those with only Medicare. However, for those with both Medicare and Medicaid, who are so-called “dually eligible,” coverage is mandatory.

When is the enrollment period?
Enrollment for a Medicare Part D Prescription Benefit Plan begins November 15 and runs through May 15, 2006, for those with only Medicare. For beneficiaries with both Medicaid and Medicare, a plan must be selected prior to January 1, 2006. If a Medicare/Medicaid beneficiary does not select a plan prior to January 1, 2006, Medicare will randomly assign coverage in a process known as “auto-enrollment.”

How many plans are there?
In New York State, there are approximately 40 Part D plans available. However, only 11 of these plans are qualified to accept beneficiaries with both Medicare and Medicaid. A full list of available plans can be found on the Medicare web site at cms.gov.

Is enrollment in Medicare Part D free?
For beneficiaries with Medicare only, each of the plans has monthly premiums that average about $37 per month. However, there are many plans that are substantially less expensive, some costing as little as five dollars per month.

For beneficiaries with both Medicare and Medicaid, there are no premiums, deductibles or co-pays, but enrollment in a Part D plan is mandatory.

Enrollment may be done by either phone, mail or through the internet. Since the Part D benefit is administered by individual private health plans, beneficiaries must enroll directly through the insurance companies that provide these plans, rather than through Medicare.

What if a beneficiary does not have Medicaid, but has limited income and cannot afford to purchase a Part D Prescription Plan?
Financial assistance for the Medicare part D Prescription benefit is available for beneficiaries with limited financial resources. Information and applications may be obtained from the social security administration. This may be of particular interest to nursing home residents who are “Medicaid pending.” Further information can be obtained at your social security office or from the social security web site at: http://www.social security.gov/prescriptionhelp

What if I already have prescription drug coverage through a private supplemental plan?
If you already have prescription drug coverage through a private plan, you must call the plan to find out whether it provides “creditable coverage.” If the coverage is at least as good as a Medicare Part D plan, you may choose to keep your current coverage and forego a Medicare Part D plan without penalty.

Starting January 1, ChemRx, the company that runs The Hebrew Home’s pharmacy, will begin submitting claims for prescription drugs to the insurers that cover Hebrew Home residents. Individual residents will be financially responsible for any deductibles or co-pays. For those residents with Medicare only, who opt not to enroll in a Medicare Part D Prescription plan, they will receive itemized bills for medications from ChemRx.

Will I have to change my medications when the new Medicare Part D medication benefit starts?
Each Medicare Part D Plan is required to develop its own formulary of approved drugs, representing 146 types of medications in 41 drug categories. It is possible that one or more medications currently being taken by the resident will not be available on a Part D Provider’s formulary. If that happens, either the physician will need to change medications to those available on the formulary or coverage for a non-formulary drug may be requested through the plan’s exception process.

Where can I find further information about the Medicare Part D Prescription benefit?
The following links provide a wealth of information about the Part D plans:

From Medicare:
Information on finding a Medicare D prescription drug plan, which includes a comparison of plans and enrollment information
http://www.medicare.gov/MPDPF/Home.asp

Quick Facts about Medicare's New Coverage for Prescription Drugs
http://www.medicare.gov/Publications/Pubs/pdf/11102.pdf

New Medicare Prescription Drug Coverage - Who Can Help Me Apply and Enroll? –Explains how to go about enrolling if the beneficiary is not able to enroll himself or herself
http://www.medicare.gov/Publications/Pubs/pdf/11125.pdf

Facts about Medicare Part D for People With Limited Income:
http://www.medicare.gov/Publications/Pubs/pdf/11105.pdf

Help With Prescription Drug Costs (From Social Security Administration)—may be especially relevant for those who are “Medicaid pending”
http://www.ssa.gov/prescriptionhelp/

What You Need To Complete The Application For Help With Medicare Prescription Drug Plan Costs
http://www.ssa.gov/pubs/10128.html

Prescription Drug Coverage: Common Situations:
http://www.medicare.gov/pdp-common-situations.asp

From AARP:
AARP’s Medicare Part D Web Page
http://www.aarp.org/health/medicare/drug_coverage/medicarerx_coverage.html

The New Medicare Prescription Drug Coverage: What You Need to Know—A 28 page booklet outlining the basic facts about Medicare Part D Prescription Drug Coverage
http://assets.aarp.org/www.aarp.org_/articles/health/medicare_d_full.pdf

More Information For People with Medigap Policies—Explains what to do if you already have a Medigap plan with prescription drug coverage
http://www.aarp.org/health/medicare/drug_coverage/medigap_policy_info.html