Medicare Part D Information
Staring January 1, 2006 Medicare recipients will be able to obtain assistance
from the US government in paying for prescription medications. Individuals will
need to enroll into a prescription plan to receive these benefits. However,
a multitude of plans are available and the extent of medication coverage varies
with each prescription drug benefit plan and discussing these would be beyond
the scope of this Web site. Below is a brief overview of Medicare Part D plus
Internet Web sites that are very useful in providing information, specifically
in layman's terms, addressing the prescription drug benefit program for Medicare
recipients.
Important Dates
November 15, 2005--Enrollment into drug plans begins
January 1, 2006--Coverage begins
May 15, 2006--Last day to enroll into a plan before late-enrollment penalty
applies
Costs to Patients
First $250 for prescription costs are out-of-pocket expenses (i.e., deductible),
but some plans may wave this.
25% of prescription drug costs up to $2000 in drug costs ($500 in co-pays)
after deductible reached.
100% of prescription drug costs are out-of-pocket after $2000 in prescription
drug costs (a.k.a., "donut hole").
5% of prescription drug costs are out-of-pocket expenses after $5100 in
prescription drug costs.
Some plans may provide some drug expenditure coverage during the "donut
hole" period.
Monthly plan premiums vary among the participating plans; could be $2 to
>$80 per month and depends upon the extent of prescription drug coverage provided
by the plan (i.e., higher premium for more drug coverage).
Low-income patients may be eligible for government assistance in paying
for these out-of-pocket expenses.
Please refer to a dedicated section the Social
Security Web site for assistance or call 1-800-772-1213.
Enrollment
Patients may obtain prescription drug plan enrollment forms from various
places that include:
Social Security Office or 1-800-772-1213
Medicare Office or 1-800-633-4227 (1-800-MEDICARE)
Individual insurance companies offering a prescription drug plan
Drug Formulary and Participating Pharmacies
All plans will have some variation of a formulary (a list of the drugs covered by the insurance plan).
Medicare has a "plan finder" on their Web site to determine which plans
are covering which drugs.
Insurance companies will be negotiating contracts with pharmacies to provide medications to the enrolled patients.
Thus not all pharmacies may be accepting all the various plans offered to the patients.
Drug price discounts may be offered by the pharmacies for drug costs during the "donut hole."
Patients with complex drug regimens and high prescription expenditures will be enrolled in Medication Therapy Management programs
and pharmacists will have the opportunity to provide clinical drug services to these individuals.
Other Items of Interest
Various persons will be attempting to deceive patients (e.g., telemarketers); thus do not provide any financial information, Medicare or
Social Security number, or other personal information when being solicited.
Each state has a Health Insurance Assistance Program to assist patients select an insurance plan
or call 1-800-MEDICARE.
Below are some FREE Web sites that provide extensive
information regarding the Medicare prescription drug plans. These are very
useful for the public but also informative for healthcare providers.
- US Government site for Medicare Part D.
- Includes an extensive amount of information, but is easy to understand.
- Provided information includes:
- Additional features include a cost estimator, formulary finders, and landscapes with the breakdowns of each plan, which can further aid in selection of a
particular plan.
Well organized information; can answer most questions patients (or healthcare providers) may ask.
Includes information addressing "What You Should Know Before Enrolling" and "Choosing a Prescription Drug Plan".
Site also has "Frequently Asked Questions" section, a very thorough and informative feature.
An additional link (sponsored by AetnaŽ) is valuable to answer similar Medicare Part D related questions.
Web site is dedicated to understanding Medicare Part D and is highly valuable.
Has a slide slow with audio that explains the Part D program .
Offers information in both English and Spanish.
Provides link to a highly informational, consumer pamphlet sponsored by United HealthcareŽ titled "Show Me Guide: Introduction to Part D: Medicare's New
Prescription Drug Coverage."
- Presents valuable Information in terms that are understandable to the
elderly.
- Information contained on the site is useful and also directs user to
other reputable sites such as the governments
site for Medicare Part D
- Various pamphlets, sponored by AARP, are available explaining Medicare
Part D using consumer language:
Presents vast amounts of information written for pharmacists to comprehend.
Some of the features available are:
- Sign-up for email updates from CMS (Centers for Medicare and Medicaid Services) regarding pharmacy issues
- Part D Plans available in each state
- Tools to compare Part D Plan benefits
- Drug benefit calculators
Updated Jan 4, 2006