Information for Consumers
Information provided contains links to web-sites. For persons without internet access, call Medicare’s toll-free number 1-800-633-4227; TTY 1-877-486-2048. Michigan Medicare Medicaid Assistance Program (MMAP) at (800)803-7174 has trained volunteer counselors to help persons learn about Part D coverage & help with enrollment by phone or home visit.
Consumers Top 10 Questions about Medicare Part D Prescription Drug Coverage What is Medicare Part D?
Medicare Part D is a new prescription drug insurance program which will be available beginning January 1, 2006.
Key features:
- Voluntary, highly subsidized, guaranteed enrollment, prescription drug insurance plan administered by private health insurance companies.
- Medicare recipient will pay a monthly premium and a share of the cost of the prescription drugs.
- Plans will vary in what drugs are covered, how much one pays and which pharmacies can be used.
- All plans must provide at least a standard level of coverage established by Medicare.
- Individuals are not automatically enrolled in a drug plan unless they are dual eligible (covered by Medicaid & Medicare) or notified by social security that they are eligible for
extra help with drug cost. All others, including those in Michigan’s EPIC program must enroll in a plan to get drug coverage. The EPIC program ends 12/31/05.
- Available in two ways:
- A stand-alone Prescription Drug Plan (PDP)
- Integrated with medical coverage as a Medicare Advantage Prescription Drug plan (MA-PD). Patients can add a PDP policy to traditional Medicare Part A and/or B, or any medical only insurance supplemental policy. MA-PDs replace both supplemental medical and prescription drug coverage.
- Washtenaw County has 5 insurance companies offering 15 Medicare Advantage programs.For list of plans by county go to:
http://www.medicare.gov/medicarereform/mapdpdocs/
MALandscapemi.pdf
- Complete Medicare 2006 Manual sent to Medicare recipients
http://www.medicare.gov/Publications/Pubs/pdf/10050.pdf
Who qualifies for Medicare Part D?
Anyone eligible for or enrolled in Medicare Part A and/or enrolled in Medicare Part B can
participate in Medicare Part D. Unlike other insurance plans, one cannot be denied coverage for health reasons.
- Includes: Individuals aged 65 and older and some younger people with disabilities.
- Individuals currently enrolled in Medicaid and Medicare (Dual Eligible)
- Individuals with limited income and resources, but don't have Medicaid, may
qualify for extra help to pay for Part D plan costs.
- Individuals currently covered by other “creditable” drug coverage cannot enroll into Part D without leaving the other plan. Creditable coverage is defined as coverage at least as good as a Medicare Part D plan.
- Persons should have received information from their plan administrator as to whether their plans qualify as Creditable Coverage by 11/14/05. If they haven’t received this notice, they should follow-up directly with that plan. If prescription coverage later changes to non-creditable (does not cover at least as much as the Medicare standard plan), person can enroll in Medicare prescription drug plan within 63 days and avoid higher premium rates.
- Madigan policy with drug coverage recipients cannot enroll into Medicare Part D and
maintain their Madigan drug plan simultaneously. For options available go to:
http://www.medicare.gov/Publications/Pubs/pdf/11113.pdf
- Medicare-approved drug discount card not provided by a Medicare Advantage Plan will be automatically cancelled when a Medicare drug plan is joined. Patients can continue to use their discount card until 5/15/06 or until they join a Medicare drug plan. The discount drug card program will be discontinued. For more information:
http://www.medicare.gov/Publications/Pubs/pdf/11153.pdf
Should I enroll in a Medicare Part D plan?
In general, persons with non-creditable coverage should probably enroll in Part D. Many will likely save money immediately if they choose their plans wisely and be protected against unexpected catastrophic drug expenses should additional medications be required.
Persons with creditable drug coverage should carefully consider the advisability of dropping that coverage for Medicare Part D. Many plan providers do not allow one to switch back to their previous drug plan once it has been cancelled. If patients have creditable drug coverage from an existing plan, they will have received a letter to this effect.
Persons who spend considerable time living away from their primary residence may want to:
Experts are advising persons to take time to carefully evaluate the plans and not rush their decision. Enrollment officially begins November 15, 2005 and continues through May 15, 2006.
What you should consider when selecting a plan?
Factors to consider in selecting a prescription drug plan.
- Determine person's eligibility for extra help with Part D plan costs. Call Social Security at 1-800-772-1213 to get an application.
- List current medications or anticipated medications, including, dose, dosage form, out of pocket costs
- Compare Plans looking at coverage, cost, convenience, future prescription needs.
Coverage
- Compare the plan's list of covered drugs to the patient's medication needs.
- Note if patient's medications require prior authorization or have other restrictions
- If plan doesn't cover patient drug, is there an acceptable substitute
Costs
- Individual Part D plans will vary significantly by insurer, but all health plans must offer a benefit that is financially equivalent to the “Standard Plan.” The standard plan does not cover any prescription costs above $2250 in total drug costs until $3600 spent is out-of- pocket.
- Consider all the costs associated with the plan being considered e.g. monthly premium, co-pays or co-insurance, deductible, coverage limits, and if drug is tiered.
Convenience
- Not all pharmacies are providers for each prescription drug plan
- Some plans offer mail order and others don't
Future Prescription Needs
Patients who spend considerable time living away from their primary residence may want to:
How do I enroll?
Several options are available to enroll:
What help is available if you need financial help?
- Persons who were notified that by Medicare (Dual eligible-Medicare & Medicaid recipients) or Social Security that they were eligible for help will be automatically enrolled if they don't choose and enroll in a drug plan. The Dual Eligible will be auto-enrolled by 12/31/05 for coverage to begin on 1/1/06 and the Social Security designated eligible will be auto-enrolled by 5/15/05 for coverage to begin on 6/1/06 .
- Persons qualifying for assistance will have premiums, deductibles, co-insurance and coverage gaps reduced or eliminated based on level of need.
- To determine if one qualifies for limited income assistance with Part D prescription costs
- Michigan : Free help available to help Medicare eligible clients understand & apply for this limited-income Medicare-Part D assistance (some counselors are available to come to the patient's home)
- Detroit Area Agency on Aging: ( 313)446-4444
- Michigan Medicare Medicaid Assistance Program: (800)803-7174
- Ask for a MMAP counselor when calling Social Security Administration: (800)772-1213; TTY: 1-800-325-0778
What drugs are included and excluded from Medicare Part D?
Medicare Part D includes most prescription drugs not currently covered under Medicare Part A and B. Drugs that are currently being covered under Part A & B will continue follow the same rules and will not be covered under Part D.
- Drugs excluded from Part D Coverage
- Drugs to promote fertility
- Drugs for weight loss or gain
- Drugs for cosmetic purposes
- Drugs for relief of simple coughs and colds
- Prescription vitamin and mineral products
- Non-prescription drugs
- Inpatient drugs
- Barbiturates
- Benzodiazepines
- *Exception to the excluded drug list: Michigan Dual Eligible (qualify for Medicaid & Medicare)-benzodiazepines, barbiturates and currently covered Medicaid OTCs will be covered under Part D. However, the drug plan chosen for or by the patient may require a PA or an appeal to get Part D coverage.
- To search Michigan Prescription plan coverage by drug http://plancompare.medicare.gov/formularyfinder/selectState_Inter.asp?
vid=2580547&plan_specific=False
How does this affect patients currently on Medicaid?
- Medicaid will no longer provide drug coverage to persons eligible for Part D starting 1/1/06 . Those persons will be auto-enrolled in a Part D plan if they have not chosen a plan on their own by 12/31/05 .
- Persons on both Medicare & Medicaid (Dual Eligible) will automatically qualify and be randomly assigned to one of the standalone drug plans that are below the regional benchmark. Dual Eligible can switch their drug plan at any time to another plan below the benchmark and still avoid the monthly premium.
Will all pharmacies charge the same for Medicare Part D prescriptions?
- Pharmacies have the option of not being a provider for the Medicare Part D program. Non-participating pharmacies will not be able to process prescriptions through the Part D program
- Participating pharmacies will fall into one of 4 categories:
- Preferred pharmacy-costs may be less because the pharmacy has agreed to charge your drug plan less
- Mail order program-some plans offer a mail-order program that allows you to get up to a 90-day supply
- Network Pharmacy-participates and can fill prescriptions through the Part D program
- 60-90 day Pharmacy program-some pharmacies are providers for a 60 or 90 day supply of covered drugs
Where can I get the most current information about Medicare Part D?
+ Medicare phone: 1-(800)633-4227; TTY users 1-(877)486-2048
Web page: www.medicare.gov
+ State of Michigan Medicare/Medicaid Part D Prescription Coverage http://www.mymmap.org
+ UM recommendations for UM retirees, employees, dependents eligible for Medicare
Part D http://www.umich.edu/%7Ebenefits/
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