The Medicare drug plan, also called Medicare Part D, is available to anyone enrolled in Medicare Part A (the hospital coverage portion), and Part B (the medical coverage portion). Even if you are covered by another plan, you can switch to Medicare (if you are eligible), or Medicare will help you and your employer (if you have one) improve your drug coverage. If you do not join when you first become eligible, you may have to pay a fee if you decide to join later.
The drug plan covers prescription drugs—both brand-name and generic, although you still have to pay part of the cost. Private insurance plans administer the Medicare prescription drug program. These plans must issue a list of drugs they will pay for, but they can change that list as long as they warn you that a drug will be dropped at least 60 days in advance. Plans will frequently not cover brand-name drugs for which less expensive alternatives exist. Your doctor can write a letter appealing these decisions on your behalf if needed.
The costs of the drug plan will depend on different things—the medications you use, the plan you choose, and whether you go to a pharmacy in your plan’s network. Here are some costs you can expect to pay:
Your employer must tell you whether the company plan is generally as good as Medicare's. If it isn't, you may be able to keep your current plan and join a Medicare plan, or drop your current plan completely and replace it with Medicare's. If you decide to stay with your current plan for now but drop it for Medcare's later, you may have to pay a penalty. If, however, the plan you have now is as good as Medicare's, you can keep it until you are no longer covered (eg, retirement, layoff) and then join a Medicare plan within 63 days and pay no penalty.
By answering a few questions you should be able to choose a plan that works best for you.
People with limited income and resources may be able to get extra help paying for the drug plan's monthly fee, yearly deductibles, and co-payments. The Medicare website has more information on how to obtain financial assistance.
The Department of Health and Human Services provides lists of plans available in all states, at http://www.medicare.gov/medicarereform/map.asp. Or you may contact your local Social Decurity office. In addition, local chapters of organizations advocating for the elderly community will have information on various Medicare drug plans.
If you are already a Medicare beneficiary, the Social Security Administration ( http://www. ssa.gov) should have sent you a letter encouraging you to enroll and outlining your drug plan options. They generally contact eligible persons a few months before their 65th birthday. If you did not receive a letter, need more information about how to enroll, or have any questions about Medicare benefits, call your local Social Security office or your State Health Insurance Assistance Program (SHIP). Every state has a SHIP.
To enroll in a Medicare drug plan online, go to http://www.medicare.gov. You can also obtain prescription drug coverage and the rest of your Medicare coverage through a Medicare Advantage or other health plan, such as an HMO or PPO.
RESOURCES:
Social Security Online, US Social Security Administration
http://www.ssa.gov
United States Administration on Aging
http://www.eldercare.gov/Eldercare.NET/Public/Home.aspx
United States Department of Health and Human Services
http://www.medicare.gov/Choices/Overview.asp
References:
United States Department of Health and Human Services. Extra help for people with limited income and resources. Medicare website. Available at: http://www.medicare.gov/medicarereform/help.asp. Accessed April 3, 2006.
United States Department of Health and Human Services. Medicare and You: 2010. Medicare website. Available at: http://www.medicare.gov/Publications/Pubs/pdf/10050.pdf. Accessed November 29, 2009.
Last reviewed November 2009 by Brian Randall, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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