Medicare Prescription Drug
Program (Part D) Impacts
By Lance
Hegland
Enrollment in the Medicare Part D program will begin November 15
and will become effective January 1. Part D is the new voluntary
drug benefit implemented by the federal government in response to
rising pharmaceutical costs, which had caused some medication to
be unaffordable for some seniors and individuals with disabilities.
This is the biggest Medicare program change in 40 years!
Although Part D will
help make most medications more affordable, state and other insurance
drug programs are changing to take advantage of these new benefits,
too. Therefore, consumers may experience confusion during the transition
regarding which health insurance program is helping to cover their
prescription costs. If your drug coverage is changing, you should
have received, and will likely continue to receive, a barrage of
mail notifying you of the change and what you need to do. But sometimes,
those notices may look like “junk
mail” and get discarded.
Here are the most important changes everyone needs to know:
• The Minnesota
Prescription Drug Program (MN-PDP) ends December 31.
• If you are eligible for both Medicare and Medical Assistance,
Medical Assistance will not cover prescriptions after December 31 (with
a few exceptions). Plus, the monthly co-payment charges and limit for
Medicare could be much higher than your current Medical Assistance
co-payment charges and limit depending on the number and actual cost
of your medications. Medicare Part D co-payments for people eligible
for both Medicare and Medical Assistance will range from $1 to $5 per
prescription filled. When total prescription drug costs reach $5,100
in a year, the co-payments end for the year.
• Some people will qualify for additional assistance to help pay
for Medicare Part D plan costs (e.g., premiums, deductibles, and co-payments).
For more information, please read Jim Czechowicz’s article, “Extra
Help to Meet Prescription Costs,” also in this month’s
edition.
• There are approximately 63 different Medicare prescription drug
plans being offered by 24 different organizations. Each drug plan may
charge different costs by requiring different premiums, deduct-ibles,
and co-payments. Also, drug plans may cover different drugs; they may
use different drug formularies.
• Most people must actually choose, and then notify Medicare of
their choice, by enrolling in a Medicare Part D drug plan.
• If you are currently eligible for Medicare but choose not to
enroll in a Medicare Part D plan, you may pay a “penalty” for
the rest of your life through higher monthly premiums if you apply
for drug benefits in the future. For example, Bill is eligible, does
not currently take any medication, does not want to pay the coverage
premium (approximately $30/month), and does not enroll. Four years
from now, Bill’s doctor prescribes several expensive medications.
When Bill finally enrolls, he will be required to pay an additional
48% penalty in addition to his current monthly premium for the rest
of his life (a 1% per month penalty for the 48 months he waited).
• Even if you are one of the few people automatically enrolled
in a Medicare Part D plan, it may not be the best plan for you. It
might not even cover the medications you take.
What you need to do:
• If you live in a skilled nursing facility (SNF) or intermediate
care facility (ICF/MR), you will automatically be enrolled in a plan
and will not be charged any premiums, deductibles, or co-pays.
• If you receive coverage through AXIS Healthcare/UCare Minnesota
(the Minnesota Disability Health Option program —MnDHO), you
don’t need to do anything. You will be automatically enrolled
in the most appropriate drug plan and receive the full amount of additional
assistance to pay for any drug plan premiums and deductibles. You will
still need to pay co-payments though.
• If you are eligible for Medicare AND use Medical Assistance,
Medical Assistance for Employed Persons with Disabilities (MA-EPD),
or a Disability Waiver program, you will automatically be enrolled
in one of the drug plans. BUT, that plan may not be the BEST plan for
YOU. Make a list of the medications you are taking, then use the tools
on the Medicare Web site www.medicare.gov or call the Linkage Line
800-333-2433 to find out which plan is best for you. Also, you will
automatically receive the full amount of additional assistance to pay
for any drug plan premiums and deductibles. You will still need to
pay co-payments though.
• If you currently
receive Supplemental Security Income (SSI) OR use a Medicare Saving
Program (QMB, SLMB, QI) or the Minnesota Prescription Drug Program
(MN-PDP), you must choose a plan by January 1 and you will automatically
receive full or partial assistance paying for premiums, deductibles,
and co-payments depending on income, resources and family size.
Make a list of the medications you are taking, then use the tools
on the Medicare Web site www.medicare.gov or call the Linkage
Line 800-333-2433 to find out which plan is best for you.
• If you do not
fall into any of the above categories AND are eligible for Medicare,
you will need to choose and enroll in the most appropriate plan
for you. Also, you may wish to apply for additional financial assistance.
Make a list of the medications you are taking then use the tools
on the Medicare Web site www.medicare.gov or call the Linkage
Line 800-333-2433 to find out which plan is best for you.
For more information,
please visit Medicare’s Web site www.medicare.gov,
visit Social Security’s Web site www.socialsecurity.gov, call
Medicare 800-633-4227, call Social Security 800-772-1213, or call
the Linkage Line 800-333-2433. The Linkage Line is designated by
the Centers for Medicare & Medicaid Services (CMS) to be the
State Health Insurance Assistance Program (SHIP) for Minnesota and
provides comprehensive impartial assistance to all Minnesotans with
Medicare including persons with disabilities, seniors, people with
End Stage Renal Disease, or ALS. Linkage Line hours have been extended
to accommodate the increased number of requests for assistance. Hours
are 8:00 am to 7:00 pm Monday through Friday and 8:00 am to noon
on Saturdays.
