Medicare Drug Benefit: What you need to know to protect patients and family

[NRSKarenRN, BSN, RN]

tips and tools for people with medicare and those who care for them

for the first time ever, everyone with medicare, regardless of income, health status, or prescription drug usage, will have access to prescription drug coverage. this new coverage begins on january 1, 2006. medicare & you 2006 handbook mailed to all medicare recepients explains in detail what prescription drug coverage means to you and which plans are available in your area.

if you join by december 31, 2005, your medicare

prescription drug plan coverage will begin on january 1, 2006, and you

won't miss a day of coverage. if you join after that, your coverage will be

effective the first day of the month after the month you join.

if you join a medicare prescription drug plan after may 15, 2006,

and you don't currently have a drug plan that, on average, covers at least as much as standard medicare prescription drug coverage, you will have to wait until november 15, 2006 to join. when you do join, your premium cost will go up at least 1% per month for every month that you wait to join. like other insurance, you will have to pay this penalty as long as you have medicare prescription drug coverage.

how much does it cost?

if you join in 2006, for covered drugs you will pay

• a monthly premium (varies depending on the plan you choose, but estimated at about $37).
  
• the first $250 per year for your prescriptions. this is called your "deductible."

after you pay the $250 deductible, here's how the costs work:

• you pay 25% of your yearly drug costs from $250 to $2,250, and your plan pays the other 75% of these costs, then
  
• you pay 100% of your $2,850 in drug costs, then
  
• you pay 5% of your drug costs (or a small copayment) for the rest of the calendar year after you have spent $3,600 out-of-pocket. your plan pays the rest.

joining a medicare advantage program (hmo/ppo plan) may have different costs: http://www.medicare.gov/choices/overview.asp

you pay medicare part b 2006 monthly cost $88.50 + advantage plan costs (which cover meds, some have vision and dental coverage too).

dual coverage from medicare with medicaid drug coverage. these people will automatically get comprehensive prescription drug coverage from medicare, starting on january 1.

(in pa, state automaticlaly enrolling participents in plan state is choosing.)

note: if you have limited income and resources, but you don't have medicaid, you may qualify for extra help that may pay for about 95% of your drug costs. visit extra help for people with limited income and resources for more information.

available 24/7 at 1-800-medicare.

our customer service representatives will provide information and answers to your questions. also, visit www.medicare.gov , or contact 1-800-medicare or www.eldercare.gov to find out about local counseling and assistance available in your area.

landscape of local plans

this resource helps you find medicare prescription drug plans by state or medicare advantage (medicare hmo) plans with prescription drug coverage by county.

look carefully at % of medicare formulary plan is covering. karen

to find out how much you can save with medicare prescription drug coverage, visit the compare medicare prescription drug plans

cost: the medicare prescription drug plan finder will show you a list of drug plans in your area, sorted by the plan with the lowest total cost for the drugs you take now. it can also help you narrow down the choices based on deductibles or premiums.

medicare-approved drug discount cards listed by state.

hope this helps. karen