Skip UCSF navigation|About accessibility UCSF University of California, San Francisco
About UCSF
Search UCSF
UCSF Medical Center
End of UCSF navigation
Pharmacists Clarify the Medicare Part D Fog
English
Chinese |
Russian |
Spanish |

End of section-level navigation

Skip breadcrumbs navigationUCSF which contains School of Pharmacy which contains Pharmacists Clarify the Medicare Part D Fog which contains Medicare Prescription Drug Coverage Questions and Answers
School of Pharmacy•

UCSF School of Pharmacy

Medicare Prescription Drug Coverage Questions and Answers

Wednesday, April 26, 2006

Prepared by:
Timothy W. Cutler, PharmD
and
Marilyn Stebbins, PharmD

Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco

Cutler y Stebbins
  1. What is Medicare?
    Medicare is a United States federal health insurance program. It is for people age 65 and older and for people with disabilities.

  2. What is Medicare Part D?
    Medicare Part D is a short way of referring to "Medicare Prescription Drug Coverage." Medicare Part D is prescription drug insurance for all people with Medicare. It is voluntary. It became effective January 1, 2006.

    This year the deadline to sign up for Medicare Part D without a financial penalty is May 15, 2006.

    Most people who enroll in Medicare Part D will pay a monthly premium for their drug insurance and a co-payment when they fill a prescription.

  3. How do I get Medicare Part D?
    Private health plans provide Medicare Part D coverage. There are two ways to get this coverage:
    1. You can add a separate Prescription Drug Plan (PDP) to Medicare. OR you can add a separate Prescription Drug Plan (PDP) to a Medicare Supplemental plan. See #4 for additional information.
    2. You can choose a Medicare Advantage Prescription Drug Plan (MA-PD). This kind of plan has both medical and prescription drug coverage together. See #5 for additional information.
  4. What exactly is a Prescription Drug Plan (PDP)?
    Prescription Drug Plans are the insurance plans that offer the Medicare Part D drug benefit. The plans vary by:
    • The prescription drugs that are covered (brand name drugs will be covered)
    • How much you have to pay monthly to be a part of the plan
    • The amount you have to pay out of pocket before your plan begins (deductible) and
    • The pharmacies you can use.
    Several options are available to Medicare beneficiaries in each geographic area (there are 48 PDPs available in California).
  5. Do I need to enroll in Medicare Part D if I am already enrolled in a Medicare Advantage (MA-PD) plan?
    If you are currently enrolled in a Medicare Advantage Plan, you might already have Part D coverage through your MA-PD. Your MA-PD drug benefit will be at least as good as Medicare Part D. MA-PD plans will vary by:
    • Which prescription drugs are covered (brand name drugs are now covered in these plans)
    • The amount of your monthly premiums and co-payments and
    • Which pharmacies can be used.

    If you are happy with your current plan and you know you have prescription drug coverage through this plan, do not purchase a separate drug plan. Such a purchase will result in the cancellation of your MA-PD coverage.

    Contact your Medicare Advantage Plan if you have any questions.

  6. What happens if I do not enroll in a Medicare Part D plan?
    Medicare Part D is a voluntary program. If you want to enroll, you must enroll before May 15, 2006, or you will have to pay penalties for late enrollment.

    If you sign up for Medicare Part D at a later date, your premium will increase by 1% per month (based on the national average premium for that year) for every month you were eligible but did not join. This penalty is a lifetime penalty. It will be added to your drug plan premium for the entire time you are enrolled in a Medicare Part D plan.

    If you have prescription drug coverage through your previous employer or union, please see #8.

  7. Who is eligible?
    People who are currently enrolled in Medicare are eligible for Medicare Part D. To be enrolled in Medicare you must be:

    • 65 years of age or older
    • Or you must be permanently disabled.
  8. What do I do if I have both Medicare and Medi-Cal?

    Medi-Cal is a program administered by the State of California. It provides medical assistance to people in California who have low incomes and who qualify for the program.

    Medicare will now cover your prescription drugs instead of Medi-Cal. Medi-Cal will only cover the small number of prescriptions that are excluded by Medicare. You should have been automatically assigned to a Medicare Part D Prescription Drug Plan unless you chose your own plan. You need to be sure the plan to which you were automatically assigned -- or the one that you choose -- covers all the prescription drugs you are taking.

  9. What should I do if I currently have drug coverage through my union or retirement?
    You should have received information telling you if your retiree prescription drug coverage is at least as good as the standard Medicare Part D coverage.

    • If you are told that your prescription drug benefit is "creditable" or at least as good as Medicare Part D, you do not need to do anything. Some examples of creditable coverage plans are the VA, FEHB, and Tri-Care.
    • If you are told that your prescription drug benefit is not as good as Medicare Part D, you will need to choose a Medicare Part D drug plan or you will be subject to a financial penalty. See #6 for penalty definition.
    It is important to contact your employer or union if you have questions.
  10. What prescription drugs are covered under Medicare Part D?
    Each Prescription Drug Plan has a unique formulary. This is a list of drugs that are covered in that particular plan. Not all drugs will be covered. All prescription drug plans must provide at least a standard level of coverage. However, some plans might offer more coverage and additional drugs for a higher monthly premium. When you join a drug plan, it is important to choose one that meets all your prescription drug needs.
  11. How much will Medicare Part D cost me?
    Unless you qualify for extra help, you will pay a monthly premium. Premiums will vary depending on the plan type you choose.
  12. How do I know if I qualify for extra help?
    If your income and resources are less than the amount below, you might be eligible for additional assistance from Social Security. This additional assistance is known as a Low Income Subsidy (LICS). The subsidy will:
    • Assist in paying your monthly drug premium,
    • Reduce your co-payments for brand and generic drugs, and
    • Eliminate the coverage gap.
    Income is based on federal poverty guidelines and resources that include savings, stocks, certificates of deposit, and mutual funds. The value of the home you live in or the car you drive are not included in the income/resources calculation. The income limits are:
    • $1,197/month ($14,364/year) for an individual (resources less than $11,500)
    • $1,604/month ($19,248/year) for a couple (resources less than $23,000)
    You can apply online at www.socialsecurity.gov or call 1-800-772-1213.

  13. I have heard about the coverage gap / donut hole. What is it?
    All plans offer drug coverage until your total drug costs (the amount you and your insurance plan pay combined) hit a limit. The limit is between $1,850 - $2,250. When your out-of-pocket costs (only what you pay) reaches $3,600 your Medicare Part D plan will once again resume with a $2 generic, $5 brand, or 5% drug co-payment. Please contact your plan for further information.

    If you are eligible for LICS, you do not have to worry about the coverage gap; you will have continuous drug coverage regardless of your total drug costs.

  14. What important dates should I know?
    • January 1, 2006:
      Medicare Prescription Drug Plan went into effect.
    • April 1, 2006:
      Facilitated enrollment for patients qualified for Low Income Subsidy who have not picked a plan.
    • May 15, 2006:
      Last day to sign up for a Medicare Prescription Drug Plan for 2006.
    • November 15, 2006 - December 31, 2006:
      Open enrollment to apply for a plan for 2007.

  15. How do I choose the right plan for me?
    In order to compare plans, you can:

    • Go to the www.medicare.gov website or call 1-800-MEDICARE (1-800-633-4227).
    • You will need a list of the names, dosages, and costs of the prescription drugs you use. You can get this information from your local pharmacy.
    • Have your Medicare Card available.

    Or you can:

    • Consult your local pharmacist.
    • Call Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222.
  16. Once I have chosen a plan how do I enroll?
    • By paper application. Contact the insurance company offering the drug plan you choose and ask for an application. Once you fill out the form, mail or fax it back to the company.
    • On the plan's website. Visit the drug plan company's website. You might be able to join online.
    • On the Medicare website. You will also be able to join a drug plan at www.medicare.gov by using Medicare's online enrollment center.
    • By calling 1-800-MEDICARE. You can join a drug plan by calling 1-800-MEDICARE (1-800-633-4227) and talk to a Medicare customer service representative. TTY users should call 1-877-486-2048.
  17. Who can I contact for more information?

Go To: Pharmacists Clarify the Medicare Part D Fog

Translations

This document is also available in: