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What is Medicare Prescription Drug Coverage?
Do I have to enroll in Medicare Part D?
How much does Part D cost?
Who can help me choose a Part D Plan?
When can I enroll in Part D?
What is Extra Help?
Who Qualifies for Extra Help?
How Can I Apply for Extra Help?
What is Medicare Prescription Drug Coverage? • Medicare offers prescription drug coverage to everyone who has Medicare. To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.
There are two ways to get Medicare prescription drug coverage:
• Medicare Prescription Drug Plans. You must have Medicare Part A and/or Part B.
• Medicare Advantage Plans (like an HMO or PPO). You must have Medicare Part A AND Part B.
Back to top Do I have to enroll in Medicare Part D?
No, Part D is voluntary. However, if you decide not to join a Part D plan when you are first eligible, and you do not have other coverage that is as good as or better than a Medicare prescription drug plan, you will probably pay higher monthly premiums if you join later.
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How much does Part D cost? Here is how the cost-sharing works in a standard Part D plan. The details of individual plans may vary.
Premiums. This is the monthly fee you pay to participate in the plan. Premiums average about $30, and you must pay the premium each month.
Step 1, Annual Deductible. This is the amount you pay before your insurance coverage begins. The standard deductible is $310.
Step 2, Co-Insurance. This is the amount you pay at the pharmacy for your covered prescriptions after the deductible. You pay your share, and your drug plan pays its share for covered drugs.
Step 3, Coverage Gap (Donut Hole). Once your total medication costs have reached $2,830, your plan makes no contribution, and you must pay the total cost of your medication until you have paid an additional $3,610 for medications. NOTE: These amounts will change in 2011.
Step 4, Catastrophic Coverage. Once you have paid the additional $3,610, your plan will pay most of the cost of your medications. (NOTE: This amount will change in 2011) You will then pay approximately 5% of the cost, or a small flat amount.
Each January 1, you begin again at Step 1, the annual deductible.
Back to top Who can help me choose a Part D Plan?
Benjamin Rose Institute on Aging has trained staff that can help you choose and enroll in a plan. Our Call Center is open Monday through Friday, from 9:00 AM to 5:00 PM, and provides this service free of charge. Call 216.373.1650 or toll-free 1.866.885.1650.
Medicare can also help you choose and enroll in a plan. Call 1-800-MEDICARE (1.800.433.6227).
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When can I enroll in Part D?
You can enroll when you first become eligible for Medicare, or between November 15 and December 31, 2010, or anytime if you qualify for Extra Help.
Back to top What is Extra Help?
Extra Help, also called the Low Income Subsidy (LIS), is financial assistance for Medicare beneficiaries who have limited income and assets. Those who are eligible may have all or part of their premiums and deductibles waived, will pay reduced co-insurance, and will not be subject to the coverage gap (donut hole).
Back to top Who Qualifies for Extra Help?
• Single Medicare beneficiaries with a monthly gross income of less than $1,354 AND resources less than $12,510. (NOTE: These amounts may be higher in 2011.)
• Couples with gross monthly income of less than $1,821 AND resources less than $25,010. (NOTE: These amounts may be higher in 2011.)
Back to top How Can I Apply for Extra Help?
Benjamin Rose Institute on Aging has trained staff that can submit your application for Extra Help, which will be forwarded to the Social Security Administration. Determination is made in approximately three weeks, and a letter will be sent to you regarding your eligibility. Our Call Center is open Monday through Friday, from 9:00 AM to 5:00 PM, and provides this service free of charge. Call 216.373.1650 or toll-free 1.866.885.1650.
Social Security Administration can also take your application over the telephone or will mail you a paper application, if you prefer. Call 1.800.772.1213.
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