Medicare rolls out prescription drug plan
September 07, 2005 - Medicare is rolling out a prescription drug plan for those eligible for Medicare that has basic coverage for prescription medications.
The Medicare prescription drug plan (Part D), effective Jan. 1, allows insurers and other private companies to offer prescription drug plans, or PDPs, for both generic and brand-name drugs.
In October, people with Medicare will receive a Medicare and You handbook in the mail describing Medicare plans available in their area.
Beneficiaries need to be aware of how these options could impact their coverage.
If participants already are enrolled in a Medicare Advantage, or MA, plan, they do not have to select a Medicare prescription drug (Part D) benefit. It already is included in their plan for 2006. However, if they select a stand-alone PDP and already are enrolled in an MA plan, they may lose existing MA medical benefits.
Open enrollment begins Nov. 15 with coverage taking effect Jan. 1. Open enrollment will continue through May 15 with coverage beginning the first day of the month after enrollment. Those enrolling after May 15 may pay a higher premium.
PDPs will have a monthly premium and an annual deductible. The Centers for Med-icare and Medicaid Services estimate the standard plan will cost participants about $37 per month with a yearly deductible of $250. Plans offered by private companies may provide additional coverage beyond that required by the standard plan, including filling the coverage gap. Such plans likely will require an additional premium.
After meeting the annual deductible, the standard PDP requires participants to pay 25 percent of the cost of drugs until drug costs for the year reach $2,250. This $2,250 is the total cost of the drugs, not just out-of-pocket costs. After that, participants pay 100 percent of their drug costs from $2,250 to $5,100.
After one spends a total of $3,600 in a calendar year, catastrophic coverage will kick in and pay 95 percent of all costs and beneficiaries pay a small co-payment.
For more information, call (800) MEDI-CARE or (800) 851-1768.