General Medicare Questions
Financial Assistance Questions
Employer Retiree Questions
General Medicare Questions
What is Medicare prescription drug coverage?
Beginning January 1, 2006, new Medicare Advantage prescription drug plans were available to people with Medicare to help cover medical benefits and the cost of prescription drugs. Like other insurance, you may pay a monthly premium and pay a share of the cost of your prescriptions. Costs will vary depending on the drug plan you choose and where you live. People with Medicaid and those who qualify for the 'Extra Help' program may recieve a full or partial subsidy
How much does Medicare prescription drug coverage cost?
The cost of your coverage may vary by region and by which plan you select. However, monthly premiums through Denver Health will be $32.80 in 2011. If you qualify for Medicaid or 'Extra Help,' your premium will be reduced or $0.
Do I have to enroll in Medicare prescription drug coverage?
No, enrollment in Medicare prescription drug coverage is voluntary, but if you don't enroll when you first become eligible, you may have to pay a penalty, in the form of a higher monthly premium if you enroll later on. Many people with employer-provided coverage are likely to stay with their current retiree plans and decline Medicare’s drug benefit.
How do I join a Medicare Advantage prescription drug plan?
If you currently have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), you can join a Medicare Advantage prescription drug plan during the annual enrollment period which will change in 2011 and will be from October 15 to December 7, 2011. Your Medicare plan will begin January 1 of the following year. Contact the plan directly or go to www.MyMedicare.gov.
What is the Medicare Part D Standard benefit?
In addition to your monthly premium, you must first satisfy the annual deductible of $310 in 2011. After that, the Medicare Part D standard plan pays 75% of the next $2,530 in eligible drug costs. You pay 25%. After your total yearly drug costs reach $2,840, you receive a discount on brand name drugs and pay 93% of the plan's costs for all generic drugs, until your yearly out-of-pocket drug costs reach $4,550. After that, Medicare pays 95% of any remaining prescription drug costs for the year and you pay 5% or a co-payment of $2.50 for generic and $6.30 for brand name drugs, whichever is greater.
What is creditable coverage?
Creditable coverage is coverage that is equal to or better than Medicare Part D’s standard plan. Having creditable coverage allows you to enroll in Medicare Part D during future annual enrollments without paying a late enrollment penalty. VA and Tricare are considered to be creditable coverage.
Who administers Medicare Part D?
Private health plans have contracted with the Centers for Medicare and Medicaid Services (CMS) to administer Medicare prescription drug coverage to Medicare-eligible individuals who enroll in the plan. These private health plans are also known as prescription drug plans (PDPs). Another option is to get your prescription drug coverage through a Medicare Advantage Plan (MA-PD) that offers prescription drug coverage.
Are all private health plans that will be administering Medicare Part D offering the same level of benefits?
All Medicare Part D plans must offer coverage at least equal to the standard Medicare Part D coverage. However, not all Medicare Part D prescription drug plans are the same. The plans may vary with respect to the list of approved drugs, the network pharmacies, the premiums, co-pays and cost share and whether a mail service and other optional benefits are included. You’ll need to research these points when you begin to receive information from the private health plans this fall.
Where can I get more information?
If you have questions about Medicare in general, contact Medicare 24 hours a day 7 days a week at 1-800-MEDICARE (1-800-633-4227). (TTY/TDD: 877-486-2048) or visit www.medicare.gov on the Web.
Financial Assistance Questions
Am I eligible for additional financial assistance from the government to help cover the cost of the Medicare Part D prescription drug coverage?
The government has certain financial conditions that need to be met in order for you to qualify for additional financial assistance under Medicare Part D. People with low incomes and a relatively small amount of savings are eligible for assistance to help pay the annual deductible, premiums, and co-payments related to Medicare prescription drug coverage. In addition, many state pharmacy assistance programs may supplement the Part D benefit. If you apply for this assistance, the government will notify you by letter if you qualify. You may have received an application for financial assistance from CMS earlier this year.
Information about this extra help is available from the Social Security Administration (SSA). For more information about this extra help, visit SSA online at www.socialsecurity.gov , or call them at 1-800-772-1213 (TTY 1-800-325-0778).
I received information in the mail from the Social Security Administration that I might be eligible for financial assistance to pay for prescription drug coverage. Should I apply for this assistance?
We recommend that, at a minimum, you inquire as to what you are eligible for and how that might be of benefit to you.
If I am eligible for financial assistance what do I pay?
If you qualify, you will pay no (or reduced) premiums and deductibles. You will pay only very small co-payments. You will also have no gaps or breaks in coverage. The 2011 resource limits are $8,180 ($13,020 if married) for the full low-income subsidy and $12,640 ($25,260 if married) for other low-income subsidies.
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Employer Retiree Questions
What if I have drug coverage as part of my benefits package from my former employer?
Many employers are expected to continue providing drug coverage exactly as they did before the Part D benefit was available. If you enroll in a Medicare prescription drug coverage plan you may no longer be eligible for coverage under your employer sponsored plan.
Should I stay on my employer’s retiree prescription drug plan or sign up for Medicare prescription drug coverage?
No one can answer that question for you. You need to carefully compare your options, paying particular attention to what drugs are covered and how much you will pay for your monthly premium, your coinsurance or co-payments, and your deductible under each plan.
If you need assistance in understanding your options, free counseling is available to Medicare beneficiaries through your State Health Insurance Program (SHIP) office. To find your nearest SHIP office, call 1-800-633-4227 or go online to www.shiptalk.org .
Will the same drugs that are covered under my current plan be included under Medicare Part D?
It is important to note that the standard Medicare prescription drug plan may not cover some of the drugs that your current prescription benefits program covers. You’ll need to research drug lists and the drugs available under each Medicare prescription drug plan when you begin to receive information from the private health plans this fall.