Your Medicare Prescription Drug Coverage Module 9A

Today’s Medicare Promotes a healthy lifestyle Covers preventive services Provides more choices Helps people with Medicare live longer, healthier lives Offers prescription drug coverage

Medicare Prescription Drug Coverage Coverage began January 1, 2006 Sometimes called Medicare Part D Available to all people with Medicare Provided through Medicare Prescription Drug Plans Medicare Advantage and other Medicare plans Some employers and unions

Eligibility Have Medicare Part A and/or Part B Need Part A and Part B to get Medicare Advantage Plan with drug coverage Live in plan’s service area Join a Medicare drug plan to get coverage

When You Can Join Initial Enrollment Period 7-month period when people first get Medicare Annual Coordinated Election Period November 15 – December 31 each year Special Enrollment Period In some situations

Waiting to Enroll Waiting to enroll could mean a penalty 1% premium increase for every full month you wait For as long as you have Medicare drug coverage Unless you have other drug coverage at least as good as Medicare drug coverage Creditable coverage

Late Enrollment Penalty IEP ended 5/15/06 and first enrolled 12/06 Coverage began 1/1/07 Will pay 7% higher premium per month 7 months x 1% = 7% penalty 06/06 – 12/06 7% x $27.35 = $1.91/month penalty in 2007 National base premium is $27.35/month in 2007 Can change each year

Creditable Drug Coverage Coverage at least as good as Medicare’s If you have other drug coverage Will get information from other plan If you keep creditable drug coverage No penalty if you wait to enroll

Medicare Drug Plans Medicare drug plans vary Cost—How much you have to pay Coverage—What drugs they cover Convenience—Which pharmacies they use Important to get coverage before you need it Peace of mind

Things to Consider What is your current health insurance coverage? Do you have prescription drug coverage? Is your current drug coverage as good as Medicare’s? How does your current coverage work with Medicare?

What If… Medicare & State Pharmacy Program Medicare & AIDS Drug Assistance Program Medicare & Health Savings Accounts Medicare & Patient Assistance Program

What You Need to Know Cost Module 9A

Medicare Prescription Drug Costs For coverage in 2007, you will generally pay Monthly premium, varies by plan Possible deductible, no more than $265 Copayments or coinsurance May depend on how much you have spent that year Very little after paying $3,850 out of pocket

Extra Help With Drug Costs People with lowest income and resources Pay no premiums or deductibles Have small or no copayments Those with slightly higher income and resources Have a reduced deductible Pay a little more out of pocket

Income and Resource Limits Income Below 150% Federal poverty level $1, per month for an individual* or $1, per month for a married couple* Based on family size Resources Up to $11,710 (individual) Up to $23,410 (married couple) Counts savings and stocks Does not count home you live in Includes $1,500/person funeral or burial expenses *Higher amounts for Alaska and Hawaii 2007 amounts

Qualifying for Extra Help You may automatically qualify if you have Medicare and You get full Medicaid benefits You get Supplemental Security Income (SSI) Medicaid helps pay your Medicare premiums All others must apply Apply online at or Call

What You Need to Know Coverage Module 9A

Which Drugs Are Covered? Available only by prescription Drugs, biologicals, insulin Medical supplies for injecting insulin Syringes, needles, alcohol swabs, gauze Brand-name and generic drugs

Coverage Varies Plans have formularies May not include all Medicare-covered drugs Usually cover similar drugs that are safe and effective May have different levels (“tiers”) Choosing generic drugs can save money Plans must make sure people can get the treatment they need

Coverage Varies Plans may have rules for covering some drugs Prior authorization Step therapy Quantity limits

What if Your Prescription Changes? You and your doctor should work with plan Find a drug that is on the formulary If you need a drug not on the plan’s formulary Can request an exception If plan denies your exception request Can appeal

What You Need to Know Convenience Module 9A

Pharmacies Medicare drug plans work with certain pharmacies Will send you a pharmacy directory You generally must use plan’s pharmacies Some plans also offer mail order Check with the plan Be sure it has pharmacies convenient to you

Choosing a Plan Step 1: Collect information Any current prescription drug coverage Prescription drugs, dosages, and how often you take them Step 2: Compare Medicare drug plans MEDICARE ( ) State Health Insurance Assistance Program (SHIP) Step 3: Call plan with any questions

Joining a Plan Enroll directly with the plan Internet Plan’s website Telephone Paper application Mail or fax to plan

For More Information Medicare & You handbook MEDICARE ( ) TTY users call State Health Insurance Assistance Program (SHIP) Social Security Administration TTY users call

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