The New Medicare Prescription Coverage

By A. Tereasa Rerko, Esq.

Medicare has now changed to include prescription drug coverage, known as Medicare Part D. This coverage is supplemental to Medicare Parts A and B and is not offered directly from Medicare, but is private insurance coverage that you purchase just as you would any other health insurance policy. Medicare is underwriting part of the cost of this insurance, so that those who purchase it pay a reduced monthly premium. Persons of limited resources may receive additional help with the payment of their premiums.

Medicare Part D prescription coverage is not a discount drug card. It requires you to choose a private prescription drug plan. The plan you choose will require that you pay deductibles and co-pays for prescription medications, up to certain limits per month and/or per year. There are many plans, and each covers different medications. You should carefully choose the plan that provides payment for the medications that you are taking.

Choosing the right plan may appear to be an impossible task; the many types of insurance plans are mind-boggling. However, here are some resources to turn to for help in making your decision. Medicare has a publication called Medicare & You, 2006 which includes a worksheet to help you choose a plan. You may go to the Medicare website at www.medicare.gov , or call Medicare's toll-free number: 1-800-633-4227.

Medicare is encouraging everyone who is Medicare-eligible to select and join a plan now, regardless of current prescription drug needs. If you join a plan after May 15, 2006, you will be subject to a penalty in the form of a permanently increased monthly premium.

Some dates to remember:

January 1, 2006:

  • Date that Medicare Part D prescription coverage begins

November 15, 2005 to May 15, 2006:

  • Enrollment period for the new prescription drug plans
  • If you do not choose a plan during this time, you will be subject to the penalty, estimated at 1% per month for every month that you wait to enroll. This penalty will be paid as long as you have Medicare Part D prescription coverage.

May 15, 2006:

  • The last date you can enroll until November 15, 2006

November 15, 2006:

  • The first date after May 15, 2006 you can enroll in a plan if you miss the May 15, 2006 deadline

November 15 to December 31 of each year:

  • The time period in future years during which you can join or switch plans

All plans must provide at least the standard Medicare prescription benefit. Participants pay monthly premiums of $32.20 per month, plus the first $250 per year of drug expense, and approximately 25% of the cost of prescriptions up to the benefit limit of $2,250. Then there is a gap in coverage. Participants must pay all drug expenses above $2,250 until they reach $5,100 in total prescription drug spending, after which Medicare will pay 95% of prescription drug cost. Some plans offer more coverage for a higher monthly premium.

Here are some things to consider in choosing a plan:

  • If you're a senior with little to no drug expenses, consider a plan with extremely low monthly premiums (some are under $20/month).
  • If you want your drug expenses balanced throughout the year, consider a plan with no deductible.
  • If your annual drug expenses are between $2,250 and $5,100, consider a plan that offers some coverage for the gap, or "doughnut hole".
  • Make sure that the specific drugs that you need are covered by your plan.
  • Although not permitted to recommend a specific plan, your pharmacist may be able to help you decide which plan best suits your needs.

We at Quatrini Rafferty will continue to keep you informed of developments about Medicare and prescription drugs. And, as always, please contact us with any questions you may have about health care and prescription drug coverage. Email a Pennsylvania Social Security Disability Attorney now or phone us at 724-837-0080 in Greensburg or toll free at 888-534-6016 if you have any questions.

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