Should I enroll in Medicare’s prescription drug benefit?
If you currently have drug coverage that is at least as good as
or better than Medicare’s basic drug benefit, you should probably
keep it. You can join a Medicare plan later without the penalty
if you need it. Your current benefit company should notify you
to confirm whether or not its benefit is as good as or better.
If you have not received that notice, call them and ask.
Will Medicare private drug plans offer uniform
Medicare drug coverage?
No, they will not. The Medicare law outlined a plan that will be used
as the standard for the overall value a plan must offer to be
approved as a Medicare plan. Many of the plans will no doubt be
different so long as the overall value is at least as good as the
Medicare basic plan. According to the Basic Plan you would pay:
- The first $250 of your drug costs for covered drugs
each year (the deductible)
- Coinsurance worth 25% of the cost of covered drugs
between $251 and $2,250
- 100% of the cost of covered drugs between $2,251 and $5,100
- 5% of the cost of covered drugs above $5,101. This is called
"catastrophic coverage" (or a co-payment of $2 for covered
generics/preferred drugs and $5 for covered brand-name drugs,
whichever is greater)
- You will have to reach $3,600 in out-of-pocket costs in 2006
before you can receive catastrophic coverage
Questions to ask BEFORE you join or consider joining ANY PLAN!
COST - How much are the co-pays/co-insurance for each drug
on my list?
- If a drug I take has high co-insurance, is there a substitute I can take?
- Will I have to pay the full cost of my drug(s) at some point?
- How much will I pay in monthly premiums and annual deductible?
Covered Drugs - Will the plan cover all the drugs
- Will it cover the most expensive drugs I take and the most important?
- If it doesn’t cover my most expensive and important drugs, will it cover
an acceptable alternative?
- Does the plan require that I get permission before it will cover
any medications that I take (i.e. prior authorization)?
Pharmacy - Is the pharmacy I use a regular pharmacy
in the plan“s network? If not, what happens if I fill a
- Can I access prescriptions through mail order?
- What happens if I travel or go out of state for
long periods of time (i.e. Florida)?
Coordination - Will the Medicare plan work with my
current drug coverage?
What you need to know:
The new Medicare drug program is voluntary. Seniors may choose
to enroll - or not. There are a couple of important things to know
about this, though. (1) If you have both Medicaid and Medicare, and
if you do not pick a plan and enroll before December 31, 2005 you will
be enrolled in one of the new drug plans automatically, because your
Medicaid drug benefit will end on December 31, 2005. (2) If you have
drug coverage now, you will need to find out if Medicare considers
this coverage to be "as good as or better" than the new Medicare
drug benefit. This will affect your decisions about enrolling in the
Medicare drug benefit. You might have to pay a late enrollment
penalty if you don’t enroll until after May 15, 2006. You
won’t have to pay the late penalty if the benefit you have is
not "as good as or better than" the Medicare standard benefit.
The new Medicare prescription drug program works with New
York’s EPIC program. Seniors with EPIC can keep their EPIC
coverage. For some, particularly those eligible for extra help for
low-income beneficiaries, enrolling in a Medicare drug program
will mean more savings.
The new Medicare drug program has extra help to pay for drug
costs for beneficiaries with lower incomes. The Social Security
Administration has been mailing applications for this "extra
help" (or low income subsidy) to those who may be eligible.
You may have gotten this application already. Those already in
Medicaid or one of the Medicare Savings Programs (QMB, SLMB,
and QI-1) will be eligible automatically for the "extra
Keep in mind that applying for the "extra help" is a
separate step from enrolling in the new drug benefit.
This new Medicare benefit will only be available through
private plans. This means that in order to get prescription drugs
covered through Medicare, New Yorkers must enroll in one of the
plans offering the benefit in New York. HMOs and other Medicare
Advantage plans will also be offering the new prescription drug
How to Protect Yourself from Unscrupulous or False Marketing
Be an alert and informed consumer. Plans will be competing to get
the most people enrolled as quickly as possible, so take care
before making any decisions.
Don’t give personal information over the phone,
including to the "marketing representatives" of plans.
Marketing representatives cannot request personal information as part
of their marketing activities (however, other representatives from
the same plans, such as enrollment representatives, will be asking
for this information. Be sure to verify if they are
Meet plan representatives in a public place - not in
your home. Verify the credentials and identification of whomever
you speak with.
Just Say "Stop." Plans must honor
your request if you ask them not to call back. No legitimate
plan requires personal information over the phone or needs
to use pressure tactics.
The Do-Not-Call Registry toll-free number is (888) 382-1222
(TTY (866) 290-4236), or www.dontcall.gov. Plans must honor "do
not call" requests.
Be Alert for Scams and Identity Theft. Unfortunately,
the massive marketing that will take place also provides
opportunities for fraud and abuse. Check and double-check the
credentials of those you are dealing with before taking any action.
Report any suspicious contacts.