Assemblyman Bill Reilich
Medicare
Prescription
Drug Coverage
Update

from
Assemblyman
Bill
Reilich

2300 West Ridge Road
Rochester, NY 14626
(585) 225-4190
reilicw@assembly.state.ny.us



NYS Seal

Dear Neighbors:

Starting in January 2006, Medicare Part D will provide prescription drug coverage to eligible individuals. This new plan will give beneficiaries more choices, so you can select a plan that offers the best coverage for the medicines you take.

Soon, you will begin to receive an abundance of information detailing all your options. Since this transition can be very confusing, I have compiled some important information for our senior citizens and interested residents. If you choose to participate in this program, consider your options soon. Open enrollment begins Nov. 15. If you do not enroll by May 15, 2006, you may have to pay higher premiums, or you may have to wait until November 2006 to enroll. This is only a fraction of the information available regarding this new program. Should you have additional questions, please refer to the contact numbers below, or call my district office.

As always, if there is any situation for which you need assistance, please do not hesitate to contact me.

Sincerely,
signature
Bill Reilich
Member of Assembly
134th District



What is Medicare Part D?

  • Part D is an addition to Medicare that provides an outpatient prescription drug benefit starting Jan. 1, 2006.

  • You can join from Nov. 15, 2005 - May 15, 2006.

  • Individuals who don’t join by May 15, 2006 may have to wait until Nov. 15, 2006, and pay higher premiums.

  • The program is voluntary, and you will not be penalized if you choose to keep your current coverage.

  • The Medicare drug benefit will be available through private plans, including:

    • A stand-alone prescription drug plan (PDP), or
    • A Medicare private plan, like an HMO, PPO or PFFS (private fee-for-service).

  • Part D covers brand name and generic drugs.



What You Need to Know:

Individuals with Medicare

  • All Medicare recipients are eligible for Part D prescription drug coverage.

  • Those enrolled in Medicare and Medicaid who do not choose a plan by Dec. 31, 2005 will be automatically enrolled in Part D; you must notify Medicare if you choose not to enroll in this new program.

Individuals with EPIC

  • EPIC will continue to exist to benefit its recipients.

  • You are encouraged to consider the Medicare Part D plan. Many seniors may save more money by using the two plans together.

  • You may continue your coverage with EPIC if you decide to enroll in Part D.

  • EPIC may pay the 25 percent “initial benefit” (between $251 and $2,250) and the 5 percent of all remaining drug costs over $5,100.

Individuals with Employer or Union Drug Coverage

  • Medicare is working with employers and unions to help keep your current coverage.

  • Contact your benefits administrator to decide whether you should keep your current coverage. You may be able to keep your current coverage and not pay a higher premium if you join a Medicare prescription drug plan later. If your current coverage is not as good as Medicare Part D, you must enroll by May 15, 2006.

  • If you join a Medicare prescription drug plan, you may not be able to revert to your former coverage.

  • You may qualify for extra help paying for prescriptions.

Individuals in Managed Care

  • If you have drug coverage, you can stay in your plan and have Medicare prescription drug coverage.

  • If you do not have drug coverage, you can stay in your plan and add Medicare prescription drug coverage.

Individuals with Fee-for-Service and Medigap
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  • You won’t be able to buy new Medigap policies that cover prescription drugs after Jan. 1, 2006.

  • You can drop the prescription part of your policy and join a Medicare Prescription Drug Plan (PDP).

  • You can enroll in a PDP and still have Medigap without drug coverage.

  • Most Medigap coverage, on average, is not as good as Medicare prescription drug coverage.


Under the new Part D, Medicare beneficiaries can join a prescription drug plan and pay a monthly premium, estimated at $35 for 2006.

In addition to monthly premiums, standard coverage received is as follows:

Coverage Drug Costs Part D Pays Beneficiary Pays Beneficiary’s Cumulative Total Out-of-Pocket Payment
Deductible $0 - $250 0 100 percent $250
Initial benefit $251 - $2,250 75 percent 25 percent* of covered drugs $750
“Doughnut Hole” - no coverage $2,251 - $5,100 0 100 percent $3,600
Catastrophic benefit Over $5,100 95 percent of all remaining drug costs 5 percent of all remaining drug costs* or co-payments of $2 and $5 $3,600, plus 5 percent of all costs above $5,100
* EPIC may cover these percentages for those beneficiaries enrolled in the state’s program and Medicare Part D.

“Extra Help” is Available

The new Medicare prescription drug program provides significant benefits to those who are eligible for “extra help”:

  • Qualifying individuals whose monthly income is between $798.01 and $1,076 will have minimal co-payments (between $1 and $5 per prescription drug) with no premiums or deductibles.
  • Qualifying individuals whose monthly income is between $1,077 and $1,196.99 will have a small premium, $50 deductible and a 15 percent cost share.
  • “Extra help” is based on income and assets and is determined on a case-by-case scenario.
  • Eligible enrollees for full “extra help” who join a Medicare drug plan may have EPIC fees waived and will not pay a premium or deductible for their Medicare drug coverage.

Important Contact Information
(800) MEDICARE (633-4227) • www.medicare.gov
EPIC - (800) 332-3742
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