Medicare Part D Prescription Drug Coverage

* This is a "new" program that is evolving before our eyes. Below are some of the facts you should know about the new Part D program. As more information about the new program become clear we shall update this section.

Effective January 1, 2006 a new component was added to the Federal Medicare Program. This new component is called Part D Medicare and it covers prescription drugs. Part D is available to anyone with Medicare Part A or B. To receive prescription drug coverage under Part D you must first enroll in either a prescription drug plan (PDP) or a Medicare Advantage Plan (MA-PD). All of these plans are privately run.
Medigap insurance policies that include drug coverage (plans H, I, and J) are NOT considered PDPs.
Premiums will average about $32 per month (subject to where you live and which plan you choose)
Medicare Part D is an optional program, you do not have to enroll. However, if you do not enroll and later decide to enroll, your monthly premium will increase by 1% for each month you are not enrolled. No penalty increase will be imposed for late enrollment if you have "credible coverage" (existing drug coverage that is as good or better than Part D).
Medicare "Open Enrollment" period begins November 15th and continues through December 31st. During this period, you may enroll in a Medicare Part D plan, or if your currently have a plan, you may change plans. If you are in a "Medicare Advantage Plan" you may return to traditional Medicare, change your existing Advantage plan or enroll in an Advantage Plan for the first time.

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**Click here to go to a Medicare site that can compare Medicare Advantage and Original Medicare Plans.

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**Click here to go to a Medicare website that can help you evaluate the different drug plans based upon your medications.

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Basic Drug Benefit Chart : what are your out-of-pocket costs, if you are not eligible for the 'low income' subsidy? (as of 9/2008)

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OUT-OF-POCKET(per year)

$295 deductible / year

$295

25% copayment on first $2,700

$500

100% copayment between $2,401 and $5,450 (known as the doughnut hole)

$3,049

Estimated $32 per month premium x 12

$384

Total Out-of-Pocket costs plus premium (for the first $5,100 per year)

Total =$4,198

* After reaching the $5,450 'castistrophic threshold', member pays 5% of cost over $5,450.

$ Amount Varies

*If you have limited income and resources, and you qualify for "extra help", you may not have to pay a premium or deductible.Add your content here

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EPIC, Part D Medicare and Medicaid Spenddown

The following are some basic questions and answers about how Medicaid benefits will work with Part D Medicare if you have a "spenddown":

Will seniors on a Medicaid spenddown and EPIC be automatically enrolled into a Medicare Part D drug plan? Answer = YES.
After being automatically enrolled in a Medicare Part D drug pllan, can seniors continue to use their EPIC coverage? Answer = YES.
Prior to meeting their spenddown, can seniors choose to use EPIC as a primary plan rather than their Medicare Part D coverage? Answer = NO.
For Seniors with a Medicaid spenddown, along with Medicare Part D coverage and EPIC, what drug costs will be applied to their Medicaid spenddown? Answer = When the drug is covered by their Part D plan, their out of pocket co-payment for drugs is applied to their Medicaid spenddown. When EPIC pays for a drug not covered by Part D, both the amount paid by EPIC and the EPIC co-payment can be applied to the Medicaid spenddown.
After seniors meet their spenddown, do they use EPIC or Medicaid for the drugs that are covered by their Medicare drug plan? Answer = They may use either Medicaid or EPIC (not both) for drugs not covered by Part D.