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Medicare Prescription Drug Coverage Part D

New Program Beginning Jan 1^st 2006

Part D Plan:

Will take effect on January 1, 2006

Participation is voluntary.

Coverage is to be provided by private insurance companies.

Monthly premiums will range upwards from $33 month , automatically deducted from an individual’s Social Security check. This would be in addition to the monthly premium for Medicare Part B premium.

Individuals may enroll starting on November 15, 2005.

Individuals generally will be responsible for various fees, co-pays and deductibles.

The first $250 in drug costs will be the deductible, then the new Part D drug insurance will pay 75% of drug costs up to $2,250, then no reimbursement exists (called the "doughnut" but really the "doughnut hole") until drug costs exceed $5,100. After the threshold of $5,100 is reached, the insurer will pay 95% of drug costs.

Each company will have a list of drugs available under its plan ("formulary").

There will be separate rules for the low income person. Income less than
135% of the poverty income amount will qualify an individual for payment of most of the drug cost; special benefits will exist up to 150% of poverty.

Prescription Drug Costs:	Medicare Pays:	Enrollee Pays:	Maximum Out-of- Pocket Expense
$0-$250	Nothing	100% of the costs	$250 (deductible)
$250-2250	75% of the costs	25% of the costs	$500
$2250-$5100	Nothing	100% of the costs	$2,850
Above $5100	95% of the costs	5% of the costs	$3,600

Once an individual pays $3,600 of out of pocket expenses, per year, Medicare will begin to cover 95% of all prescription costs

For low income beneficiaries, Medicare will offer sliding scale premiums, lower deductibles, less coinsurance, and reduced co-pays based on income ranges.

Dually eligible Medicare/Medicaid beneficiaries will receive prescriptions through Medicare Part D, and Medicaid will assist in paying the out of pocket expenses

For More Information use the web sites on the first page of my website

(because those links direct you to the specific pages within
the following sites which are constantly being updated)

General Links:

Medicare - http://www.medicare.gov/ or 1-800-MEDICARE

Specifically: How plans work?

Elderly Pharmaceutical Insurance Program - http://www.health.state.ny.us/nysdoh/epic/faq.htm
or call 1-800-332-3742 or write EPIC @ PO Box 15018 Albany, NY 12212-5018

Medicare Rights Center - http://www.medicarerights.org/

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