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Illinois Attorney General Lisa Madigan
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Advocating for Older Citizens

The New Federal Drug Benefit: Medicare Part D


WHAT DO I NEED TO DO?

 
 
   
   
   
   
 
 
       

Get Basic Information. Back to top

 

If you are eligible for Medicare, you should have received the “Medicare & You 2006" handbook recently. You can also get more information from Medicare’s Web site. Also, click on WHERE CAN I GET HELP? to find out how to contact the Senior Health Insurance Assistance Program (SHIP) and for links to other helpful Web sites.

ALERT: Medicare's handbook "Medicare & You 2006" mailed in early October 2005 contains an error in the comparison charts of drug plans beginning with page 97-A. The column "If I Qualify for Extra Help, will My Full Premium be Covered?" erroneously lists "Yes" for every plan. In fact, 60 percent of the Prescription Drug Plans listed should have a "No" in this column. Copies of the "Medicare & You 2006" book posted at www.medicare.gov are accurate.

       

Understand Your Choices. Back to top

 

You have two important decisions to make:

1) Should you enroll in a Medicare Part D prescription drug plan?

2) If so, which plan is right for you?

Answering the following questions will help you decide:

   

Do you currently have prescription drug coverage under the Illinois Senior Care or Circuit Breaker? Back to top

In June 2005, Gov. Blagojevich signed the “No Senior or Person with Disability Left Behind” law, which created the Illinois Cares Rx program to fill in the financial gaps created by the federal prescription drug program.  All seniors and persons with disabilities who are currently getting Illinois SeniorCare and Circuit Breaker prescription drug coverage will be automatically enrolled into Illinois Cares Rx.

Illinois Cares Rx enrollees will get their prescription coverage from one of two private Medicare-approved insurance plans that are willing to coordinate with the state. This coverage begins January 1, 2006.

Illinois Cares Rx eligible seniors and persons with disabilities will NOT have to pay the high out-of-pockets costs that may be found in the federal program.

Caution: All seniors and persons with disabilities who are in the current SeniorCare or Circuit Breaker programs, or who think that they may qualify for either program, MUST fill out and send in the “Extra Help” application for the new federal prescription drug program. This form is available from Social Security.

Caution: If an Illinois Cares Rx enrollee signs up for one of the private prescription plans approved by Medicare that does NOT coordinate with Illinois Cares Rx, then they will only qualify for partial benefits by having a basic premium paid for. They will NOT receive the full coverage provided by the state to pay for additional out-of-pocket costs.

   

Do you already have other private prescription drug coverage with an employer, a union, etc.? Back to top

If you do, you MAY OR MAY NOT be able to continue that coverage. In fall 2005, you will receive notices from your employer, former employer, or union, or from a Medigap (Medicare Supplemental Insurance) policy. These notices will let you know whether your coverage will continue, and whether it meets Medicare’s guidelines for “creditable” coverage allowing you to avoid a penalty if you enroll later in a Part D plan. READ THESE NOTICES CAREFULLY AND SAVE THEM. You must make sure you choose the best option available to you.

NOTICES OF CREDITABLE OR NON-CREDITABLE COVERAGE
If you currently have prescription drug coverage under a retiree plan, or a private plan, you may be better off staying with those plans instead of enrolling in Medicare Part D. If you receive a Notice of Creditable Coverage from your current plan, it means that your plan is at least as good as Medicare’s standard Part D plan, and may even be better. It also means that you will not be subject to a penalty for enrolling in a Part D plan later if your current plan or your personal circumstances change. Save the notice of creditable coverage in order to avoid a penalty later. DO NOT THROW THE CREDITABLE COVERAGE LETTER AWAY!

NOTE: If you have creditable coverage, do not sign up for Medicare Part D unless you have received one-on-one, trustworthy counselingfrom SHIP, your Area Agency on Aging or another reliable source. Enrolling in Medicare Part D will almost certainly terminate your current prescription drug coverage, and you may risk losing your retiree or supplemental general health coverage as well.

If you receive a “Notice of Non-creditable Coverage,” however, and you do not enroll in a Part D plan by May 15, 2006, you will be subject to a penalty if you decide to enroll in a Part D plan later. The penalty will be a one percent increase in the premium cost for every month you delay enrollment. For example, if you do not enroll until two years later, on May 15, 2008, your premium will cost 24 percent more every month than it would have if you signed up in 2006.

   

Are you interested in obtaining prescription drug coverage through a Medicare Advantage Plan (managed care plan)? Back to top

Instead of enrolling in a Medicare prescription drug plan, you may be able to obtain drug coverage at lower cost through a Medicare Advantage Plan. The Medicare Advantage Plan would also provide your health benefits. It may offer lower overall costs, but will limit you to physicians and providers who participate in the plan.

   

Do you need extra help to cover the costs of the prescription drug benefit? Back to top

Extra help is available for low-income beneficiaries who meet the eligibility requirements. If you received an application for extra help from the Social Security Administration, it is recommended that you submit the application even if you think you may not be eligible. If you are eligible, you will still have to then choose and enroll in a plan, so it is a two-step process.

Note: Certain beneficiaries currently enrolled in both Medicaid and Medicare (“dual eligibles”) will be automatically enrolled in Medicare Part D. Medicare has mailed these beneficiaries information about the auto-enrollment printed on yellow paper. If you now have your prescriptions covered by Medicaid, it is important to understand that as of January 1, 2006, Medicaid will no longer pay for prescription drugs and you must be enrolled in a Medicare Part D plan to have a prescription drug benefit.

       

Compare Prescription Drug Plans. Back to top

 

If you must, or you decide you should, enroll in a Medicare prescription drug plan, be very careful to choose the best plan for you. Take the following steps:

1) Make a list of the medications and dosages you take.

2) Do not necessarily enroll with the first or even second plan you learn about. Do not let marketers rush you into a decision. Instead, take your time and get reliable help.

3) For each plan available in Illinois, check:

  • which drugs it offers – make sure the ones you take are included;

  • which pharmacies it uses – make sure your regular pharmacy is included;

  • what you will have to pay for premiums, deductibles, and prescription co-payments.

  • whether you will have to get prior approval for a drug or substitute generic drugs for brand names

  • what happens if your doctor prescribes a new drug for you that is not in the plan, or what if you take a drug in a different dose than the one the plan offers;

  • whether the plan is available in another state in which you regularly spend time, for example, Florida or Arizona.

 

To compare plans:

  • Go to the Illinois Benefits Web site. Illinois Benefits is an education, screening and enrollment tool designed to inform you about health care and other benefits, rights and options in Illinois. This site offers a Medicare Interactive Counselor and Benefits Check Up, and you will find out about the additional benefits available only to Illinois residents.

  • Read Attorney General Madigan’s Fact Sheets, Choosing a Drug Plan: It’s Not Just the Premium that Matters and Illinois Insurance Facts: Medicare Prescription Drug Coverage and Illinois Cares Rx

  • Go to Medicare Part D Drug Plan Finder on the Medicare Web site.

  • Call 1-800-MEDICARE. Someone will be able to search the “Drug Plan Finder” for you and send you a printed copy of the results.

  • Contact the Senior Health Insurance Assistance Program (SHIP) office online or by calling 1-800-548-9034. SHIP staff and volunteers are very knowledgeable about Medicare, and will provide you one-on-one, objective and trustworthy help with your particular situation.

  • Contact your local Area Agency on Aging. You can find a complete list of Area Agencies online.

       
Enroll in the Right Plan for You. Back to top
 

For help, you can also use a free Medicare Prescription Drug Coverage Personal Information Worksheet provided by SHIP. Click here to download the worksheet.

   

Timing: Medicare Part D coverage can begin as early as January 1, 2006. If you are Medicare-eligible and do not have any drug coverage, or your current drug coverage will not continue after January 1, 2006, YOU MUST ENROLL in a plan between November 15, 2005, and December 31, 2005, to have coverage beginning January 1. If you can afford to wait a bit, you have until May 15, 2006, to enroll in Medicare Part D. If you choose not to enroll before May 15, 2006, and you do not have “creditable” under another plan, you may have to pay a penalty if you decide to enroll in Medicare Part D later. Check with your current drug coverage to find out.

   

Ways to enroll:

  • Through the company offering the plan you choose. You may be able to enroll by paper application, on the company’s Web site, or over the phone. BE SURE that, whatever method you choose, you are dealing with a legitimate, Medicare-approved company, the company’s real Web site, and an actual representative from the company. Click on HOW CAN I SURVIVE THE MARKETING AVALANCHE AND AVOID SCAMS for more information about avoiding pitfalls.

  • Through Medicare, either online at http://www.medicare.gov/, or by phone at 1-800-MEDICARE. Not all plans will offer this option. Again, be sure you are on the correct Web site or talking to an actual Medicare employee, particularly because you will have to provide your Social Security and Medicare numbers to enroll.

       

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