(50PlusPrime) SOUTHFIELD, MICHIGAN --
Beginning January 1, 2006 all Medicare beneficiaries, older adults 65+, will be eligible for a prescription drug benefit under Medicare Part D. The benefit will be available through at least one private plan and one enhanced Medicare + Choice Plan (HMO). In areas where there are fewer than two plans, the federal government is required to administer coverage through traditional Medicare.
I currently have a Medigap policy that provides prescription drug coverage. Will I be able to continue with this plan?
No Medigap policies providing drug coverage will be sold, issued or renewed after January 1, 2006. This currently includes plans H, I & J. Individuals with Medigap policies that provide a prescription benefit will be required to enroll for the new Medicare Prescription Drug benefit under Medicare Part D to have continued coverage.
Is there a deductible on this plan and do older adults have to pay any monthly premiums?
Yes, there is a deductible on the new Medicare prescription drug benefit of $250 per year in 2006 which is indexed to increase annually. The estimated cost of the deductible for the year 2013 is $445. Additionally, there is a premium of $35 per month, which is also indexed to increase annually. The estimated cost of the monthly premium by 2013 is $58. The monthly premium will be deducted from the beneficiaries Social Security check.
Do I have to enroll for the Medicare Prescription Benefit?
The new prescription benefit is an optional program under Medicare. If you wish to have this benefit you will need to enroll in the program. There will be an initial enrollment period before the program launches in 2006. If a current Medicare beneficiary chooses not to enroll during the initial enrollment period and enrolls at a later date, that beneficiary will pay a higher monthly premium. Also, if you are currently on Medicaid, you will be required to enroll in the Medicare drug benefit to continue receiving prescription coverage.
How does the co-pay work when purchasing prescriptions and is there any time when I may not have coverage?
Each year, after meeting the deductible of $250, the Medicare benefit plan will pay for 75% of your drug cots from $251 to $2,250. The plan does not provide any coverage for prescription drug costs between $2,251 and $5,100. Once costs have exceeded $5,100 you will pay the greater of $2 for generics or $5 for brand names (this copay will increase annually) or 5% of the cost of each prescription.
Is there a subsidy for lower income older adults?
Yes, older adults with incomes less than $8,980* (or 100% of poverty level) will have no deductible, or premium, and a copay of $1 for generics and $3 for name brand drugs up to $2,250. When your drug costs exceed $2,250 the copay will be waived.
Older adults with incomes between 100 to 135% of poverty, or $8,980 to $12,123* who have assets no greater than $6,000 for a single person or $9,000 for a couple will have no deductible or premium and a copay of $2 for generics and $5 for name brand drugs up to $2,250, after which the copay is waived.
Lastly, individuals with incomes between 135 to 150% of poverty, or $12,123 to $13,740* who have assets no greater than $10,000 for a single person or $20,000 for a couple will pay a sliding scale premium, a $50 annual deductible and a 15% copay up to $2,250. Once the cost exceeds $2,250 the individual will pay the greater of $2 for generics and $5 for name brand drugs or 5% of the cost of each prescription.
Will there be any interim coverage available between now and January 2006?
New Medicare-endorsed prescription drug discount cards will be available to all Medicare beneficiaries beginning in April 2004. The annual cost for the card will be approximately $30 and savings are estimated between 10 and 25 percent. For older adults with incomes less than $12,123, who do not have Medicaid, the government will pay the enrollment fee and deposit $600 to their discount card account.
Who can I call if I have additional questions on the new Medicare Prescription Drug Benefit?
Any individual, including older adults and family caregivers, residing in Michigan who have questions on the new program may call the Medicare Medicaid Assistance Program at 1-800-803-7174 and speak with a specialized counselor. There is no charge for this program.
* Income amounts are based on the Federal Poverty Levels for 2003.