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Review the section below to find answers to many commonly asked questions about Medicare, supplemental Medicare coverage (Medigap), and the new Medicare Part D prescription plan.
Q. What is Original Medicare?
A. Original Medicare is a federally funded health insurance plan. It is designed for people age 65 or older and some disabled people under age 65. Medicare Part A pays for inpatient hospital charges, skilled nursing facility care, and hospice care. Medicare Part B pays for outpatient hospital charges, doctor visits, and many other medical services not covered by Part A.
With Medicare, you get easy access to care.
Q. What is Medicare Part D?
A. Medicare Part D is a new benefit designed to help those eligible for Medicare pay for the cost of prescription medications. The program is part of the Medicare Prescription Drug Improvement and Modernization Act of 2003. With Part D, Medicare shares the cost of the prescription benefit with those eligible.
Q. How will the program work?
A. Medicare will offer the Part D benefit by contracting with private companies, also referred to as Prescription Drug Plan Sponsors (PDPs) or Medicare Advantage Drug Plan Sponsors (MA-PDs). Medicare beneficiaries will have the opportunity to purchase the Part D benefit from a PDP in the area. This is similar to the process that Medicare used to offer to the Medicare approved drug discount card program.
Q. What are the advantages to Medicare Part D?
A. Medicare Part D should result in the following benefits:
Q. What if I currently have a supplemental Medicare plan (like Medex) that includes prescription coverage?
A. If you are currently enrolled in a supplemental Medicare (Medigap) plan that includes medication coverage, you can:
Q. Why is there a late enrollment fee?
A. Congress believes that unless you already have creditable prescription coverage, Part D plans are a great way for you to get help with the cost of prescriptions. They crafted the rules to encourage people to enroll in the beginning instead of waiting to join only when health problems develop and prescription costs rise. The late enrollment fee gives people a reason not to postpone the decision to join.
Q. Who is eligible for Medicare Part D prescription coverage?
A. All individuals with Medicare Part A and enrolled in Medicare Part B are eligible to enroll regardless of age, income or health conditions.
Q. Do I have to participate in a Part D plan?
A. No, you do not have to participate. It is your choice. However, similar to other types of insurance, the longer you wait, the higher your premium will be.
Q. How do I know if I should sign up?
A. You will need to review your options carefully to see if a Part D plan is right for you. Part D plans are designed to provide financial savings to most people with Medicare . As insurance plans, they provide protection against future, unexpected costs. They also provide additional financial assistance for people with lower incomes.
Q. How do I find out if I qualify for help?
A. If you have both Medicare and Medicaid , you already qualify for low-income assistance. If you don't qualify for Medicaid, you may still qualify for some assistance if your income is below $14,355* for an individual, or $19,245* for a couple. In some cases, the government will also review how many assets you own. If you think you might qualify, contact your local Social Security Administration office. You have nothing to lose by applying.
Q. What assets will be counted to determine if I am eligible for help?
A. The assets that will be counted include cash or any property that can be converted to cash within 20 days. This includes checking accounts, savings accounts, certificates of deposit, retirement accounts (like IRAs or 401ks), stocks, bonds, mutual fund shares, promissory notes, mortgages, and life insurance policies. Property that is not counted includes your primary home, burial plots, or burial agreements. Certain funds set aside for burial expenses, up to $1,500, will also not be counted.
Q. Can I change Part D plans once I have enrolled?
A. Yes, you can change your Part D plan. The opportunities to switch are:
Annual enrollment: Each year, you will be able to choose a different Part D prescription plan or Medicare Advantage plan during an annual enrollment period that lasts from November 15 through December 31. Coverage under the new plan will begin the following January 1.
Other exceptions: There are other limited exceptions that may give you the right to switch plans during a year. For example, if you move out of the service area of your current plan, you will have an opportunity to choose another plan that serves your new area.
Q. Can premiums be deducted from Social Security checks?
A. Yes, you will have the option to have the premium deducted from your Social Security check (just like your Part B premium), or you or your former employer can pay your premium directly to the private company.
Q. What is creditable coverage?
A. Creditable coverage is coverage, from a plan other than a Part D plan that meets certain Medicare standards. If you currently have prescription coverage that is considered creditable coverage, you may keep that coverage and wait to enroll in a Part D plan. If you later decide to enroll in a Part D plan, you will not have to pay a late enrollment fee.
Q. Will Part D coverage only be available through a private company, or will I be able to get coverage directly from Medicare, the same way that I get Part A and Part B coverage?
A. No, Part D coverage will not be available directly from Medicare. Although you will be able to have your premium deducted from your Social Security check, you must purchase Part D coverage from a private company that has been approved by Medicare to offer coverage.
Q. I have prescription coverage through the Veterans' Administration (VA). Can I continue to get my medications through the VA in 2006?
A. The introduction of Part D prescription plans in January 2006 will have no impact on Veterans' Administration benefits. Medicare beneficiaries who currently have prescription benefits through the VA will be able to continue to obtain their prescriptions through the VA.
Q. How often will I be able to change plans?
A. If your needs change, so can your coverage. Each year, there will be an open enrollment period in which you can review your plan choices for the coming year and either rejoin in your current Medicare prescription plan or choose a new one. You may also have another opportunity during the year to switch plans under limited circumstances. For example, if you move out of the service area of your plan, you'll have an opportunity to choose another plan that serves your new area.
Q. What happens to my Medicare Prescription Drug Discount card?
A. You can use your Medicare-approved drug discount card until May 15, 2006, or until you enroll in Medicare Part prescription plan, whichever is first. Once you have a Medicare Part D prescription plan, you can't use your Medicare-approved drug discount card. You will get coverage for prescription medications through the Medicare Part D plan you enroll in, instead of saving with the discount card.
