In 2003, Congress passed the Medicare Modernization Act (MMA). The new law created enhancements to the benefits available under Medicare, including a new prescription medication benefit, called Medicare Part D. These plans are also known as prescription drug plans, or PDPs. Medicare Part D will be available beginning January 1, 2006.

Beginning January 1, 2006, new Medicare prescription drug plans (also called PDPs) will be available to Medicare beneficiaries. These plans are different from the Medicare approved drug discounts cards, which phase out by May 15, 2006, or when your enrollment in a Medicare prescription drug plan takes effect, if earlier. To be eligible, you must be eligible for Medicare Part A and enrolled in Medicare Part B.

Medicare prescription plans provide insurance coverage for your prescription medications. Like other insurance, if you join you will pay a monthly premium (generally around $35, the CMS standard premium, in 2006) and pay a share of the cost of your prescriptions. Costs will vary depending on the prescription plan you choose. If you qualify for low-income assistance your premiums may be different.

Medicare prescription plans may vary in what prescription drugs are covered, how much you have to pay, and which pharmacies you can use. All prescription plans will have to provide at least a standard level of coverage, which will be determined by Medicare. However, some plans might offer more coverage and additional drugs for a higher monthly premium. When you join a drug plan, it is important for you to choose one that meets your prescription medication needs.

Medicare has contracts with different companies—including Blue Cross Blue Shield of Massachusetts—to offer Medicare Part D prescription coverage. To get prescription coverage through Medicare Part D, you will need to decide how you want to get your prescriptions—there are three ways you can obtain coverage for your prescriptions:

1. You can get your health care benefits through a Medicare supplement health plan, such as one of our Medex plans. In these kinds of plans, you may be able to choose a Medicare prescription plan such as Blue Medicare Rx.
2. You can get all your health care benefits and prescriptions through a Medicare Advantage plan, like Medicare HMO Blue (Blue Care 65) or Medicare PPO Blue. You can learn more about these plans here.
3. You can get your health care benefits through the Original Medicare plan and choose to purchase a stand-alone Part D plan, like Blue Medicare Rx.

Blue Cross Blue Shield of Massachusetts makes it easy for you to choose a Medicare Advantage or supplemental Medicare health plan and get your Medicare Part D prescription coverage, too. Click here to learn more about our plans.

Enrolling in a Medicare Part D prescription plan is not mandatory. However, if you do choose to enroll, you will have some out-of-pocket costs. The following costs show what you might pay in a standard Medicare Part D prescription plan. If you enroll in Blue Medicare Rx, your costs may be different. Click here for specific Blue Medicare Rx benefit information.

• A monthly premium
• A $250 annual deductible

After you meet your $250 deductible, Medicare will cover 75% of medication costs, up to $2,250.

• You will pay 25% of medication costs up to $2,250.
• After your total medication costs reach $2,250, you will have to pay an additional $2,850 in out-of-pocket costs before Medicare will continue coverage. This is called the coverage gap, also known as the doughnut hole.
• Once your out-of-pocket medication costs (not including premiums) reach $3,600, Medicare will start paying again.
• Currently, Medicare will cover up to 95% of medication costs (also called catastrophic benefit .)
• Right now, you pay either $2 for generic medications and $5 for brand-name medications or 5% of the prescription cost, whichever is greater.