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A Publication of WTVP

Beginning January 1, 2006, Medicare is offering prescription drug coverage in addition to its current health insurance program. Medicare prescription drug coverage, or Medicare Part D, is a new and important step in Medicare reform. Part D is intended to protect Medicare beneficiaries from high out-of-pocket costs on their prescription drug coverage. Medicare beneficiaries or those caring for them need to understand that like Medicare Part B or Medicare Part C, Medicare Part D requires the beneficiaries to enroll to receive the benefit. If a beneficiary doesn’t enroll between November 15, 2005 and May 15, 2006, the penalties may be as high as 1 percent for each month they’re eligible but choose not to enroll.

To help Medicare beneficiaries prepare for this important decision, they must currently be enrolled in Medicare Part A and Medicare Part B. They need to calculate current out-of-pocket pharmacy expenses. If they have prescription drug coverage through a supplement, group retirement plan, or prescription drug card, they must determine if that coverage is considered “credible coverage.” Beneficiaries who have credible coverage will be allowed to enroll at a later time without penalty. Most importantly, all beneficiaries need to shop and compare. There will be a number of pharmacy benefit management plans available to Medicare beneficiaries. Some plans will offer pharmacy benefit management only. Some will offer enriched medical benefits in addition to pharmacy coverage. Because Medicare won’t announce the contracted providers until October, it’s impossible to assist beneficiaries in choosing the plan that’s best suited to their needs at this time.

The Social Security Administration (SSA) is actively identifying beneficiaries who will require assistance with pharmacy costs. The SSA has mailed an application to all Medicare beneficiaries to assist them in early identification of those beneficiaries. The Social Security Administration is encouraging all Medicare beneficiaries to complete the application, regardless of their enrollment in supplemental policies or Medicare Advantage plans. In fact, SSA is using the phrase, “If in doubt, fill it out!” in their communications to those Medicare eligible.

The purpose of the application is two-fold. It’s used to identify beneficiaries who qualify for a federal low-income subsidy, as well as identifying beneficiaries who may not meet the federal requirements for assistance but may require some assistance with their pharmacy costs. If you or anyone you know hasn’t received an application and isn’t currently enrolled in Medicaid, please notify the Social Security Administration. Medicaid beneficiaries automatically will be transferred from drug coverage through Medicaid to Medicare without interruption. No additional application is required.

Medicare has an informative Web site and a toll-free telephone number that provide very helpful information. Their toll-free number is (800) 633-4227, and their Web site is www.medicare.gov. On the Web site, select “Medicare Part D Coverage” for additional details. IBI

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