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Ask the Expert


Joining a Medicare Prescription Drug Plan


Doug Terwilliger, NEA Member Benefits


 

These days, our federal government seems to be more passionate about promoting private business interests than giving you drug coverage.

How else to explain the incredibly complicated system it has created for you to figure out?

Until the law changes, though, the only alternative to diving in is to do without drug coverage, which can be very dangerous.

So here’s how a strategy for making drug coverage decisions.

Anyone in Medicare can get the drug coverage, known as Medicare Part D. You are in Medicare if you are enrolled either in Medicare Part A (which covers hospital and some home health care as well as skilled nursing facility care) or Part B (doctor visits and other outpatient care).

To get Medicare drug coverage, you must enroll in one of the private insurance plans that Medicare has approved. Some operate nationally, others only in certain regions of the country. 

There are a lot of variations among the plans in the drug coverage they offer. By law, each plan must be at least as good as the standard Medicare coverage guidelines in overall value.

But there will be differences in the premiums and co-payments these private plans charge, which drugs they cover, what prices they charge for drugs, and which pharmacies are covered by their networks. 

There are several ways to get information and enroll in a plan available in your area:

How to choose among the many plans?

  • Start by making a list of the drugs you use.
  • Then see which plans offer those drugs in your area.
  • Next, look at the copayments and premiums.
  • Finally, make sure there’s a nearby pharmacy that offers the best plan for you.

Those currently eligible can enroll at any time through May 15, 2006.

After May 15, most people who are already in Medicare will not have another opportunity to enroll until November, and will be penalized for signing up late. There will be exceptions—for example, if you move out of your plan’s service area, or if you lose “creditable” drug coverage from another source through no fault of your own.

(Your drug coverage is “creditable” if the company that offers it certifies, in a letter to you, that this coverage meets the Medicare minimum standards.)

People who are not yet eligible for Medicare, but who become eligible in or after March 2006, can enroll in a drug coverage plan during an initial enrollment period that extends for seven months—three months before and three months after the month they become eligible for Medicare. Younger individuals receiving disability insurance benefits may also enroll three months before and three months after they become entitled to Medicare.

Medicare will start covering your drugs at the beginning of the month after you enrolled in a Medicare drug plan. For example, if you sign up between April 1 and April 30, 2006, your coverage will start May 1.

 

C or D?

Don’t Confuse Medicare Advantage (Part C) with Medicare Part D

Two kinds of Medicare plans offer drug coverage:

  • Medicare Part D: These plans offer only prescription drug coverage. This may suit people who wish to stay in (or change to) the traditional Medicare fee-for-service program (Parts A and B) for their other health coverage.
  • Medicare Part C: A Medicare Advantage Plan that offers comprehensive coverage for medical care plus coverage for prescription drugs. This type may suit people who prefer managed care that covers drugs and other medical expenses.

Yet more complications: There are several kinds of Medicare Advantage plans: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Point of Service (POS) plan, private fee-for-service (PFFS).  Most are variations of man-aged care. In some, you can only use doctors from the plan’s network. In others, you can also choose doctors from outside the network, but you’ll likely pay more to do so.

Starting January 1, 2006, all Medicare Advantage Plans (except private fee-for-service plans) must offer at least one option that includes prescription drug coverage.

If you select a private fee-for-service plan that does not include drug coverage, you can still get drug coverage separately from a stand-alone Medicare Part D drug plan.

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Published In

March, 2006


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