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QUESTIONS ABOUT MEDICARE?

HELPFUL LINKS

www.medicareadvocacy.org
www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
wwww.cms.hhs.gov

MEDICARE PART D: CHOOSING THE RIGHT PLAN

Beneficiaries have to sift through a variety of plan choices, making complicated decisions about what plans are likely to be best for their particular circumstance. Issues of price, access to specific drugs (including dosing and packaging) and location of pharmacies are just some of the factors to be considered.

In most states, beneficiaries have a variety of choices of Prescription Drug Plans (PDPs), providing prescription drug coverage only, to be used in conjunction with the traditional Medicare program. In addition, there are a variety of Medicare Advantage Prescription Drug Plans (MA-PDs), offered by managed care organizations, providing the other Medicare benefits in addition to prescription drug coverage. These require thoughtful evaluation of values and benefits versus costs and limits on access to needed assistance to discover if they really do provide an advantage. There are several national plans as well as a variety of regional and statewide plans.

Retirees with prescription drug coverage may wish to visit the CMS Medicare Modernization Act retiree drug subsidy page. It provides links to a variety of information sources, including frequently asked questions for retirees. Of particular concern is working with former employers to encourage them to continue providing a certain level of retiree health coverage, including how these rules apply to spouses, dependents and individuals eligible for Medicare coverage due to disability or end stage renal disease (ESRD). The key issue is not whether employers will continue coverage, but whether employers will require people to choose between part D and their retiree coverage. People need to know whether enrollment in Part D will terminate all of their retiree health coverage, including coverage that supplements Medicare Part A and B.

Part D beneficiaries need to know:

• They will only get assistance with drugs that are on the formulary of the plan they choose.
• They will not automatically get all drugs their doctor believes to be medically necessary, but may first need to go through a special process to ask the plan to pay for the drugs.
• Once they reach $2250 in combined beneficiary and drug plan costs, they will have to pay the full cost of their drugs (doughnut hole). They will get out of the doughnut hole, and additional insurance coverage for their prescription drugs, only if the drugs they take are covered by their plan.
• Most people will be required to keep the same drug plan for a year, even if they develop a new illness and need drugs they could not have anticipated when they first chose their plan. Plans are not similarly bound; they can change which drugs they cover, and the rules they use, during the year.
• The plan with the lowest premium and cost sharing might not be the best plan if it does not include all of the drugs in the dosages and formats they require.
• People with limited incomes and resources may have to pay a part of the premium if they enroll in a plan with a higher premium, even though the plan may include more of their drugs and have more convenient pharmacies.
• People with retiree health coverage may lose all of their health coverage, and not just drug coverage, if they join a Part D plan.

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To get a copy of this information in Spanish, call 1-800-MEDICARE (1-800-633-4227).TTY users should call 1-877-486-2048. Para una copia en español, llame gratis al 1-800-MEDICARE (1-800-633-4227). Los usuarios de TTY deben llamar al 1-877-486-2048.

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