Medicare Prescription Drug Program
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Online applications available for Extra Help at www.SocialSecurity.gov
or
call 1-800-633-
4227
What is it?
How will I pay for it?
Who does it affect?
What do I need to do?
When do I need to act?
Where do I get more information?
Training Resources for Assistants
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What is it?
- January 1, 2006, Medicare implemented a new Prescription Drug Benefit for all Medicare beneficiaries.
- The Plans are administered by private companies and have varying levels of premiums, co-payments and drugs covered (formulary).
- There are a minimum of two plans available in Montana. For the general Medicare population, participants will be charged a monthly premium (average estimate of $37/month in addition to other Medicare premiums) and will be responsible for a $250 annual deductible.
- Co-payments and gaps in coverage will add additional costs for many individuals.
- How will I pay for it?
- For low-income Medicare beneficiaries there is the "Extra-Help" program offered by the federal government.
- This program is also known as the Low Income Subsidy or Limited Income Subsidy (LIS). This program will help you pay for the prescription drug benefit by reducing the cost-share amounts you have to pay.
- If you are not sure if you'll qualify, go ahead and apply. For information, contact the Social Security Administration at 1-800-772-1213 or visit www.SocialSecurity.gov.
- Who does it affect?
- All Medicare eligible persons are affected by this plan!
- Even if you are not currently taking medications, you should be aware of this program and how it may affect you.
- Full benefit dual eligible beneficiaries (enrolled in both Medicare & Medicaid) who now received their drugs from Medicaid are covered by this new Medicare benefit.
- What do I need to do?
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- If you are a Full Benefit Dual Eligible (Full Medicare and Medicaid Benefits) - you will be auto enrolled in a plan. You should have received a letter in October 2005 that explains the plan and covered prescriptions. Review this plan carefully. You may elect to change plans to find one better suited to your individual needs. If you change plans, you will be responsible for the difference in premium cost or co-payments if the plan you choose is more expensive than the plan into which you were going to be auto-enrolled.
- If you are a Partial Benefit Dual Eligible (Medicaid pays for your Medicare premiums and other Medicare cost-sharing) you must enroll on your own by May 15, 2006. If you have not enrolled by this date, CMS will "facilitate" your enrollment into a plan of their choice beginning June 1, 2006.
- If you are a Medicare beneficiary but not Medicaid eligible - this is a voluntary program. However! If you do not have a qualifying prescription drug coverage plan from another source (past employer, union, etc) you must enroll in a Plan by May 15, 2006 to avoid paying a premium penalty later. The penalty is one percent of the average drug premium per uncovered month. The penalty will increase yearly based on the prescription drug benefit premium.
- When do I need to act?
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- July 1, 2005 - Online applications became available for Extra Help at www.SocialSecurity.gov
- November 15, 2005 - Open enrollment began for all Prescription Drug Plans
- January 1, 2006 - Medicare Prescription Drug Coverage (Medicare Part D) went into effect. (Medicaid prescription drug coverage for full benefit dual eligibles ended on this date too.)
- May 15, 2006 - Last day of open enrollment. You will be subject to a penalty forever if you did not enroll before this date (unless you are covered by a qualified plan).
- Where do I go for more information?
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Plan Finder
- The plan finder can be found at http://www.medicare.gov/MPDPF/Public/Include/DataSection/Questions/Questions.asp.
- Individuals can conduct a personalized search by entering their Medicare insurance information and zip code. They will need their Medicare claim number found on their Medicare insurance card, a list of their medications, and the doses of the medications.
- Individuals can also conduct a general search but cannot search for multiple medications with this tool (see formulary finder, below). This involves multiple screens and requires the individual to go to the individual plan formularies to verify information on prior authorization requirements and co-payment tiers.
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Formulary Finder
- The formulary finder allows individuals to search available plans by the list of medications the individual is currently using. The direct link to the formulary finder is: http://plancompare.medicare.gov/formularyfinder/selectstate.asp.
- The user may list multiple medications and may view the results according to the exact dosages they take or based on the most common dose as covered by the formulary.
- The formulary finder gives the user a list of plans which cover all or some of the medications in the person’s list. The tool also identifies whether those medications have co-payment tiers; and whether the medications require prior authorization or step therapy.
- Individuals will have to access the specific formulary of a specific plan to get details for the co-payment amounts and prior authorization requirements either by calling the plan or using the plan finder tool above.
Montana Plans
- To quickly find a list of plans offered in your state/region, use this link.
- This chart contains information about contacting the plan by phone as well as general information about premiums and deductibles.
Plan Help Desk
Medicare Advantage Plans
- A detailed state by state breakdown of Medicare Advantage (MA) Cost Plans, Demonstrations & Stand-Alone Prescription Drug Plan (PDP) Organizations can be found at http://www.medicare.gov/medicarereform/map.asp.
- The Stand Alone PDP information includes approved plans, monthly premium and annual deductible information, and coverage information such as whether only generics are required during the coverage gap and whether mail order is offered. Note that there is a column designating which plans have no premium cost for those receiving the Extra Help, including those with Medicaid & Medicare.
Training Resources for Assistants
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Last Updated: April 11, 2008
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