A Medicare Prescription Drug Primer, Part 2: Coverage Costs and Enrollment

Based on the “Medicare.gov - MPDPF: Supporting Information” and “Prescription Drug Coverage: Basic Information” webpages on the Medicare website

Edited (with Introduction) by Dr. Don Rose, Writer, Life Alert

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Now that the 2007 active enrollment period for the Medicare Prescription Drug Benefit is here (the active period runs November 15 to December 31, 2006), we thought an overview article covering the basic concepts involved in choosing a plan would be useful. Such a primer follows below. We urge all seniors to gather information that can assist in their decision making, whether they are contemplating a plan change or deciding on a plan for the first time. (Below is part 2 of our two part article.) --Dr. Don Rose

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How much will the plans cost? 

Your costs will vary depending on which drugs you use, whether you get extra help paying your Part D costs, and which Medicare drug plan you choose. Most drug plans charge a monthly premium that varies by plan. You pay this in addition to the Part B premium.

Some drug plans charge no premium. If you have limited income and resources, you may get extra help to pay for your Medicare drug plan costs. Depending on what you can afford, you may be able to pick a plan with or without a monthly premium, deductible or coverage gap.

What if I have limited income and resources?

There is extra help for people with limited income and resources. Almost 1 in 3 people with Medicare will qualify for extra help. Medicare will pay for almost all of their prescription drug costs. You can apply or get more information about the extra help by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or visiting www.socialsecurity.gov .

When can I get Medicare prescription drug coverage?

This year, you may sign up from November 15, 2006 to December 31, 2006. Your coverage will start January 1, 2007.  Enrolling by December 8, 2006 can help ensure that you will be able to use your coverage as soon as you need it after it starts.

If you don't sign up when you are first eligible, you may pay a penalty.

After December 31, 2006, your next opportunity to enroll will be from November 15, 2007 to December 31, 2007. Note: there may be exceptions to this; call the Medicare 800 number to get more information (see Resources section below).

How do I enroll? 

You can enroll in three ways:

• Sign up online at the Medicare website’s Enrollment Center
       (use this tool to join the Medicare drug plan you've selected)
• Call the plan directly
• Call 1-800-MEDICARE (1-800-633-4227) and Medicare will help you enroll 

           (TTY users should call 1-877-486-2048).

Read New Medicare Prescription Drug Coverage - Who Can Help Me Apply and Enroll?
 
Can I change plans after I enroll? 

Yes. You can change plans under certain circumstances:

• You can switch plans from November 15 to December 31 each year

• In special circumstances, Medicare may give you an opportunity to switch to another plan. For example, if you permanently move out of your plan’s service area; if you get help from your state Medicaid program paying Medicare premiums and/or cost sharing; if you qualify for extra help paying for prescription drugs; if the plan stops offering prescription drug coverage; or if you enter, live in, or leave a nursing home.

Read Quick Facts about Medicare's New Coverage for Prescription Drugs .
 
Resources

For more information, please read The Facts About Medicare Prescription Drug Plans .

Also, you can read other fact sheets about Medicare Prescription Drug coverage as it relates to the following topics:

• People with Limited Income
• Residents of Nursing Homes / Long-term Care Facilities
• People who get help from state pharmacy programs
• People with Medigap (Medicare Supplement Insurance) Policies
• People who get Supplemental Security Income benefits or an MSP program
• Bridging the Coverage Gap.

For more details about Medicare benefits, contact:
Toll-free ................1-800-MEDICARE (1-800-633-4227);
                               TTY users should call 1-877-486-2048.
Online....................www.medicare.gov

Seniors can also read the Medicare & You 2007 handbook that was mailed to many homes in October.

This article is based on the “Medicare.gov - MPDPF: Supporting Information” webpage, and the “Prescription Drug Coverage: Basic Information” webpage; both are part of the Medicare website. The information provided here is, to the best of our knowledge, reliable and accurate. However, while Life Alert always strives to provide true, precise and consistent information, we cannot guarantee 100 percent accuracy. Readers are encouraged to review the original article, and use any resource links provided to gather more information before drawing conclusions and making decisions.

Dr. Don Rose writes books, papers and articles on computers, the Internet, AI, science and technology, and issues related to seniors.