Medicare Part D Prescription Drug Program

November 4 , 2005

Members of the MS community may already be aware of the highly publicized Medicare Part D Prescription Drug Program, which officially begins on January 1, 2006. Hopefully all individuals who qualify for this program are learning about their options so they may choose a plan that best fits their needs.

Anyone who is enrolled in Medicare is eligible. This program is voluntary for most Medicare recipients. You do not need to participate if you determine that you have a better plan already in place or available to you, whether through your employer or other health insurance provider. If you receive Medicare as well as Medicaid, however, you must enroll in the Medicare Part D plan to keep your prescription drug coverage.

Individuals who enroll in Medicare Part D must choose one of the several private prescription drug plans that Medicare has approved. Each plan must meet certain minimum coverage criteria. From there, these different plans vary in terms of what drugs they cover and how much they pay – so individuals need to look at their options carefully.

In general, participants will be required to pay a small monthly premium (approximately $32) as well as a $250 deductible, although some plans will waive that deductible. Participants must then pay 25 percent ($500) of the next $2,000 in eligible drug purchases. A gap in coverage requires the participant to pay the next $2,850 (if applicable) in eligible drug purchases, before the plan kicks in again with 95 percent coverage (known as the Catastrophic Benefit).

Each plan has a different “formulary,” or list of prescription drugs that it will cover. You should look very carefully at the formulary for each plan to determine whether that plan will cover the drugs that you need. If the plan you choose does not cover a drug you take in its formulary, you will have to pay the entire cost of that prescription drug.

Individuals who are on Medicaid will only have to pay a small co-payment for their prescription drugs, and some states will provide coverage through Medicaid to cover the cost of that co-payment. Individuals who: are not on Medicaid, earn a limited income ($14,355 for a single person; $19,245 for a married couple living together), and have limited resources, may qualify for extra help through the Social Security Administration, which provides a subsidy to help cover the cost of some premiums and co-payments.

Please note that Medicare Part D has strict deadlines that must be followed. Individuals who are eligible to enroll in Medicare Part D, and wait to enroll after the May 15, 2006 deadline, may be given higher rates to pay as a penalty. This penalty, however, may be waived if you have prescription drug coverage through an employer-sponsored plan.

Deadlines are:

November 15, 2005: Enrollment begins for Medicare Part D.

January 1, 2006: Drug coverage begins for those who enrolled with the new program.

May 15, 2006: Last day to enroll without a penalty, unless you qualify for an exception; those who have yet to begin Medicare may enroll in the new drug program when they initially sign-up for Medicare.

For more information, please go to any of the sources listed below:

AARP’s free guide: visit www.aarp.org/medicarerx or call (888) 687-2277

Medicare: visit www.medicare.gov or call (800) 633-4227; TTY at (877) 486-2048

Social Security Administration: visit www.socialsecurity.gov or call (800) 772-1213; TTY at (800) 325-0778

State Health Insurance Assistance Program (SHIP): visit www.shiptalk.org to find the toll-free phone number for your state

Anyone in need of additional information about MS and its treatments may contact MSAA's Helpline consultants by calling (800) 532-7667, Monday through Thursday, 9:00 am to 8:00 pm, eastern time, and Friday, 9:00 am to 5:00 pm, eastern time. Media questions should be directed to Andrea Borkowski at (800) 532-7667, ext. 123.

Written by Susan Wells Courtney, MSAA Senior Writer

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