Medicare Prescription Drug Program (Part D) Impacts

Enrollment in the Medicare Part D program will begin November 15 and will become effective January 1. Part D is the new voluntary drug benefit implemented by the federal government in response to rising pharmaceutical costs, which had caused some medication to be unaffordable for some seniors and individuals with disabilities. This is the biggest Medicare program change in 40 years!

Although Part D will help make most medications more affordable, state and other insurance drug programs are changing to take advantage of these new benefits, too. Therefore, consumers may experience confusion during the transition regarding which health insurance program is helping to cover their prescription costs. If your drug coverage is changing, you should have received, and will likely continue to receive, a barrage of mail notifying you of the change and what you need to do. But sometimes, those notices may look like “junk mail” and get discarded.

Here are the most important changes everyone needs to know:

• The Minnesota Prescription Drug Program (MN-PDP) ends December 31.

• If you are eligible for both Medicare and Medical Assistance, Medical Assistance will not cover prescriptions after December 31 (with a few exceptions). Plus, the monthly co-payment charges and limit for Medicare could be much higher than your current Medical Assistance co-payment charges and limit depending on the number and actual cost of your medications. Medicare Part D co-payments for people eligible for both Medicare and Medical Assistance will range from $1 to $5 per prescription filled. When total prescription drug costs reach $5,100 in a year, the co-payments end for the year.

• Some people will qualify for additional assistance to help pay for Medicare Part D plan costs (e.g., premiums, deductibles, and co-payments). For more information, please read Jim Czechowicz’s article, “Extra Help to Meet Prescription Costs,” also in this month’s edition.

• There are approximately 63 different Medicare prescription drug plans being offered by 24 different organizations. Each drug plan may charge different costs by requiring different premiums, deduct-ibles, and co-payments. Also, drug plans may cover different drugs; they may use different drug formularies.

• Most people must actually choose, and then notify Medicare of their choice, by enrolling in a Medicare Part D drug plan.

• If you are currently eligible for Medicare but choose not to enroll in a Medicare Part D plan, you may pay a “penalty” for the rest of your life through higher monthly premiums if you apply for drug benefits in the future. For example, Bill is eligible, does not currently take any medication, does not want to pay the coverage premium (approximately $30/month), and does not enroll. Four years from now, Bill’s doctor prescribes several expensive medications. When Bill finally enrolls, he will be required to pay an additional 48% penalty in addition to his current monthly premium for the rest of his life (a 1% per month penalty for the 48 months he waited).

• Even if you are one of the few people automatically enrolled in a Medicare Part D plan, it may not be the best plan for you. It might not even cover the medications you take.

What you need to do:

• If you live in a skilled nursing facility (SNF) or intermediate care facility (ICF/MR), you will automatically be enrolled in a plan and will not be charged any premiums, deductibles, or co-pays.

• If you receive coverage through AXIS Healthcare/UCare Minnesota (the Minnesota Disability Health Option program —MnDHO), you don’t need to do anything. You will be automatically enrolled in the most appropriate drug plan and receive the full amount of additional assistance to pay for any drug plan premiums and deductibles. You will still need to pay co-payments though.

• If you are eligible for Medicare AND use Medical Assistance, Medical Assistance for Employed Persons with Disabilities (MA-EPD), or a Disability Waiver program, you will automatically be enrolled in one of the drug plans. BUT, that plan may not be the BEST plan for YOU. Make a list of the medications you are taking, then use the tools on the Medicare Web site www.medicare.gov or call the Linkage Line 800-333-2433 to find out which plan is best for you. Also, you will automatically receive the full amount of additional assistance to pay for any drug plan premiums and deductibles. You will still need to pay co-payments though.

• If you currently receive Supplemental Security Income (SSI) OR use a Medicare Saving Program (QMB, SLMB, QI) or the Minnesota Prescription Drug Program (MN-PDP), you must choose a plan by January 1 and you will automatically receive full or partial assistance paying for premiums, deductibles, and co-payments depending on income, resources and family size. Make a list of the medications you are taking, then use the tools on the Medicare Web site www.medicare.gov or call the Linkage Line 800-333-2433 to find out which plan is best for you.

• If you do not fall into any of the above categories AND are eligible for Medicare, you will need to choose and enroll in the most appropriate plan for you. Also, you may wish to apply for additional financial assistance. Make a list of the medications you are taking then use the tools on the Medicare Web site www.medicare.gov or call the Linkage Line 800-333-2433 to find out which plan is best for you.

For more information, please visit Medicare’s Web site www.medicare.gov, visit Social Security’s Web site www.socialsecurity.gov, call Medicare 800-633-4227, call Social Security 800-772-1213, or call the Linkage Line 800-333-2433. The Linkage Line is designated by the Centers for Medicare & Medicaid Services (CMS) to be the State Health Insurance Assistance Program (SHIP) for Minnesota and provides comprehensive impartial assistance to all Minnesotans with Medicare including persons with disabilities, seniors, people with End Stage Renal Disease, or ALS. Linkage Line hours have been extended to accommodate the increased number of requests for assistance. Hours are 8:00 am to 7:00 pm Monday through Friday and 8:00 am to noon on Saturdays.