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Medicare, Part D: What is it and should I join?
With the initial enrollment deadline only a month away, many people are trying to firm up their decision on whether to enroll in Medicare, Part D or to continue paying for their prescriptions as they are now.
Medicare, Part D is the new prescription program being rolled out by the government. It is a different program than Medicare, but will be part of the whole system. Medicare (www.medicare.gov) has 4 parts, Part A is the part of Medicare that handles hospitalization. It is run by Anthem Blue Cross/Blue Shield. Part B is the part of Medicare that covers medical needs such as doctor visits and routine medical care. Part B is run by TrailBlazers. Part C is an HMO form of Medicare and Part D is the new prescription plan being implemented as we speak. The new plan, Part D, is being run by private companies, and is overseen by CMS (Center for Medicare Services).
Medicare, Part D is a prescription plan, like many are already familiar with. The participant pays a premium every month to be a part of the plan. There is also a deductible, which varies depending on the plan that you choose. The standard deductible is $250. Once you have met the deductible, you then pay a set co-pay (usually a percentage of the total price) for each prescription that you purchase.
Anyone eligible for Medicare is eligible to participate in the new prescription plan. Anyone currently receiving Medicaid will be automatically enrolled. The initial enrollment period is November 15, 2005 through May 15, 2006. After that, there will be an annual enrollment period November 15 – December 31 of each year. If you choose to not enroll this year, there are penalties for enrolling later. When you finally do decide to enroll, your premium will be 1% higher for each month since the initial enrollment when you were eligible. For instance, if you are eligible now, but you choose not to enroll until the enrollment period in 2007, you will have waited about 20 months, therefore, your premium will be 20% higher each month, than it would have been had you enrolled in the initial enrollment period.
You have many choices for which provider to use for your plan. There are 18 different providers in Virginia and 41 different plans. You have to be very careful in selecting which plan you would like to use, as each company has the ability to choose which drugs it will cover and not every company will cover every drug or work with every pharmacy. This is one of the problems that Medicaid participants are finding out the hard way. Many nursing homes generally contract with one pharmacy for all of their residents’ prescription needs. However, as people with Medicaid are automatically switched over to Medicare, Part D, the plan that they are enrolled in may not be one that works with the same pharmacy that the nursing home contracts with. Nursing homes may not influence the decision of their residents or choose for them, which increases the problem of residents being enrolled in a plan that does not work best for them.
For some people, they have creditable coverage through their employer or retirement plan. For these lucky people, the coverage that they currently have is better than that of the Medicare, Part D program and they do not need to enroll. If their situation should change in the future, such as if their plan ceases to exist, they will have 60 days from the termination of their prior plan to enroll in Medicare, Part D at the lower rates without penalty.
Whether or not you enroll in Medicare, Part D is a decision that should be made with great thought. You should weigh the benefits and risks/inconveniences that accompany your switching to their plan. You will have to choose a specific provider, as well as a premium and a specific plan. You will have to weigh the benefits of each plan that you are looking at based upon which pharmacies the plan works with as well as which drugs the plan will cover. You may not be lucky enough to find a plan that covers all of the prescription drugs that you need.
For help in analyzing which plan is best for you, there is a coverage request on www.medicare.gov that will allow you to input your prescriptions and determine a range of plans for you to choose from.
If money is an issue for you, you can contact the Social Security Administration (www.socialsecurity.gov) regarding their assistance program for lower income individuals and families. You should not decline participation in the program due to lack of resources to pay for the program.
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