Volume 9 • Issue 4 • Fall 2005
Medicare Part D - The Basics
IMPORTANT DATES
November 15
Enrollment begins for Medicare Part D.
January 1, 2006
Medicare Part D coverage begins. Medicaid no longer pays for
prescription coverage.
Early April, 2006
CMS will identify beneficiaries eligible for low income subsidies
who have not enrolled in a plan.
Late April, 2006
CMS notifies beneficiaries, plans and state Medicaid agencies of
plans to which beneficiaries will be assigned if they do not
enroll in a plan on their own. This is CMS’s “facilitated
enrollment.”
May 15, 2006
Last day to enroll in Medicare Part D without incurring monthly
penalty (1% of monthly premium cost). Last date for beneficiary
eligible for low-income subsidy to self enroll in a plan.
May 16, 2006
Beneficiaries enrolling after this date will have to pay a penalty
for every month they delay enrolling. This penalty will be added
on to monthly premiums for as long as the beneficiary is enrolled
in Part D. No enrollments will be taken for current Medicare
enrollees. New beneficiaries have that same open enrollment as for
Part B benefits.
June 1, 2006
Facilitated enrollment takes effect for beneficiaries eligible for
low income subsidy. These beneficiaries have one additional
opportunity to change plans.
Nov. 15 - Dec. 31, 2006
Annual open enrollment period for Medicare drug plans for the
following calendar year.
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•
All Medicare beneficiaries are eligible for the Part D benefit.
•
Beneficiaries with incomes over 150 percent of the Federal Poverty Level
are not eligible for low-income subsidies, but Medicare will pay for a
portion of these beneficiaries’ drug costs.
•
Beneficiaries with incomes under 150 percent of the Federal Poverty Level
and with limited assets may be eligible for the low-income subsidy (or
“extra help” as Medicare calls it).
• Individuals
should apply for the low income subsidy now. This does not enroll them in
a plan; it will only let them know what level subsidy, if any, for which
they are eligible. Beneficiaries looking to apply for low-income subsidy
may do so online at
www.ssa.gov or may request a paper application by
calling 1-800-772-1213.
• Dual
eligibles—beneficiaries who are eligible both for Medicare and
Medicaid—are automatically eligible for the low income subsidy and do not
need to fill out an application.
•
Beneficiaries must enroll in a specific drug plan to be covered by
Medicare Part D, unless they are dually eligible for Medicare and Medicaid
(dual eligibles). Dual eligibles will be automatically enrolled in a plan.
• Medicare
Part D will not cover barbiturates, benzodiazepines, weight loss and
weight gain medications.
• Drug plans
will not need to make available every covered medication, but they do need
to make available at least two medications in every therapeutic class.
Plans may also offer more comprehensive coverage through enhanced or
supplemental coverage.
• Drug plans
will contract with certain pharmacies, which will be their pharmacy
network. These drug plans may but are not required to contract with
federally qualified health centers, rural health centers or other
federally funded safety net providers.
•
Beneficiaries may change plans once a year except for dual eligibles who
may change plans whenever they want.
How St. John’s Seniors can help
St. John’s Seniors operates a CLAIM site, which is a volunteer-based
program developed to assist seniors with their insurance claims.
Trained volunteers can answer Medicare recipients’ questions about
coverage and help recipients apply for the discount cards.
Please call the CLAIM (Community Leaders Assisting the Insured of
Missouri) line at 1-800-390-3330 to set up an appointment.
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Important information for
St. John’s PremierPlus members |
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 This
fall, St. John’s PremierPlus members will probably receive
information from a number of health plans offering Medicare
prescription drug coverage. As a member of St. John’s PremierPlus,
you are already enrolled in a Medicare Advantage plan and will
automatically have Medicare prescription drug coverage as of Jan. 1,
2006.
However, if you sign up for Medicare prescription drug coverage from
any other Medicare prescription drug plan, you will automatically be
dis-enrolled from St. John’s PremierPlus.
While you would continue to be covered under Medicare, dis-enrolling
from your PremierPlus plan could affect your choice of physician;
the costs of hospital stays, prescription drug benefits and any
supplemental benefits that you currently receive. St. John’s
PremierPlus members who want to receive the new Medicare
prescription drug coverage will have two choices for this benefit:
1. You may stay in a Medicare Advantage plan or join another
Medicare health plan that covers your doctor and hospital care and
provides Medicare prescription drug coverage. As a member of St.
John’s PremierPlus, you are already enrolled in a Medicare Advantage
plan and will automatically have Medicare prescription drug coverage
from St. John’s PremierPlus; or
2. You may choose to join a Medicare prescription drug plan that
adds coverage to the original Medicare plan. |
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