Medicare Part D Patient Facts
- It is voluntary, except for people who have both Medicaid and Medicare.
- Private insurance companies, not Medicare, offer the prescription plans. However, Medicare has approved of every company that has a plan.
- There are two ways of getting prescription drug coverage: through a stand alone plan or from a Medicare Advantage Plan with prescription benefits (MA-PD). The MA-PD combines coverage for Medicare Parts A and B with drug coverage.
- Plans will have a monthly premium and costs for the drugs you get through that plan. These costs vary depending on what state you live in and what plan you choose.
- Your yearly income and the amount of assets you have (not including the home you live in or your car) determine how much of the Part D costs Medicare will pay.
- If your income is under 150% of the Federal Poverty Level and you have limited assets, Medicare will give you “extra help” in paying for Part D. This can mean paying for part or all of your premium costs and paying a larger share of the medication costs than it does for people who have higher incomes.
- If your income is over 150%, once your drug costs (the part you pay and the part Medicare pays) go over $2,400 you are in the doughnut hole or coverage gap. Now, you will need to pay all of your drug costs until you spend $3,051 more on
- medication. Then Medicare will pay almost all of your drug costs for the rest of the year.
- Most states have many, many plans to choose from, making it difficult to make a decision. All plans have to offer what Medicare calls a basic package, but some companies will offer more than one plan. The average premium in 2007 will be about $24, but premiums can be higher or lower, depending on the plan and where you live. See
www.medicare.gov in the Compare Prescription Drug Plans link.
- In order to reduce your medication costs should:
- Decide whether you can take generic medications for any of the brand name medications you are currently taking;
- Decide whether you can use a mail order pharmacy or another pharmacy if the pharmacy you usually use is not one that the plan uses
- In order to decide which plan is best for you should:
- Make a list of all the prescription medications you are taking as well as the dosage and how much medication you use in a month;
- Make sure the medications you take are covered by the plan;
- Look at your what the plans tell you your annual costs will be, based on your medication list and their monthly premiums;
- Decide whether it makes sense for you to find a plan that has coverage in the doughnut hole.
- Enrollment for 2007 begins on November 15, 2006 and ends onDecember 31, 2006. After that date you will not be able to enroll in a plan until November 15, 2007. If you do wait to enroll and you haven’t been part of another prescription plan that the government considers to be as good as Part D you will have a late fee added to your premiums. This fee is one percent of the premium.
What counts as an asset?
Under the Medicare Part D regulations, assets to be considered in determining eligibility for “extra help” are:
- Real estate other than the beneficiary’s primary residence, such as rental property, vacation or undeveloped property
- Business equity
- Assets at financial institutions, such as savings, checking accounts, CDs
- Retirement accounts such as IRAs, Keogh, 401(k) accounts
- Stocks and mutual funds
- Bonds, securities and U.S. savings accounts
- Other financial assets
Primary residence, first and second cars and burial plots and/or life insurance worth less than $1,500 do not count as assets.
An asset test is required ONLY for beneficiaries seeking “extra help.” If your total household income is over 150% of the Federal Poverty Level you are not eligible for “extra help” so it doesn’t matter how many assets you have.
If your total household income is between 135% and 149% of the Federal Poverty Level, in order to get “extra help” from the government your assets must be less than 10,000 for an individual and $20,000 for a couple. You may have life insurance worth less than $1,500.
If your total household income is under 135% of the Federal Poverty Level, in order to get extra help from the government your assets must be less than $6,000 for an individual and $9,000 for a couple.
Medicare Part D Resources
The official Medicare web site; the drug plan comparison tool is very useful for looking at the costs of different plans in your community.
The website of the Social Security Administration where Medicare beneficiaries may apply for Medicare’s “extra help” for assistance with Part D costs.
Medicare Rights Center (MRC) is the largest independent source of health care information and assistance in the United States for people with Medicare. Founded in 1989, MRC helps older adults and people with disabilities get good, affordable health care. MRC provides telephone hotline services to individuals who need answers to Medicare questions or help securing coverage and getting the health care they need. MRC also works to teach people with Medicare and those who counsel them–health care providers, social service workers, family members, and others–about Medicare benefits and rights.
The Access to Benefits Coalition and the National Council on Aging are working together to help enroll individuals in Medicare Part D and to make information available to consumers. This website gives information in easy-to-understand language so that people with Medicare can work on their own to assess their options, find and compare plans, and enroll online if they choose to enroll.
The Eldercare Locator is a public service of the U.S. Administration on Aging. The Eldercare Locator connects older Americans and their caregivers with sources of information on senior services. You can also call 1-800-677-1116.
The State Health Insurance Assistance Program, or SHIP, is a national program that offers one-on-one counseling and assistance to people with Medicare and their families. Through federal grants directed to states, SHIPs provide free counseling and assistance via telephone and face-to-face interactive sessions, public education presentations and programs, and media activities.
This website uses information prepared by the Disability Policy Collaboration, a partnership between The Arc and United Cerebral Palsy, and is tailored for individuals with disabilites.