Johns Hopkins Medicine - Department of Psychiatry and Behavioral Sciences
TALKING TO YOUR PATIENTS ABOUT MEDICARE PART D
MEDICARE PART D |
Chapter 1 - Choosing to Join
Select a link below for quick reference:
Who should join before December 31, 2005? Answer |
Who can wait to join until later, up until May 15, 2006? Answer |
Who should stay with their current drug program? Answer |
What are the penalties for not joining? Answer |
How often can enrollees switch plans? Answer |
Who should join before December 31, 2005?
Anyone who has Medicare and drug coverage through Maryland Medical Assistance or Maryland Pharmacy Assistance will lose that coverage on Dec. 31, 2005.They will need to enroll in a drug program before the end of 2005 in order to have uninterrupted drug coverage. People with Medicare and full Medical Assistance drug coverage are being automatically enrolled, and assigned to one of the basic 15 drug programs with the full low income subsidy.These patients should have received a letter from Medicare, and a letter from the drug program they have been assigned to, giving the assignment details.These patients may need to switch programs if the program they have been assigned to does not cover their drug needs.They will be able to switch programs before the Dec. 31, 2005 date, and once per month afterward.
Patients with Medicare and Maryland Pharmacy Assistance are also being automatically enrolled and assigned to a drug program, through the state of Maryland. This was recently announced in an Advisory from the Maryland Pharmacy Program (No.20, dated 11/23/05).These patients will receive a letter from the Maryland Pharmacy Program informing them of the assignment details. They may also need to initially switch programs in order to have their drug needs met. They are also eligible to switch programs once per month afterward.
Please click here to view a PDF of Maryland Pharmacy Program Advisory 20
Who can wait to join until later, up until May 15, 2006?
People who have no drug coverage, who have a Medicare discount card, or a Medigap policy with drug coverage can wait to make their decision about joining a Medicare drug program. The Medicare discount program will continue until May 15, 2006, or until an individual enrolls in a drug program. Most Medigap policies do not have drug coverage. But for people who do have drug coverage, they will need to determine if their current coverage is as good as or better than the coverage under the new program. They should have received by now information from their Medigap program about this question. If the Medigap policy drug coverage is not as good as the new Medicare program (most of them fall in this category), the person should join a Medicare drug program before May 15, 2006.
After the initial enrollment period people will not be able to join a plan until the next annual coordinated election period, which will take place from Nov.15 to Dec. 31, 2006. People who fail to enroll before May 15, 2006 will be subject to the monthly penalty explained below. People who have enrolled by Dec. 31, 2005 may switch their plan one time between the time they enroll and May 15, 2006.
Who should stay with their current drug program?
There are people with Medicare who currently receive prescription drug coverage that is equal to or better than the coverage that will be available under the new Medicare program. People who currently get their drugs through the VA, through a retired employee or union program, through Tricare, or through a Federal Employee Health Benefits plan, will probably want to stay with their current provider. They should have received information from their current drug provider about whether to stay in the program or to join a Medicare program. If a person has a program that is currently equal to or better than the Medicare program, and they lose that coverage in the future, they will have 60 days to enroll in a Medicare drug program before they would become subject to the penalty for late enrollment.
What are the penalties for not joining?
Medicare designed the rules for this program to encourage people to join during the initial enrollment period, from Nov. 15, 2005 through May 15, 2006. People who are eligible to enroll, who do not have current drug coverage that is equal to or better than the new drug program, and who do not enroll, will start accruing monthly penalties after May 15, 2006. For each month that the person is not enrolled, a 1% penalty will be added to their monthly premium cost when they do join a program. The 1% will be based on the average premium cost in Maryland. The penalty is permanent, and will be attached to the monthly premium as long as the person stays enrolled in a Medicare Part D program.
People who are currently enrolled in programs with coverage that is equal to or better than Medicare’s drug program will not be subject to the penalty. If they lose their coverage in the future, and fail to enroll before 60 days after the loss of coverage, they will begin to accrue the monthly penalty.
Fortunately there are several programs in Maryland with very low monthly premiums and very good coverage. People who may be reluctant to join a Medicare Part D program may want to consider one of these lower cost programs. (One drug program has a monthly premium of $6.44). This may appeal to people who do not currently have high drug costs who might consider not joining a Medicare drug plan until later. If someone signs up for a low cost plan now, they will avoid the penalty for not joining later.
How often can enrollees switch plans?
Enrollees who qualify for full low income assistance will be able to change plans once per month. Enrollees who qualify for partial assistance will be able to change plans once per year, during the annual coordinated election period. People who do not qualify for extra help will be able to change plans one time before May 15, 2006 if they have signed up for a plan before Dec. 31,2005. After that time they must wait until the next annual coordinated election period (Nov. 15, 2006 to Dec. 31, 2006) to switch plans.
Janet A. Bachur LCSW-C
12/12/05
CHOOSING TO JOIN: RELEVANT LINKS and CONTACTS
Medicare: “Your Guide to Medicare Prescription Drug Coverage”
www.medicare.gov/Publications/Pubs/pdf/11109.pdf
“Your prescription drug coverage choices” (pages 31-54)
AARP: “The New Medicare Prescription Drug Coverage: What you need to know”
www.aarp.org/health/medicare/drug_coverage/medicarepdf1.html
“Making a decision about Medicare prescription drug coverage” (pages 7-14)
Medicare Rights Organization: “Medicare Drug Coverage 101”
www.medicarerights.org/drughelp.html
“Should I get Medicare drug coverage?" Questions 17-19
“What happens to the prescription drug coverage I have now?"
Questions 75-87
Maryland Pharmacy Program: Advisory No. 20 (11/23/05)
“Medicare Part D Drug Coverage" Click here to view as a PDF
Maryland Department of Hygiene and Mental Health: "Important note to Maryland Program Recipients who have Medicare”
www.dhmh.state.md.us/mma/mpap/pdf/partd_engl.pdf
