Frequently Asked Questions for Providers about Medicare Part D
On January 1, 2006 over 42 million Americans will be eligible to participate in Medicare Prescription Drug Coverage. Below are some questions that you may be asked about this new prescription drug benefit.
Who is eligible for a Medicare drug plan?
All patients who currently have Medicare coverage are eligible. These groups include:
- People over the age of 65
- People with specific disabilities under the age of 65
- People of all ages with permanent kidney failure
How can a patient join Medicare’s drug plan?
Patients can begin to join on November 15th. Each Medicare drug plan will have a different formulary. It is important that patients choose a Medicare Prescription Drug Plan whose formulary matches the medications they are taking. Medications used for weight loss/gain, promoting fertility, cosmetic purposes, and cough and cold will not be covered by any Medicare drug plans. Over the counter medications, barbiturates, benzodiazepines, and vitamins will not be covered by any plans.
Patients can get help choosing the plan that is right for them by calling
1-800-MEDICARE. Web links on www.medicare.gov are also available to help patients choose their plan. In future years, patients will have the opportunity to change Medicare drug plans between the dates of November 15th and December 31st.
Medicare beneficiaries who do not join by May 15, 2006 and do not have coverage on average at least as good as Medicare’s drug plan will have to pay a penalty for late enrollment. Patients with Medicare and Medicaid insurance (known as "Dual Eligibility") will be automatically enrolled into Medicare Prescription drug coverage by December 31, 2005.
What will the prescription costs be for a patient?
On average, patients will pay a monthly premium of $32. There will be a $250 deductible each year. After the deductible is met, Medicare will cover 75% of all drug costs up to $2,250. Patients are responsible for the next $2,850 in medication prescription costs. This is known as “the donut whole.” Once total medication costs reach $5,100 (of which $3,600 is out-of-pocket spending) a patient will pay the greater of 5% of a prescription drug cost or a $2/$5 (generic / brand) copay. This is known as “Catastrophic Coverage.” Some plans will provide additional patient assistance such as reduced premiums and lower deductibles.
Patients with limited income and resources will have extra help paying for prescription drug costs. If a patient believes they qualify for this additional coverage they can call 1-800-772-1213 or visit www.socialsecurity.gov to request an application. Patients who have dual eligibility will have State Assistance Prescription Coverage for donut whole costs. This is known as “Wrap Around Coverage.”
More information is available about Medicare Prescription Drug Coverage on the Web at www.medicare.gov.
