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What are
Medicare Parts A, B, C and D?
Medicare Part A
typically pays for your inpatient hospital expenses.
There is no fee charged for this coverage.
Medicare Part B
typically covers your outpatient healthcare expenses, including doctor
fees. There is a premium for this part of your coverage.
Medicare Part C
offers a choice of options, including Medicare Managed Care plans (like
Medicare HMOs and PPOs) and Medicare private fee-for-service plans. In
2006 these will be known as Medicare Advantage Plans.
Medicare Part D is
the new prescription drug benefit resulting from the Medicare
Modernization Act of 2003, providing all beneficiaries with the option to
add prescription drug coverage. A premium will be charged for Part D in
the same way there is a premium for Part B benefits. It is important to
note that some prescription medications may be excluded from this program.
Click here for a complete guide to Medicare Part D
Prescription Drug Plan
How the Part D
Plan Works
You will have to pay a
premium each month for the Part D benefit. The premium for Part D is
approximately $35-$37 a month. Each enrollee wishing to participate will
have to elect the part D coverage and choose a corresponding Prescription
drug plan (PDP) or a Medicare Advantage Plan (MA-PD).
The Standard Benefit
in 2006
In 2006, the beneficiary
pays a $35 per month premium ($420 per year) if they want Part D coverage.
Beneficiaries are not required to enroll in Part D, but if they enroll at
a later date, they will pay a higher monthly premium.
■ Beneficiary pays $250
annual deductible before Medicare pays anything.
■ Beneficiary pays 25% of
the costs of the next $2,000 of drug expenses (beneficiary pays $500 of
next $2,000 of drugs costs plus all of the first $250 of drug costs for a
total of up to $750).
■ After $2,250 of drug
costs, there is no coverage until the beneficiary has paid another $2,850
worth of drug expenses (beneficiary pays up to $3,600 for up to $5,100 in
drug costs).
■ Catastrophic coverage
begins after beneficiary has paid $3,600 of out-of-pocket expenses ($5,100
total drug costs). The beneficiary pays $2 for generic, $5 for brand name
drugs, or 5 percent of the drug’s cost, whichever is greater.
December of 2005 and
January of 2006
You should receive an enrollment
package from United States Social Security Agency in the early fall. For
everyone else, the Initial Enrollment Period is similar to the Initial
Enrollment Period for Part B.
FREQUENTLY ASKED QUESTIONS
- Part D
I have NO
prescription coverage now, how do I enroll in Medicare Part D?
The initial
enrollment period will be November 15, 2005 to May 15, 2006, for people
who are currently eligible or will become eligible in November and
December of 2005 and January of 2006. You should receive an enrollment
package from United States Social Security Agency in the early fall. For
eve ryone else, the Initial Enrollment Period is similar to the Initial
Enrollment Period for Part B.
Presently
I am under a Medicare + Choice program (Part C). What changes can I expect
with the new Medicare Part D Prescription plan?
Medicare Pa rt
C is being restructured to Medicare Advantage (MA) Plans. Medicare
Advantage Plans are made available through private health care companies.
Medicare Advantage Plans may be a HMO (Health Maintenance Organization),
POS (Point of Service) plan, PFFA (Private Fee-For-Service) plan or PPO
(Preferred Provider
Organization).
Each MA will offer varied benefits, depending on the plan you select. If
you choose a MA that does not offer prescription drug coverage, you may
participate in the Medicare Part D program.
I have
prescription coverage through my employer -sponsored retirement plan. Do I
need to enroll in Medicare Part D?
This decision will have to be made once your former employer decides
whether or not they are going to maintain coverage for retirees. Companies
have the option to either maintain their current drug benefits, or to
reduce or eliminate prescription drug coverage for Medicare-eligible
beneficiaries. Employers must notify their Medicare eligible retirees
prior to
November 10, 2005
of their decision to discontinue, reduce or maintain drug coverage.
Beneficiaries must compare the benefits available to them and select the
option that best suits their needs.
I have
both Medicare and Medicaid (with prescription coverage). Do I need to
enroll in Medicare Part D?
Beneficiaries
who are dually eligible for both Medicare and Medicaid must enroll in
Medicare Part D by December 31st, 2005. After that date, the Medicaid
program will no longer provide prescription drugs for dual-eligibles. All
other health related services you receive under Medicaid will continue.
You will need to select a prescription drug plan (PDP) under Part D that
best suits your medication needs. You will now have a co-payment on every
prescription drug, which will be based on your income. There will be
premium assistance available for low income beneficiaries.
■
Beneficiaries that are dually eligible for Medicare and
Medicaid with assets of less than $2,000 for a single person and $3,000 for couples-
- No monthly
premium or annual deductible
- Beneficiary
pays $1 for generic and $3 for brand name drugs if below poverty level
or pays $2 for generic or $5 for brand name drugs if income is above
poverty level and below 135% of the poverty level
- Medicare
pays all other drug costs (no “gaps” in service)
■
Beneficiaries below 135% of the poverty with higher assets
($6,000 for a single person and $9,000 for couples)-
- No monthly
premium or annual deductible.
- Beneficiary
pays $2 for generic or $5 for brand name drugs
- Medicare
pays all other drug costs (no “gaps” in service)
■
Beneficiaries below 150% of pove rty level, not eligible
for above programs, and have assets, excluding the home you live in, below
$10,000 for a single person or $20,000 for couples-
- Monthly
premium based on sliding fee scale $50 annual deductible after the
deductible, beneficiary pays 15% of drug costs for the next $2,200 of d
rug costs
- Medicare
pays until $5,100 of drug costs
- After
$5,100 of drug costs, beneficiary pays $2 for generic or $5 for brand
name drugs (www.egyptianaaa.org)
Will I be
penalized for not enrolling in Part D?
If the beneficiary enrolling in Part D does not have credible drug
coverage (defined as at least as good as Part D), then they will be
penalized for not enrolling by
May
15, 2006.
Penalties take the form of increased monthly premium charges. Rates will
be determined by the length of your delayed enrollment. If the enrollee
does have credible coverage, he/she will be able to enroll in Part D at a
later date with no penalty.
What about
my current Medigap coverage? Will it continue to cover my prescription
drugs?
Medigap
policies that include a prescription drug benefit will NOT be sold, issued
or renewed as of 1/1/06. You will need to enroll in Medicare Part D or one
of the Medicare Advantage Plans to have prescription drug coverage. Medigap will have plans K & L that will remain available, but will not
provide prescription drug coverage.
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