Medicare Part D Prescription Drug Plans
Medicare Part D now offers prescription drug coverage. Coverage is available through numerous Prescription Drug Plans (PDPs) and Medicare Advantage Plans (HMOs). Costs vary depending on the plan that is chosen. Each PDP can set their premiums, deductibles, co-payments and coverage gaps, as long as they have been approved by and are in accordance with federal law. Medicare Part D plans may not cover all the medications that are on the market. Each Prescription Drug Plan has their own formulary (list) of drugs they will cover. Under federal law, certain classes of prescription drugs are excluded for coverage.
People who become eligible for Medicare (at either age 65 or due to Social Security disability status) can join a Part D plan to start in the month their Medicare becomes available. For individuals already in a Medicare Part D plan, and wish to change to another plan, the next Annual Open Enrollment Period begins November 15, 2006 and ends on December 31, 2006, for coverage to begin as of January 1, 2007. You may change plans without penalty during the Annual Open Enrollment Period.
Consumers who were eligible to join a plan earlier this year, but did not join a Part D plan by May 15th, will be required to pay a higher premium, unless they had drug coverage that is at least as good as the standard Medicare plan (e.g., former employer or union plans). These individuals should join a plan during the Annual Open Enrollment Period, to avoid further penalty and delay.
Extra Help is Available for People with Limited Incomes and Resources
People with limited income and resources will be eligible for assistance with their prescription drug coverage. This is referred to as Medicare Rx Extra Help. Although the amount of Extra Help will vary according to income and resources, it will provide for both lower premiums and lower drug costs. Fill out an application from Social Security (1-800-772-1213), if you think you qualify or need assistance, call your local SHIP office.
How You Can Get Assistance to Understand Medicare Part D
The Maryland Department of Aging and the 19 Area Agencies on Aging (AAAs) offer information and assistance with Medicare and other insurance through SHIP, the Senior Health Insurance Assistance Program. Each of the 19 AAAs has a designated SHIP Coordinator, as well as trained volunteers who will be answering telephone calls and counseling clients. There are approximately 130 SHIP volunteers, statewide. Each Area Agency offers public seminars focusing on Medicare Prescription Drug Coverage.
Contact Maryland SHIP at 410-767-1100 or 1-800-243-3425 for information and enrollment assistance on the Medicare Prescription Drug Plans, for help applying for Medicare Rx Extra Help, or to find a seminar date and location.
Useful Telephone Numbers for Medicare/Medical Assistance Beneficiaries
Medicare beneficiaries who are also on Medical Assistance and those who are receiving Extra Help with their Medicare Prescription Drug Plan costs have a Hotline to contact if they are encountering problems getting their drugs. Beneficiaries should call: 1-800-638-3403. The local SHIP offices can also provide assistance (410-767-1100 or 1-800-243-3425).
Useful Telephone Numbers for Pharmacies Regarding Medicare/Medical Assistance Beneficiaries
To start the enrollment process or identify a recipient’s plan, call 1-800-662-0210. In the event recipients know they are enrolled in a Part D plan, but do not have documentation with them, the pharmacy may call 1-866-835-7595 to identify the appropriate plan. A pharmacy may use the E1 query point-of-sale system to determine which plan a recipient is enrolled. If the pharmacy is having problems with the system, they may call 1-800-388-2316 for technical assistance.
More information about Medicare Part D is available from the following resources:
- Federal Resources
- State and Local Resources
- Other Resources