The Best of Times Online -- News

Sponsor: The Strand Theatre of Shreveport

FaceBook Page | Subscribe Online! | Advertiser Info | Contact Us

Please pick up the March/April 2024 issue and 2024 Silver Pages at our 270 distribution locations!

Current News | News Archives | Events

Search Magazine

Search News

Search Radio

Sponsor

RSS Feeds

Magazine
News
Radio
Events

News

29 Questions answered regarding Medicare Part D - Prescription Drug Coverage on June 18th live radio show on THE BEST OF TIMES RADIO HOUR
June 19th, 2005

Ms. DORA MILLER, Public Affairs Specialist of the Social Security Administration was a guest on THE BEST OF TIMES RADIO HOUR with host GARY CALLIGAS on Saturday, June 18th from 9 to 10 am on NEWSRADIO 710 KEEL to answer questions of those who called into the live radio talk show about the new Medicare Part D – prescription drug coverage which will begin on January 1, 2006. The following is a summary of the questions and answers about this new Medicare program. If you have additional questions, please visit www.Medicare.gov or call 1-800-MEDICARE. There will be future articles and information in THE BEST OF TIMES newspaper and on future THE BEST OF TIMES RADIO HOUR shows about this new Medicare Part D coverage. (www.thebestoftimesnews.com)

Questions and Answers about Medicare Part D - Prescription Drug Coverage

1. How are the new Medicare drug plans/coverage that are starting on January 1, 2006 different from the Medicare-approved drug discount cards that are already available?
A: The Medicare-approved drug discount cards that became available in May 2004 are a way for you to get a discount on your prescriptions at the pharmacy. They work like other grocery store or pharmacy discount cards you may have. You can sign up for one of these cards only until December 31, 2005. They were offered as a transition step to help people with Medicare save money on prescription drug costs until Medicare prescription drug plans became available. You can continue to use your Medicare-approved drug discount card and your credit until May 15, 2006 or until you join a Medicare prescription drug plan, whichever is first.

2. After a person joins the new Medicare drug plan, can they still use the Medicare Drug Discount card?
A: After you join a Medicare prescription drug plan, you can’t use your Medicare-approved drug discount card. You also can’t use any of the credit you have left.

3. The new Medicare drug plan begins on January 1, 2006 and will pay for Medicare beneficiaries drugs in what manner?
A: Medicare prescription drug plans are a new type of insurance that can give you prescription drug coverage from Medicare. These plans work like other insurance you may already have. If you join one of these plans, you will pay a monthly premium, and you will have to pay a co-payment or coinsurance for each prescription you fill.

4. When can a person apply for this new Medicare Part D Coverage?
The initial enrollment period is November 15, 2005 through May 15, 2006. The next enrollment period will begin in November 2006.

5. So if a person enrolls after January 1, 2006, when is the effective date for coverage?
A: Effective date is the beginning of the next month, so if a person applies on January 5, 2006, their coverage would begin on February 1, 2006.

6. What is the Standard Coverage (without extra help) in Medicare Part D?
A. Beginning in 2006, Medicare beneficiaries will have access to the standard drug coverage. Although drug plan sponsors may change some of the specifications below, the coverage offered must at least be equal in value to the standard coverage. Standard coverage includes:
• A monthly premium of about $37
• A yearly deductible of $250
• Co-payment of 25 percent up to an initial coverage limit of $2,250
• Protection against high out-of-pocket prescription drug costs, with co-pays of
generally $2 for generics and preferred drugs and $5 for all other drugs, or 5 percent of the price, once the enrollee’s yearly out-of-pocket spending reaches $3,600.

7. Will there be a charge for the new Medicare Drug Card, like before?
A: There will be no charge for the new Medicare Drug Card, but there will be a monthly premium and other costs.

8. Will Medicare Prescription Drug Plan (Part D) premiums be deducted from Social Security benefits (like Part B)?
A: Medicare beneficiaries may choose to have the Part D premium withheld from their Social Security check or they may send the premium payments to the prescription drug plan sponsor.

9. Will there be any prescription drugs that Medicare Part D will not cover?
A: In general, the Medicare drug benefit will cover all FDA-approved drugs and biologicals normally covered in the Medicaid program as well as insulin and supplies associated with taking insulin. In addition, the Medicare drug benefit will cover drugs that help people to stop smoking. The specific prescription drug coverage will depend on the plan the individual chooses. Individuals will be able to obtain more specific information about the prescription drug coverage by calling 1-800-MEDICARE or by visiting the website at www.Medicare.gov.

10. Can a person apply for Medicare to pay for their prescriptions that they purchased from Canada”?
A: Medicare will not reimburse or pay for prescriptions from other countries.

11. How does a person Know which Providers are Legitimate and Connected with Medicare Part D?
A: All Medicare approved prescription drug plan sponsors will be listed on the internet at http://www.Medicare.gov or an individual can call 1-800-MEDICARE.

12. What if a person has prescription drug coverage from an employer or union?
A: If you have prescription drug coverage from an employer or union, you will get a notice from your employer or union that tells you if your plan covers as much or more than a Medicare prescription drug plan.
If your employer or union plan covers as much as or more than a Medicare prescription drug plan you can…
• keep your current drug plan. If you join a Medicare prescription drug plan later your monthly premium won’t be higher (no surcharge), or
• drop your current drug plan and join a Medicare prescription drug plan, but you may not be able to get your employer or union drug plan back.
If your employer or union plan covers less than a Medicare prescription drug plan you can…
• keep your current drug plan and join a Medicare prescription drug plan to give you more complete prescription drug coverage, or
• just keep your current drug plan. But, if you join a Medicare prescription drug plan later, you will have to pay more for the monthly premium (a surcharge), or
• drop your current drug plan and join a Medicare prescription drug plan, but you may not be able to get your employer or union drug plan back.

13. Who qualifies for Medicare Prescription Drug Coverage?
A: An individual is eligible for Medicare Prescription Drug Coverage if he or she:
• Is entitled to Medicare Part A and/or enrolled in Medicare Part B, and
• Lives in the service area of a prescription drug plan (PDP) or Medicare Health Plan with Prescription Drug Coverage (MA-PD) (Service area does not include facilities in which individuals are incarcerated but otherwise covers the 50 States, District of Columbia and U.S. Territories.)

14. Does a person have to enroll in this Medicare Part D plan” or is it voluntary? If they want it later, can they get it?
A: Medicare Part D is a voluntary plan and one can apply to obtain it at a later time.

15 When will people get more information about choosing a Medicare Prescription Drug Plan?
A: Throughout 2005, Medicare will provide you more information about Medicare prescription drug plans, including how to choose and join a drug plan that best meets your needs. In the fall of 2005, the “Medicare & You 2006” handbook will list the Medicare prescription drug plans available in your area, and you will be able to get personalized information at this website.

16. Certain Medicare beneficiaries are receiving notices about this new Medicare Part D Coverage? Who are these individuals and what do they need to do?
In May 2005 through August 2005, SSA is sending people with certain incomes information about how to apply for extra help paying their prescription drug costs and some will be automatically enrolled and will great extra help.

17. Will all pharmacies be part of the Medicare Prescription Drug Plan and can a person use a mail order pharmacy?
A: We don’t know. It is up to the pharmacies and CMS to determine if they will be part of a PDP. Pharmacies are not necessarily in or out of the Medicare program, but will determine what Prescription Drug Plan (PDPs) they want to honor. The same is true with mail-order pharmacies.

18. Will Medicare pay a person directly for those medicines that a person purchases after January 1, 2006 to reimburse them?
A: Medicare generally not pay individuals for purchases of their medicines.

19. How is Medicare Prescription Drug Coverage funded?
A. Medicare Prescription Drug Coverage is a Medicare benefit and, unlike Medicaid, is funded entirely with Federal dollars. There are no State funds involved.

20. What is this Extra Help with Medicare Part D drug plan costs?
A. The extra help is financial assistance with the monthly premium, the yearly deductible, the per-prescription co-payment, and continuous coverage with no gap prior to reaching $3,600 in out-of-pocket spending. The help may be full or partial depending on the income, family size and resources of the beneficiary. If your annual income is below$14,355 for an individual $19,245 for a married couple living together. To qualify, your resources must be limited $10,000 for an individual $20,000 for a married couple living together.

21. Is there Full Extra Help available with Medicare Part D drug plan costs?
A. Beneficiaries with very low savings and incomes will receive:
• A $0 yearly deductible
• A $0 monthly premium if their drug plan’s premium does not exceed the LIS premium subsidy amount
• Continuous coverage prior to catastrophic coverage.
• Co-pays of not more than $2 for generics and preferred drugs and not more than $5 for other drugs up to the out-of-pocket limit.
• No co-pays for prescriptions after reaching $3,600 in out-of-pocket spending.

Beneficiaries with Medicare and Medicaid and income at or below 100% of the FPL will have co-pays reduced to $1 and $3, respectively, up to the out-of-pocket limit. Beneficiaries who have full Medicaid benefits and reside in an institution will have no co-payments.

22. What is the Partial Extra Help?
A. Beneficiaries with limited savings and income below 150% of the federal poverty level can enroll in a plan with:
• A sliding scale monthly premium that is between $0 and about $37.
• A $50 yearly deductible
• Continuous coverage prior to reaching $3,600 in out-of-pocket spending
• Coinsurance of 15% up to the out-of-pocket limit ($3,600)
• Co-payments of $2 and $5, respectively, beyond the out-of-pocket limit.

23. Will a person lose their extra help if, during the year, they lose their status as automatically qualifying for the extra help?
A. The beneficiary will not lose the help during calendar year 2006. The change would be effective January 1, 2007.

24. Will the extra help “work” if the Medicare beneficiary does not choose a prescription drug plan?
A. No, enrollment in a prescription drug plan may occur before or after application for the extra help, but it is important to remember that the extra help provides no benefit if the beneficiary is not enrolled in a prescription drug plan. Most Medicare beneficiaries must actively enroll in a prescription drug plan. The exceptions are:
• Beneficiaries who are already enrolled in a Medicare Health Plan with Prescription Drug Coverage (MA-PD).
• Persons with Medicare and full Medicaid will be enrolled automatically in a PDP, with an effective date of January 1, 2006, if they have not enrolled in a Part D plan by December 31, 2005. This ensures that these individuals do not lose drug coverage on January 1, 2006, when Medicaid coverage ends.
• Other persons who automatically qualify for extra help those with the MSP will get enrollment into a PDP facilitated if they have not chosen a plan by May 15, 2006. Their enrollment would be effective on June 1, 2006. Beneficiaries who qualify automatically for extra help may change plans if they do not wish to remain in the plan chosen for them.
• Beneficiaries who apply for the extra help on their own and who are found eligible but who do not enroll in a PDP by May 15, 2006 will be enrolled into a plan with an effective date of June 1, 2006. These beneficiaries will have an opportunity to change plans if they wish.

25. What counts as income and resources to determine if a person can get the extra help on Medicare Part D costs?
A. The income of the applicant and that of a spouse living in the same household will be counted and compared to a Federal poverty level standard applicable to the size of the family, which includes the applicant, their spouse, and dependent family members who live with them. The resources of the applicant and the spouse, if any, will be counted and compared to the resource threshold, and generally include liquid resources that can be readily converted to cash within 20 days, such as checking and savings accounts, and real estate that is not the applicant’s primary residence. The resource standards apply to individuals and couples who have burial funds set aside for burial expenses. If no funds are set aside for burial expenses, the resource standards are $10,000/individual and $20,000/couple.

26. Will a person have to sell his/her car or their farm/ranch to qualify for the extra help?
A. No. Vehicles and any farm or ranch land that is adjacent to your primary residence are not counted as resources.

27. Will a person have to cash in their life insurance policies to qualify for the extra help?
A. No, we will not require you to cash in your policies. However, if the policies have a total face value (i.e., death benefit) of $1,500 or more, the cash value of the policies (i.e., the amount you would receive if you turned them in today) counts towards the resource limit.

28. How does a person know if he/she qualifies for the extra help?
A. SSA will conduct a comprehensive, national outreach campaign to encourage potentially eligible people with Medicare to apply for the extra help. Outreach strategies include direct mailings, thousands of community events, and partnering with stakeholders such as States and community-based organizations. SSA will mail applications to potentially eligible people with Medicare in May through August of 2005, and begin processing applications July 1, 2005. SSA will send the person a determination once the application is processed, and will call individuals if there are questions about their application.
In separate mailings that began in May 2005, Medicare will notify certain groups who automatically qualify for extra help for the 2006 calendar year that they do not need to apply. These groups are people with Medicare who have full Medicaid benefits, and people with Medicare and Medicare Saving Program. Anyone who believes that he or she may qualify for the extra help is encouraged to apply, and can do so by calling the Social Security Administration at 1-800-772-1213, by visiting www.socialsecurity.gov on the web or a State Medicaid office.

29. Who can help someone apply for the extra help?
A. There are other people who can fill out the application for someone to see if s/he qualifies for the extra help. These individuals are called personal representatives. A personal representative can be any of the following:
• The person who acts on someone’s behalf if s/he is incapacitated or can’t make decisions for himself/herself.
• Anyone someone chooses to act as his/her representative (such as a spouse, a child, or a caregiver).
• The representative payee whom the Social Security Administration selects to act on someone’s behalf or a person authorized under State law to represent him/her.

The above questions and answers are compliments of THE BEST OF TIMES newspaper and THE BEST OF TIMES RADIO HOUR located in Shreveport, Louisiana. For more information, visit our website at www.thebestoftimesnews.com. Call us at (318) 636-5510 or email Gary Calligas at GLCALLIG@hotmail.com.

For more information on Medicare Part D - Prescription Drug
Call 1-800-MEDICARE
Website www.medicare.gov
Contact Dora Miller at (318) 676-3173
Email address of Dora Miller dora.miller@ssa.gov

News Archives

Subscribe Online! | Advertiser Info | Contact Us | Privacy Statement | Confidentiality Policy