What are the Medicare Part D Benefits for 2009?

Medicare Part D covers prescription drug costs. Government-approved private insurance companies offer it.  People who have Medicare Part A or Medicare Part B are eligible for Medicare prescription drug coverage. You can enroll in any of the Part D plans that serve the area where you live.

The annual enrollment period for Part D is from November 15 to December 31. During that time period anyone with Medicare can enroll in a plan or change from one plan to another.

What should I consider when choosing a plan?

• Costs - The Medicare Plan Comparison Tool helps you compare costs such as premiums, co-payment/co-insurance and deductible expenses. We can also help you compare annual costs, based on the drugs you take.

• Doctors/Providers - If you are part of a Medicare Advantage Plan like and HMO or PPO, and get your Part D coverage as part of this, you need to make sure that you’re able to visit the providers you want. You also need to check if there will be additional costs if the provider is out of network or referrals are needed.

• Travel - Are my drugs covered if I travel (or live part-time) in another state?  If you are part of a Medicare Advantage Plan, and get your Part D coverage as part of this, you should make sure that your plan provides coverage in that state.

What are my costs for 2009?

• Premium - You pay a monthly premium for Part D, which varies from plan to plan.

• Deductible – The annual deductible depends on your plan. Most plans have a deductible of $295. You usually pay all of your drug costs, up to $295. After you have paid $295 deductible for your drugs, you usually pay 25% of your prescription drug costs up to $2,700.

• Initial Coverage Limit – The coverage limit is $2,700. Once this limit is reached for prescription drugs, your coverage stops. You are responsible for paying 100% of the drug costs up to $4,350 (including the costs of the deductible and coinsurance). This period is known as the Coverage Gap or Donut Hole.

• Catastrophic Coverage – Once you have reached the out-of-pocket costs of $4,350, you qualify for catastrophic coverage. You will pay no more than 5% of your drug costs for the remainder of the year.

Only 4% of seniors reach the Catastrophic Coverage period. The following conditions or drug classes most frequently reach the Coverage Gap during the year.

1. Alzheimer’s

2. Oral Anti-Diabetics

3. Proton Pump Inhibitors

4. Anti-depressants

5. Angiotensin Receptor Blockers

6. Statins

7. Osteoporosis

8. ACE Inhibitors

What can I do to prevent hitting the Coverage Gap or Donut Hole?

• Find Medicare Part D plans that cover all of your medications.

• Find out whether there are generic alternatives for any of your medications.

• Find out if any of the local pharmacies offer your drugs at low cost ($4.00 to $5.00).

• Buy your medications from a mail-order pharmacy. Mail-order pharmacies typically provide a 3-month supply of your prescriptions for the cost of two co-payments.

Is there any extra help for my Medicare Drug Plan costs?

You have to join a Medicare drug plan to get extra help paying your drug costs. If you qualify, there is financial assistance available for monthly premiums, yearly deductibles, and prescription co-payments. The amount of help will depend on your income and resources.

You automatically qualify for extra help if you have any one of the following:

• You have coverage from a state Medicaid program.

• You get help from Medicaid paying your Medicare Part B premiums.

• You get Supplemental Security Income (SSI) benefits but not Medicaid.

If you don’t automatically qualify for extra help, you may still apply.

• If you qualify, you still need to join a Medicare drug plan to get the extra help.

• If you qualify, and you don’t join a drug plan, then Medicare will enroll you in a Medicare drug plan.

• If you think you may qualify for extra help, you may call Social Security at 1-800-772-1213, visit the Social Security website (www.socialsecurity.gov), or apply at your State Medical Assistance (Medicaid) office.

What drugs are not covered?

There is a small list of drugs that The Centers for Medicare and Medicaid Services (CMS) do not require the plans to cover. These drugs are also known as excluded drugs. However, some plans may decide to include them as an added benefit to their consumers.

The Centers for Medicare and Medicaid Services (CMS) does not require these categories of drugs to be covered:

• Barbiturates (seizure drugs)

• Benzodiazepines (anxiety drugs)

• Weight loss or weight gain

• Fertility

• Cosmetic (e.g., hair growth)

• Cough and cold

• Over The Counter (OTC) Smoking Cessation (prescription smoking cessation drugs are covered)
  
  Related Articles: 

• Return to Drug Coverage>>
• Choosing A Medicare Prescription Drug Plan For Your Loved One
• Is my current Part D Drug Plan right for me?
• Part D Enrollment For Employer and Group Retirees
• Part D And Me - Which situation is most like you?
• What is the Donut Hole?
• When to Enroll for Part D Coverage

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