This page is organized in two sections; the original information about how plans work (from 2006), penalties for not enrolling, enrollment periods, changes, etc., at the bottom of this page, and annual updates giving parameters for each year. Please contact the office for rates and benefits, as well as a custom proposal based on your specific prescriptions used. We’ve developed a Prescription List for 2012 to collect your information if you’d like us to create a report for you.
Before we meet, we’ll need your signature on the 2012 Scope of Appointment (government requirement).
To see if you’ll qualify for financial assistance for Part D premiums and other benefits, we recommend you visit the following website sponsored by the National Council on Aging: www.BenefitsCheckUp.org .
Medicare Part D for 2012
The standard deductible is now $320, with many options available. There are 33 plans available in California. The “initial coverage limit” is $2,930, and the coverage gap ends at $4700. During the gap, or “donut hole”, plans will pay 14% toward generic medications, and there is a 50% discount on brand-name medications from the participating manufacturers. Premiums for Part D may be higher than those shown on the Medicare.gov website and/or the Summary of Benefits document for each plan, based on your income. For details: Higher Premiums Medicare 2012 Publication.
Medicare Part D 2010 & 2011
The standard deductible has been increased to $310 (stable for 2011). Several carriers are offering plans with lower or zero deductibles, so it pays to shop around. The “initial coverage limit” is $2,830 in 2010 and $2840 in 2011. The out of pocket limit is $4,550 (the end of the coverage gap). The Annual Election Period for 2012 will be October 15 – December 7, 2011, for January 1 effective dates. We continue to offer plans from many carriers, including AARP, Aetna, Anthem Blue Cross, Blue Shield of California, Coventry (Advantra & First Health plans), Health Net, Humana, and United Healthcare. Formularies change annually for all plans, so you’ll want to research your current prescriptions in light of those changes. In 2010, beneficiaries who enter the “coverage gap” may be eligible for a $250 rebate. Click for Rebate information.
Starting in 2011, Part D enrollees will receive a 50% discount on the total cost of their brand-name drugs while in the coverage gap (a.k.a. the doughnut hole). The full retail cost of the drugs will still apply to getting out of the donut hole even though 50% was paid for by the pharmaceutical manufacturers. Enrollees will pay a maximum of 93% co-pay on generic drugs while in the coverage gap. Some carriers indicate you’ll need to use participating pharmacies to take full advantage of this improvement. Click for the official CMS message about Medicare and the Health Care Reform Law.
The only enrollment period available for 2012 Part D plans will be the AEP. The AEP begins on October 15 and ends December 7, 2011. After this period, there will be a dis-enrollment period for Medicare Advantage Plans members. Advantage plan members who would like to dis-enroll from their plan can do so beginning January 1 through February 14. If they choose to dis-enroll, they will have an opportunity to return to original Medicare and purchase a stand-alone Part D insurance plan. After that period members will be locked into their choice until December 31.
Medicare Part D 2009
This year, no carrier is offering coverage for Brand Name drugs in the coverage gap or “donut hole”. We are happy to offer Part D plans from a variety of carriers, including Aetna, Anthem Blue Cross, Blue Shield of California, Coventry (Advantra), Humana, Wellcare, and others. This year’s standard deductible is $295. The new coverage gap starts when yearly drug costs reach $2,700, and ends when the out of pocket drug costs reach $4,350. Open enrollment continues to be November 15 – December 31 each year, and we’ll want to research your prescriptions in light of the formularies offered by all available plans.
Medicare Part D 2008
Medicare Part D was first offered for 2006. November 15th – December 31st each year is the open enrollment period for January 1st effective date. During this time, Medicare Beneficiaries should re-evaluate their current prescription utilization and select a new plan. Premiums, benefits, deductibles, etc. have all changed since last year, so most people will want to make a change. If you do not exercise your option to change, you will likely be “locked in” for another year.
Each carrier may offer multiple Part D options, with benefits greater than or equal to this basic plan. In addition to comparing the benefits offered, consider:
1) Formulary, or list of covered pharmaceuticals. Are all of your prescriptions available on the plans you’re considering?
2) Participating Pharmacies. Can you pick up your prescriptions at your favorite pharmacy?
3) Coverage in the gap, or “Doughnut Hole”. In 2006 Humana offered the only plan covering Brand names in this coverage gap, while Sierra Rx covered Brand Name drugs during this gap for 2007. In 2008, it appears no insurance company has agreed to cover brand name prescriptions during this gap.
4) Do you have other coverage? If you’re enrolled in a Group Retiree plan, are actively employed and have group insurance including prescription coverage, are on COBRA from a group, have V.A. benefits, OR have already enrolled in a Medicare Advantage plan including prescription coverage, you may not want to sign up for Part D right now. We may be able to give you advice in those situations.
We’ll be happy to help you research plans based on your specific prescriptions, and will have the enrollment materials for most of the plans in our office. Give us a call for help!
Medicare Part D — Basic Information — Questions and Answers
What is Medicare Prescription Drug Coverage?
Medicare prescription drug coverage is insurance provided by private companies that have been approved by Medicare. Starting January 1, 2006, new Medicare prescription drug coverage will be available to everyone with Medicare. This drug coverage may help lower prescription drug costs and help protect against higher costs in the future.
You can get Medicare prescription drug coverage in the following ways:
1. Through Medicare Advantage Plans or other Medicare Health Plans that are offering coverage for prescription drugs.
2. Through Medicare Prescription Drug Plans, which add coverage to the Original Medicare Plan, and some Medicare Cost Plans and Medicare Private Fee-for-Service Plans.
You can choose and join the Medicare drug plan that works for you. You will have to pay a monthly premium. All drug plans must provide coverage that is at least as good as standard Medicare prescription drug coverage. Some plans might offer more coverage and additional drugs for higher monthly premiums. If you decide not to join a Medicare drug plan when you are first eligible, you may have to pay a penalty if you decide to join later.
If you have limited income and resources, you may qualify for extra help. Most people who qualify for this extra help will pay no premiums, no deductibles, and no more than $5 for each prescription. The amount of extra help depends on your income and resources. If you qualify, you will need to join a plan to get drug coverage. If you apply and qualify, and don’t join a plan, Medicare will enroll you in one by May 15, 2006 to make sure you get this important coverage.
What if I already have prescription drug coverage?
If you already have prescription drug coverage, you should talk to your plan, benefits administrator, or insurer before making any changes. You will be notified about any changes in your current coverage so you can decide if you should join a Medicare drug plan.
Is this Medicare prescription drug coverage better than what I have now?
If you already have prescription drug coverage through a Medicare private health plan or other insurance, check with your current plan to see if this coverage is changing. Your plan or insurer will notify you in the fall of 2005 to let you know if your coverage pays, on average, at least as much as standard Medicare prescription drug coverage or if it is changing.
Do I have to join a Medicare drug plan?
No. Joining a Medicare drug plan is your choice.
Should I join a Medicare drug plan even if I don’t take many prescription drugs?
You should still consider joining a Medicare drug plan in 2006. As we age, most people need prescription drugs to stay healthy. For most people, joining now means you will pay the lowest possible monthly premium. If you don’t join a plan by May 15, 2006, and you don’t currently have a drug plan that, on average, covers at least as much as standard Medicare prescription drug coverage, you will have to wait until November 15, 2006 to join. When you do join, your premium cost will go up at least 1% per month for every month that you wait to join. Like other insurance, you must pay this penalty as long as you have Medicare prescription drug coverage. If you join by December 31, 2006, your coverage will begin January 1, 2007.
How do I join a Medicare Prescription Drug Plan?
You can join a Medicare Prescription Drug Plan in the following ways:
By paper application. Contact the company offering the drug plan you choose and ask for an application. Once you fill out the form, mail or fax it back to the company.
On the plan’s website. Visit the drug plan company’s website. You may be able to join online.
On Medicare’s website. You will also be able to join a drug plan at www.medicare.gov on the web using Medicare’s online enrollment center.
By calling 1-800-MEDICARE. You can join a drug plan by calling 1-800-MEDICARE (1-800-633-4227) and talking to a Medicare customer service representative. TTY users should call 1-877-486-2048.
What happens if I choose not to join a Medicare drug plan by May 15, 2006? Can I join later?
If you don’t join a plan by May 15, 2006, and you don’t currently have a drug plan that, on average, covers at least as much as standard Medicare prescription drug coverage, you will have to wait until November 15, 2006 to join. When you do join, your premium cost will go up at least 1% per month for every month that you wait to join. Like other insurance, you will have to pay this penalty as long as you have Medicare prescription drug coverage.
If you join after May 15, 2006, the next open enrollment period is November 15, 2006 to December 31, 2006. However, coverage for people who enroll during this period will not take effect until January 1, 2007.
When and how often can I switch my Medicare drug plan?
Generally if you join a Medicare Prescription Drug Plan, you can only change plans under certain circumstances. You can choose to switch your current plan from November 15 through December 31 of every year. Enrollment is generally for the calendar year. In certain cases, such as if you move or enter a nursing home, you can switch your plan at other times. If you have both Medicare and Medicaid, you can change plans at any time.
How do I pay for the coverage? Can it be deducted from my Social Security or my retirement check?
In general, there are three ways you can pay your Medicare drug plan premiums:
1. You can give permission to the company that offers the Medicare drug plan you choose to deduct the premium automatically from your bank account, or
2. You can have your premium deducted every month from your
Social Security benefits, similar to your premiums for Medicare Part B, or
3. You can pay the prescription drug plan directly for your premium by mailing them a check or money order each month.
Is there someone to help me choose a Medicare prescription drug plan?
Talk to a family member, friend, or other caregiver to help you decide what drug coverage meets your needs. You may also
• Visit www. medicare.gov and select the “Search Tools” option to get personalized information that can help you compare plans.
• Call 1-800 MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
• Call Your State Health Insurance Assistance Program (the telephone number will be in your copy of the “Medicare & You 2006” handbook).
• Look for information about events in your local newspaper or listen for information on the radio.
• Call your local office on aging. For the telephone number, visit www.eldercare.gov on the web.
Is there information and help available to compare Medicare drug plans?
• Look for information about plans in your area in the “Medicare & You 2006” handbook, which you will get in the mail in October;
• Visit www.medicare.gov on the web. Starting in October, you can look under the “Search Tools” option for detailed information about the plans available in your area; or
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
How should I compare Medicare drug plans?
There are many factors you may want to consider when comparing your Medicare drug plan choices. These factors include:
• Coverage – Medicare drug plans will cover generic and brand-name drugs. Most plans will have a formulary, which is a list of drugs covered by the plan. This list must always meet Medicare’s requirements, but it can change when plans get new information.
• Cost – Monthly premiums and your share of the cost of your prescriptions will vary depending on which plan you choose.
• Convenience – Drug plans must contract with pharmacies in your area. Check with the plan to make sure the pharmacies in the plan are convenient to you.
• Security now and in the future – Even if you don’t take a lot of prescription drugs now, you still should consider joining a drug plan in 2006. For most people, joining now means you will pay your lowest possible monthly premium. If you don’t join a plan by May 15, 2006, and you don’t currently have a drug plan that, on average, covers at least as much as standard Medicare prescription drug coverage, you will have to wait until November 15, 2006 to join. When you do join, you will have to pay a penalty. You will have to pay this penalty for as long as you have Medicare prescription drug coverage.
Who can help me to find out more information about how this coverage will work for me?
For personalized assistance, you can call your State Health Insurance Assistance Program (see your copy of the “Medicare & You 2006” handbook for their telephone number). The handbook will be available to you beginning in October 2005. You can also visit www.medicare.gov on the web or call 1-800 MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Look for information about events in your local newspaper or listen for information on the radio. You can also get personalized counseling by calling your local office on aging. For the telephone number, visit www.eldercare.gov on the web.
Where can I get more information about Medicare prescription drug coverage?
For more information on Medicare prescription drug coverage, read the “Medicare & You 2006” handbook mailed to you in October 2005. It will list the specific plans available in your area. After October 2005, if you need help
• visit www.medicare.gov on the web and get personalized information.
• call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Have your Medicare card, a list of drugs you use, and the name of the pharmacy you use ready when you call.
• get a free copy of the booklet “Your Guide to Medicare Prescription Drug Coverage,” (CMS Pub. No. 11109) on www.medicare.gov or by calling 1-800-MEDICARE.
• call your State Health Insurance Assistance Program for free personalized health insurance counseling.
• check for local events for help joining. Contact your local office on aging. For the telephone number, visit www.eldercare.gov on the web.