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Medicare Part D Prescription Drug Plan

Facts about Medicare’s New Coverage for Prescription Drugs

Starting January 1, 2006, Medicare offers prescription drug plans to help you pay for the prescriptions you need. If you don’t join a Medicare prescription drug plan by May 15, 2006, you will pay a higher premium unless you have drug coverage that, on average, is at least as good as standard Medicare prescription drug coverage (such as from a former employer or union). Your insurer will notify you before fall to let you know if your coverage, on average, is at least as good as standard Medicare prescription drug coverage.

What do I need to know?

Here are some facts to keep in mind:

To get Medicare prescription drug coverage, you must choose and enroll in a Medicare prescription drug plan.
You can first enroll in a Medicare prescription drug plan from November 15, 2005 through May 15, 2006.
If you join by December 31, 2005, your coverage will begin January 1, 2006.
If you join, your costs will vary depending on which plan you choose. In general, you pay a monthly premium (ranging from $16.70 to $107.50 in 2008) and a yearly deductible (up to the first $275 in 2008). You will also pay a share of your prescription drug costs, and your plan pays a share. Medicare helps pay for drugs up to a limit ($2,400 in 2007) and once your total out-of-pocket costs for drugs reach $4,050 in 2007, you pay 5% of the costs and Medicare pays 95% of the costs for the rest of the year.
Many people with limited income and resources will get extra help paying for their prescription drug coverage. People with the lowest incomes and resources will get the most help. If you are in this group, you will get information in the mail from the Social Security Administration (SSA) or from Medicare telling you what to do.

What if I Receive Medicaid and Medicare, and Medicaid Now Pays for my Prescription Drugs?

Your Medicaid prescription drug coverage is changing and Medicaid will no longer pay for your drugs. As of January 1, 2006:

Medicare will start paying for your prescription drugs.
The last day that your State will pay for your prescription drugs is December 31, 2005.
You will have continuous drug coverage and pay a small amount out of your own pocket.
You must join a Medicare prescription drug plan for Medicare to pay for your drugs.
Compare your drug plan options and join. You can join a Medicare prescription drug plan starting November 15, 2005.
If you don’t join a plan by December 31, 2005, Medicare will enroll you in a plan to make sure that you don’t miss a day of coverage.
Medicare will let you know the plan it has picked for you in October 2005. You can switch to another plan at any time.
To find out your drug costs, log on to: http://www.medicare.gov/publications/pubs/pdf/10050.pdf and go to page 58.

How can I get more information?

Detailed information is available now. You can look at the “Medicare & You 2008” handbook, which is accessible at http://www.medicare.gov on the web or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Also please check this web page for more updates.

Another link that provides helpful information to consumers and providers can be found at http://www.mentalhealthpartd.org/, a web site created by leading organizations in mental health (including the National Mental Health Association and the National Alliance on Mental Illness among others) as a resource that will provide essential information and answer questions.

The New York State Office of Mental Health has developed a chart, utilizing formulary information contained on the Medicare website, which permits a comparison of the formularies of each of the Medicare Part D benchmark prescription drug plans. This will allow individuals who receive Medicare, their families, and providers, to compare drug plans side by side. You will need Adobe Acrobat Reader, which can be downloaded from http://www.adobe.com/products/acrobat/readermain.html. The link is http://www.omh.state.ny.us/omhweb/medicared/2007_plans.html.

Additionally, The Coalition of Voluntary Mental Health Agencies has launched a Medicare Part D Mental Health Provider Helpline. The phone number of the helpline is 212-742-1873. The Helpline will assist mental health providers in the New York metropolitan area, including Westchester County, who have questions about the new Medicare Prescription Drug Benefit. The hours of operation for the helpline will be Tuesdays and Thursdays 10:00 AM - 5:00 PM. The Helpline will be closed for one hour each day at around 1:00 PM.

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