Topic: Making the New Medicare Prescription Drug Benefit Work for YouA reader asks: —Michael Dear Michael, There are several ways your father may be able to fill the gaps in his new Medicare drug plan: 1. Apply for Extra Help, a federal program that helps pay for some or most of the costs of Medicare prescription drug coverage, if your father's income and assets are low enough to qualify. 2. Enroll in his state's pharmaceutical assistance program (http://www.kintera.org/TR.asp?ID=M715077948099374125377665). Over a third of states offer assistance to help fill in the gaps in the Medicare drug benefit. Some have chosen to provide "wraparound" assistance and help with all out–of–pocket expenses including premiums and copayments. Others are offering premium assistance or rebate programs. What your state program pays for your drug costs will count toward the $3,600 in out–of–pocket costs you must pay in order to get catastrophic coverage (premium assistance does not count toward this amount). Check with your father's state plan for more information. 3. Apply for assistance from a certified charity that helps pay your out–of–pocket costs. What a charity pays for your drug costs will count toward the $3,600 in out–of–pocket costs you must pay in order to reach catastrophic coverage. To be able to do so, however, the charity cannot be affiliated with a specific pharmaceutical company. Support from a traditional manufacturers' patient assistance program will not count toward your father's out–of–pocket costs to reach catastrophic coverage under Part D. 4. Keep "wraparound" retiree drug coverage. Have your father talk to his former employer to find out if his current retiree drug coverage will pick up any of the costs that Medicare does not. However, what your employer or retiree insurance pays for your drug costs will not count toward the $3,600 in out–of–pocket costs you must pay in order to get catastrophic coverage. 5. Switch to an enhanced Medicare private drug plan that offers the Medicare drug benefit with lower out–of–pocket costs. Enhanced Medicare private drug plans (whether drug–only plans or Medicare private health plans, like HMOs and PPOs) generally charge higher monthly premiums than basic plans but may offer better benefits. These may include eliminating the deductible and/or coverage gap, having a broader list of covered drugs (formulary) and offering lower copayments. Some plans may also cover drugs that are excluded from Medicare coverage by law, such as benzodiazepines. You will have to determine if the extra premium is offset by any additional benefits. NOTE: For information about Medicare drug plan enrollment opportunities,
refer to our Medicare Enrollment Periods chart Keep in mind that once your father spends $3,600 out of pocket in 2006 for drugs covered by his Medicare drug plan, his costs will go down significantly. This is called catastrophic coverage , which means he will pay 5 percent coinsurance for each covered drug for the rest of the year. Remember that the only entities whose assistance will count toward that $3,600 are certified charities and his state's pharmaceutical assistance program. If he has Extra Help, catastrophic coverage works a little differently. It will begin after his total drug costs (what he pays plus what his Medicare private drug plan pays) equal $5,100. NOTE: If your father buys a drug that is not on his plan's formulary or if he buys it from a pharmacy not in his plan's network, he will have to pay the full cost himself and it will not count toward his out–of–pocket maximum ($3,600 in 2006). Survey Says . . . Did you know that Americans with above–average incomes have more difficulty
trying to see doctors and obtain necessary health care than patients in
Canada, the United Kingdom, Australia and New Zealand, all countries with
government–run, single–payer health care programs (from "Myths and Memes
About Single–Payer Health Insurance in the United States: A Rebuttal to
Conservative Claims" As a government–run, single–payer health care program for Americans 65 and older and those with disabilities, traditional fee–for–service Medicare offers its enrollees a wider choice of doctors and fewer restrictions on care, such as prior approval required by many managed care plans to utilize specialist services. According to a 2001 study published by the Commonwealth Fund (http://www.kintera.org/TR.asp?ID=M715079728099374125377665), people with Medicare generally reported more positive access experiences and ratings of care than members of private health care plans. For more about the efficiency of this government program, read "Medicare: A National Treasure for 40 Years," (http://www.kintera.org/TR.asp?ID=M715080068099374125377665) published by the Medicare Rights Center. * * * * * * Medicare Drug Benefit: Helping or Hurting? The Medicare Rights Center is collecting stories about the new Medicare drug benefit for the Medicare Rights Center's Part D Monitoring Project. Is it working for you and your loved ones? If not, why? Tell us about it by visiting http://www.medicarerights.org/partdstories.html * * * * * * This material created by the Medicare Rights Center and reprinted at AbilityMaine by permission. |