Oklahoma AgrAbility Newsletter
Spring 2005 • Volume 4 • Issue 2
Important News on Medicare Drug Benefits
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NOTE: Mention or display of a trademark, proprietary product or firm in text or figures does not constitute an endorsement by the U.S. Department of Agriculture, Oklahoma State University, Langston University or the National AgrAbility Project and does not imply approval to the exclusion of other suitable products or firms.
In This Issue
Important News on Medicare Drug Benefits
The Medicare Approved Drug Discount Card
The Main Event: Part D Medicare Drug Benefit Plan
Summary of Part D Standard Benefits for 2006
Important News on Medicare Drug Benefits
Farming and ranching families who receive Medicare need to know about important changes affecting the health benefits of all Medicare recipients. In the most significant change in Medicare benefits since the 1960’s, people currently enrolled in Medicare will receive a comprehensive prescription drug benefit. How this prescription drug benefit will affect you will depend on the drug insurance plan you choose to enroll in. Keep reading to learn more about how the prescription drug benefit will work and what you need to do to prepare for this important change!
Rachael Kircher, AgrAbility Project Coordinator
Carla Wilhite, OT/L, AgrAbility Program Specialist
The Medicare Approved Drug Discount Card
Currently if you are on Medicare and do not receive prescription drug coverage through Medicaid, you may be eligible to participate in a Medicare Approved Drug Discount Card Program. Many such programs have been advertising extensively on television and radio. Most cards can save you from 10% to 25% on the cost of your prescription medicines. This is a temporary benefit until Medicare offers its own prescription drug benefit starting January 1, 2006. However, there is still time to take advantage of the Drug Discount Card Program!
If you are still interested in participating in a Medicare Approved Drug Discount Card Program, take these 4 basic steps suggested by the AARP:
- Gather information on the medicines you take. Have your address, zip code, phone number, and income information handy.
- Call Medicare at: 1-800-633-4277 and speak to a Medicare information specialist who is available to assist you with finding out which drug plan is available to you. Or, go to the Medicare website at: www.medicare.gov to find more information. The website guides you through selecting approved drug discount cards.
- Once you know which approved discount cards you have to choose from, call your pharmacy and ask if they accept the Medicare Approved Drug Discount Card you are considering. If they don t, you may need to call Medicare again and ask for help in choosing an alternative card. Be aware: some cards charge an annual fee and others do not. The maximum annual card fee is $30.
- Call the drug discount card company you have chosen to get an application for their Medicare Approved Drug Discount Card. Complete, sign, and mail in your application.
Also, if your monthly income is no more than $1,047 (single) or $1,404 (married) you may qualify for an additional $600 credit on the Medicare Approved Drug Discount Card
If you prefer, you may also go online to the National Council on Aging’s “Benefit Check Up” website. Here you will find simple, confidential, and secure online services to assist seniors (those over age 55) search more than 1,100 federal, state, and private benefit and prescription saving programs. The program helps locate those programs for which the senior may be eligible. The website is: www.benefitscheckup.org
If communication is difficult, be sure to ask a competent relative, spouse, or health advocate for help navigating the system.
Sources: AARP, Centers for Medicare and Medicaid, National Council on Aging
Call!
Want to talk to a live person at Medicare?
Call: 1-800-MEDICARE (1-800-633-4227)
Have the following information ready when contacting Medicare about choosing a Medicare Approved Drug Discount Card:
- Your ZIP code
- Your medicines and doses (found on the pill bottle)
- Your total monthly income
- Your preferred pharmacy
- Specific drug card offers in which you may already have an interest
Best times to call to get the shortest waiting time:
- After 6:00 p.m. Eastern Standard Time and before 6:00 a.m. (EST).
- Best days to call: Thursday, Friday, and Sunday
Source: Centers for Medicare and Medicaid
The Main Event: Part D Medicare Drug Benefit Plan
Beginning January 1, 2006, a new comprehensive Medicare Drug Benefit Plan (called Part D) will be available for those currently enrolled in Medicare. This will replace the current Prescription Drug Benefit Card. The most important thing to know right now about this program is: You will NOT be automatically enrolled in the Medicare drug benefit plan!
Open enrollment for the Medicare drug benefit plan will be from November 15, 2005 to May 15, 2006. Although enrolling in the Medicare Part D drug benefit is optional, enrolling after this period will increase your monthly premium for Part D coverage for your lifetime. Once enrolled in a plan, you have the option to change your plan annually.
Over the next few months, you should start looking for mail from Medicare, Social Security Administration, your Medigap (supplemental insurance) provider, or your retiree health coverage. Don’t throw any of this information away. Read all of the information and work through the steps of deciding which plan is right for you and how to enroll.
Since some farmers or ranchers have worked off the farm, they may be receiving employee, retiree, or union health care coverage. In these circumstances, some individuals who receive retiree or union health coverage may want to decline enrolling in Medicare Part D if their present health coverage is considered “creditable coverage”. Creditable coverage is of equal or greater value than Part D standard coverage. The employer or union will notify its employees and retirees whether their coverage is “creditable”.
In all instances, it is important to compare the available plans in which you can enroll. It is expected that most states will have at least two plans to choose from for Part D coverage. Comparing drug formularies, pharmacy networks, and drug price options between the plans will be a crucial step.
Summary of Part D Standard Benefits for 2006
- You pay a $35 premium each month.
- Of the first $2,250 in drug cost, you pay the first $250 as a deductible and 25% of the remaining $2,000. The maximum you pay is $750.
- You pay 100% of the next $2,850 in drug cost.
- After you have paid the maximum of $3,600 out-of-pocket ($750 + $2,850), you pay only either 5% of the drug cost for brand name drugs or $2 per prescription for generic drugs.
- If you have low income and limited assets, you may qualify for waived fees and have to pay only a small co-payment for each prescription.
- The co-payment is increased annually.
An enrollment form for Medicare Part D is being developed by the Social Security Administration and should be available in time for the open enrollment period that begins November 15, 2005.
Source: Centers for Medicare and Medicaid, National Mental Health Association
Important Dates
May - Aug 2005
Letters from Social Security for low income Medicare recipients.
Nov 15, 2005 - May 15, 2006
Open Enrollment
Jan 2006
Permanent prescription cards issued
Nov 15 - Dec 31, 2006
Join or change plans
Financial Concerns
Extra help will be available for people with low incomes and limited assets to participate in the Medicare Part D Prescription Drug Benefit Program.
Individuals who are enrolled in both Medicare and Medicaid (called “dual eligible”) will receive premium and cost-sharing subsidies to participate in Part D plans. It is important to note that after January 1, 2006, state Medicaid programs will no longer provide coverage for prescription drugs since Medicare Plan D will be providing prescription drug coverage. Some state Medicaid programs may still choose to cover certain drugs not covered by Medicare. Also, if you are dual eligible, you will automatically be enrolled in a Plan D, unless you choose a different plan.
Others who have incomes that are lower than 150% of the Federal Poverty Level and have limited assets may also qualify for a low-income subsidy to help pay for Medicare Part D coverage. The nearest Social Security Administration field office or state office that administers Medicaid can provide you with information on the income and asset requirements for qualifying and can also assist with completing a low-income subsidy application. This assistance should be available by August, 2005.
Resources
Senior Health Insurance Counseling Program
Oklahoma Insurance Department
405-521-6628
toll free 800-763-2828
AARP
State information
toll free 866-295-7277
http://www.aarp.org/states/ok/
Center for Medicare and Medicaid Services
toll free 800-633-4227
http://www.medicare.gov (English)
http://www.medicare.gov/Spanish/Overview.asp (Spanish)
Access to Benefits Coalition/Benefits CheckUp
http://www.benefitscheckup.org
National Alliance on Hispanic Health
toll free 866-783-2645
AARP
National information
toll free 888-687-2277
http://www.aarp.org (English)
http://www.aarp.org/espanol (Spanish)
U.S. Administration on Aging
Eldercare Locator Services
toll free 800-677-1116
Information on local healthy aging services
http://www.aoa.gov (English)
http://www.aoa.gov/language/language_espanol.asp (Spanish)
Thanks to Linda Fowler, Occupational Therapy Assistant Student from Oklahoma City Community College for assisting with research for this issue of the AgrAbility Newsletter
This newsletter was supported in part by USDA-CSREES grant award number 2002-41590-01370.