Medicare Drug Coverage
What is it?
Medicare drug coverage is drug coverage available for everyone with Medicare. Coverage begins January 2006. The drug plan benefits covers brand name and generic prescription drugs. Most beneficiaries will save between 30% to 50% on drug costs by getting a Medicare drug plan.
Medicare drug plans are sold by private companies. There are 48 different plans available in Humboldt and Del Norte Counties in 2006.
There is a premium cost for the plans. Premiums plans in Humboldt and Del Norte range from about $5 -$65 per month. Premiums may be deducted from your Social Security check if you wish.
Each plan has a list of drugs covered by the plan. This is called a formulary.
The plans will only pay for drugs on the plan formulary. When you choose a plan you will want to be sure the plan you choose covers your medications.
The plans work with various pharmacies. You will want to check to make sure the plan you choose is accepted at your pharmacy.
Standard Medicare Drug Plan Coverage
| YOU PAY | |
| Monthly Plan Premium | $37 Average |
| Annual Deductible | $250 Per Year |
| Up to $2,250 Total Annual Drug Costs | 25% of Drug Costs |
| Between $2,250 and $5,100 Total Annual Drug Costs | All Drug Costs |
| After $5,100 Annual Drug Costs =$3,600 Annual Beneficiary Out Of Pocket Costs | 5% Of Drug Costs |
Please Note:
- This is the standard plan design from Medicare.
- Actual plans may vary in deductibles and co-pays.
- All plans must provide catastrophic coverage after the beneficiary pays $3,600 in annual out of pocket costs.
Extra Help to Cover Medicare Drug Plan Costs is available.
Individual Plan List
Medicare Drug Plans and Veteran's Benefits
When and How do I Enroll?
Generally, you can only enroll in a Medicare Drug Plan, or change your Medicare Drug Plan during the Annual Election Period from November 15 through December 31 of each year. You may have premium penalties if you could have enrolled in a Drug Plan by May 15, 2006 but chose not to enroll in a Drug Plan.
You may have a Special Enrollment Period to enroll in a Medicare Drug Plan in the following circumstances:
If you are newly eligible to Medicare, you can enroll in a Drug Plan
- During the three months before you get Medicare or
- During the month you get Medicare or
- During the three months after you get Medicare
If you apply for Extra Help (the Low Income Subsidy) and are accepted you can enroll in a Medicare Drug Plan
- After you receive your acceptance letter
- You will automatically be assigned a Drug Plan, you can change plans one time
If you had creditable drug coverage through an employer or union sponsored plan and lost the coverage you can enroll in a Drug Plan
- Within 63 days of losing your coverage
If you have Medi-Cal or become eligible for Medi-Cal you can enroll in a Drug Plan
- Once you get Medi-Cal
- You will automatically be assigned a Drug Plan
- You can change plans once per month
1) Call 1-800-MEDICARE (1-800-633-4227) to enroll by telephone
2) Call Individual Plans to get an enrollment packet click here for Individual Plan List
3) Enroll using the Medicare website
Medicare Drug Plans for People with Medicare and Medi-Cal
If You Have Medicare and Full Scope Medi-Cal
You must use a Medicare drug plan for your drug benefits. If you did not choose a Medicare Drug plan, Medicare will automatically enroll you in a Medicare Drug plan.
You will automatically receive Extra Help to Cover Medicare Drug Plan Costs. You will pay $1/month for generic drugs and $3/month for brand name drugs.
You will want to choose a drug plan that covers your drugs. You must pay full price for drugs that your plan does not cover!
If you would like to change your Medicare Drug plan for a different Medicare Drug plan, you be able to change plans once per month
If you have Medi-Cal with a Share of Cost
You can apply for Extra Help to Cover Medicare Drug Plan Costs.
If you apply for Extra Help (the Low Income Subsidy) and are accepted you can enroll in a Medicare Drug Plan
- After you receive your acceptance letter
- You will automatically be assigned a Drug Plan, you can change plans one time
If you are not accepted for the Extra Help, you can enroll in a Medicare Drug plan during the Annual Election Period from November 15 through December 31 of each year. You may have premium penalties.
Extra Help to Cover Medicare Drug Plan Costs
You can get this extra help with Medicare Drug Costs if you have Medi-Cal or if you do not have Medi-Cal but your income is limited.
You need to apply for help using an application from Social Security. You can call Social Security at 1-800-772- 1213 to apply by telephone. Or you can Apply Using the Social Security Online Application.
| Your Income | Your Assets | You Pay |
|---|---|---|
| Medi-Cal Singles: below $12,920 a year Couples: below $17,321 a year | Below $2,000 for individuals and $3,000 for couples |
|
| Do NOT have Medi-Cal Income: Singles: below $12,920 a year Couples: below $17,321 a year | Below $6,000 for individuals and $9,000 for couples |
|
| Do NOT have Medi-Cal Income: Singles: below $14,355 a year Couples: below $19,245 a year | Below $10,000 for individuals and $20,000 for couples |
|
Medicare Drug Plans and Retiree Plans
If your retiree drug coverage is as good as Medicare Part D "Creditable Coverage":
If you are advised that your retiree drug coverage is as good as Part D coverage, you may simply continue your current coverage.
If you have retiree drug coverage as good as the Part D drug benefit, you CANNOT also join a Part D plan. NOTE: Joining a plan under these circumstances could cause you to lose your retiree insurance including medical coverage!!
In the future, if your plan is discontinued or is no longer as good as Part D coverage, you will have 63 days from the time your plan ends or changes to enroll in a Part D Prescription Drug Plan with no financial penalty.
If your retiree drug coverage is discontinued:
If your retiree drug coverage is discontinued, you can join a separate Part D prescription drug plan. Enrolling in a Part D plan is optional. However, if you do not have coverage as good as Part D coverage and decide to join a Part D drug plan after May 15, 2006, there will be a permanent premium increase of 1% for every month you delay obtaining coverage. In addition, you will only be able to join these plans during the annual enrollment period.
Medicare Advantage Plans
Medicare Advantage Plans are Medicare plans offered through private insurance companies. They may have additional benefits to Original Medicare.
You must have both Medicare part A and part B in order to be able to enroll in a Medicare Advantage Plan. Many Medicare Advantage plans have a premium cost in additional to the premium cost fro Medicare part B.
Once you enroll in a Medicare Advantage plan you get all your Medicare benefits through the plan.
You can not use a Medicare supplement with a Medicare Advantage Plan.
You can enroll in a Medicare Advantage plan through June 30, 2006.
After June 2006, you can enroll in a Medicare Advantage plan from November 1 through December 31 every year for the plan to be effective January 1 of the following year.
Freedom Blue Chart August 2006 (14K)Humboldt Secure Horizons Chart August 2006 (13K)
Del Norte Secure Horizons Chart August 2006 (13K)
More information on Medicare Advantage Plans