Ten Facts About Medicare’s New Prescription Drug Coverage

If you are eligible for Medicare, you may be asking yourself if enrolling in a prescription drug plan would be worthwhile. Research shows that many people with Medicare can save hundreds, even thousands, of dollars on their prescription medication by enrolling in a prescription drug plan. However, sorting through the information about the new prescription drug coverage from Medicare can be challenging. Here are 10 facts about the new Medicare prescription drug benefit to help you decide if enrolling might be the best decision.

  • Medicare Part D is the new benefit that helps people with Medicare who are enrolled in Medicare Part A or Part B pay for their prescription medications.
  • Sign-up for Medicare Part D begins on November 15, 2005, and will run through May 15, 2006. The Centers for Medicare and Medicaid Services (CMS) has placed all plan information on its Web site, www.cms.hhs.gov, and individual coverage companies began marketing individual plans on October 1, 2005.
  • Prescription drug coverage is available through private companies for a monthly premium. Coverage will begin on January 1, 2006, if you enroll prior to December 31, 2005.
  • You can choose from a wide range of plans and benefits. People with Medicare can sign up for Part D through a Medicare Advantage Prescription Drug plan (MA-PD) or a stand alone prescription drug plan (PDP). Many companies, such as PacifiCare, offer both types of programs.
  • You are not required to sign up for Part D, but if you sign up after May 15, 2006, you may be required to pay a higher premium each month for as long as you are enrolled in a Part D plan. The late-enrollment penalty is an additional 1 percent of the national average monthly premium ($32.20 in 2006) for every month you delayed enrolling after May 15, 2006.
  • Do you currently have prescription drug coverage through a former employer or another company or organization? If so, make sure to talk with you current prescription drug coverage provider to make sure that your current coverage is as good as, or better than, the new coverage offered through Medicare. Also, be sure your current provider will continue to offer coverage; signing up for a separate plan could jeopardize those benefits.
  • There are many plans to choose from in each state, and each plan has its own premium, co-pay structure, deductible, list of covered drugs and included services. To get the best value, it could pay to look past the lowest monthly premium to the other benefits and services each plan offers. To help narrow your search, try searching for plans that:
  • Cover your most expensive medications;
  • Pay the deductible;
  • Provide coverage through the gap;
  • Work with your favorite pharmacy or offer home delivery.
  • In general, the Part D benefit should be particularly useful to people with low incomes or high drug expenses. For those with high monthly prescription drug costs, Medicare Part D out-of-pocket expenses are limited to five percent, or a small flat fee, for each prescription once your costs reach $3,600 during the year. Most of your costs, including deductibles, coinsurance and co-payments, count toward that limit.
  • If you are on a limited income, or if you also qualify for Medicaid, you will receive additional savings on prescription drugs through Medicare Part D, including no (or reduced) monthly premiums, no (or reduced) deductibles and no gap in coverage.
  • If you are eligible for both Medicare and Medicaid (dual-eligible) and are not already enrolled in a Medicare Advantage plan, you will be automatically enrolled by the state into one of the available Part D plans in your region. Dual-eligible beneficiaries may change to another plan at any time.

The Seniors Coalition has endorsed a new Medicare prescription drug plan called Prescription Solutions from PacifiCare. This program offers prescription drug coverage under a variety of plans that will meet the needs of most people with Medicare. Every senior should call 1-800-330-5330 to learn how you can start saving on prescription drugs.

Here’s more information on The Seniors Coalition-endorsed Prescription Solutions from PacifiCare...

PacifiCare’s family of companies has been helping members attain better health and more affordable health care coverage for more than 20 years. We were among the first companies to provide prescription drugs and other benefits above and beyond what Medicare offered. We understand that what’s right for one person may not be right for someone else.

That’s why Prescription Solutions from PacifiCare offers a variety of prescription drug plans in every state that are designed to work with most existing health care coverage. All plans offer zero deductible and one plan provides coverage through the gap. Plans cover more than 2,000 brand-name and generic drugs, and offer convenient access to more than 50,000 pharmacies as well as the option of home delivery.

PacifiCare also offers Medicare Advantage plans with prescription drug coverage in many states through its Secure Horizons company. For more information, visit our Web site at www.prescriptionsolutions.com.

Prescription Solutions from PacifiCare Medicare prescription drug plans are underwritten by PacifiCare Life and Health Insurance Company (PacifiCare Insurance Company in the State of New York), which contracts with the federal government. Plans, programs, premiums and benefits vary by state. Network pharmacies include 46,844 preferred pharmacies and 3,697 non-preferred network pharmacies. Savings estimates based on information detailed in the Center for Medicare and Medicaid Fact Sheet – July 26, 2004.


Summer 2006