2008 Medicare Prescription Drug Coverage

 

BASIC FACTS:

 

  • Coverage is available for all people with Medicare, you must be entitled to Part A and/or enrolled in Part B.
  • The enrollment period for people NEW to Medicare covers is a seven month window.  The seven months are:
    • The three months prior to your 65th birthday or month of eligibility for Medicare
    • The month of your 65th birthday or Medicare eligibility
    • The three months after your 65th birthday or month of Medicare eligibility.
      • If you enroll in Medicare Prescription Drug Coverage in any of the three months prior to the month of eligibility, your coverage will be effective the first day of the month of eligibility. 
      • If you enroll during the month of eligibiltiy or during the three months following the month of eligilblity your coverage will be effective the first day of the next month
  • The annual coordinated election period to sign up for a plan of your choice begins November 15 and continues until December 31 of every year and coverage begins January 1.
  • Coverage may be provided through:
    • Prescription Drug Plans (PDPs)
    • Medicare Advantage Plans (MA-PDs)
    • Some employers and unions to retirees 
  • The prescription drug plans must offer the standard benefit.
  • Beneficiaries with lower income and assets may be eligible for extra help - click here for benefits chart
  • You may only sign-up for only one plan. You can switch plans once a year from November 15 to December 31. Full dual eligible beneficiaries (Medicare/Full Medicaid population) may switch plans at any time. 
  • For some beneficiaries, this is a two step process.

    • Fill out the application for extra help

    • Pick your drug plan

  • If you are not sure whether to fill out the application for extra help, it is always good to err on the side of caution. Fill it out, send it in and wait for Social Security to make a final determination.

  • If you currently have Prescription Drug Coverage through an Employer Group Plan, VA coverage, TRICARE for Life or any other credible prescription drug plan, you will should have received a letter in October of 2005 from your plan telling you if your current plan is credible. This means that the current plan that you have is as good or better than the Medicare Plans. If your plan is credible than you may choose to stay in that plan. If it is NOT credible than you can switch to a Medicare plan or choose to stay with your current coverage.
    • For those who do NOT have credible coverage, if you stay with your current coverage and decide years later to sign up with a Medicare plan, you will have a higher premium. You will be assessed 12% of the base premium for each year you are late signing up (1% each month).
    • For those who have credible coverage and want to sign up at a later date, you will NOT be penalized for signing up late.

STANDARD BENEFIT CATEGORY

  • The beneficiaries who have an income over 150% of Federal Poverty Level and assets over $11,990 for an individual and $23,970 for a married couple will enroll into the drug plan of their choice.
  • There is no need to fill out an extra help application. click here for benefits chart  

EXTRA HELP CATEGORY

  • If you have lower income and lower assets than listed in the section above and are not on any form of Medicaid you should fill out an application to find out if you are eligible for extra help.
    • Applications are available from the Social Security Administration or their website, www.ssa.gov. Tri-County Office on Aging also has extra help applications. If you choose to fill out the application you will send it in the postage paid envelope to Wilkes Barre, Pennsylvania.
  • You will receive a letter in the mail from Social Security saying if you are or if you are not approved for extra help.
  • The next step is to enroll a drug plan.
    • You can enroll by calling Medicare at 1-800-MEDICARE or on their website, www.medicare.gov.
    • You can also call the plan of your choice to enroll
    • TCOA can also assist in enrollment.  Please call to make an appointment.

 

FULL BENEFIT CATEGORY

  • Full dual beneficiaries (Medicare/Full Medicaid) are automatically enrolled into extra help AND assigned into a drug plan before. These individuals could select a plan on their own instead of being automatically enrolled.
  • This group may switch to another plan at any time during the year as many times as they wish.
  • Coverage will start the first day of the following month click here for benefits chart

MEDICAID ELIGIBLE CATAGORY (QMB, SLMB, ALMB)

  • Medicare Savings Program (QMB, SLMB, ALMB)
  • This group falls into the dually eligible category.  These programs are forms of Medicaid and you are considered to have Medicare/Medicaid. click here for benefits chart  
  • This group can also switch plans any time throughout the year.
  • If you switch to a different plan, coverage will start the first of the following month.

Special Enrollment Periods (SEP)

There are special enrollment exceptions for certain individuals. For example

  • If a new beneficiary loses their extra help
  • New to extra help/low income subsidy (LIS)
  • Individuals who enter or exit a nursing facility
  • Change in residence
  • There are more SEPS, please contact TCOA for additional information.

 

IF YOU HAVE QUESTIONS,

CONTACT TRI-COUNTY OFFICE ON AGING

517-887-1416