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Details of Medicare Prescription Drug Plan

Highlights of changes to be phased-in through 2006

By Robert Longley, About.com

The Medicare Prescription Drug Improvement and Modernization Act of 2003 added important new prescription drug and preventative health care benefits to the Medicare program. In addition the law provides extra help for persons with low incomes. This article presents the most current information regarding the Medicare Prescription Drug Improvement and Modernization Act of 2003 that you will need to help you make the best decisions regarding your Medicare coverage.

  • First, you should know that if you are happy with the Medicare coverage you already have, you can keep it. No matter what you decide to do, you are still in the Medicare program.

    Starting in 2004:

    Medicare-Approved Drug Discount Cards will be available in 2004 to help you save on prescription drugs. Medicare will contract with private companies to offer new drug discount cards until a Medicare prescription drug benefit starts in 2006. A discount card with Medicare’s seal of approval can help you save 10 to 25 percent on prescription drugs.

     You can enroll beginning as early as May 2004 and continuing through December 31, 2005. Enrolling is your choice. Medicare will send you information soon with details about how to enroll.

    People in the greatest need will have the greatest help available to them. If your income is no more than $12,569 for a single person, or no more than $16,862 for a married couple, you might qualify for a $600 credit on your discount card to help pay for your prescription drugs. These income limits change every year. Different rules may apply if you live in Puerto Rico or a U.S. territory. (You can’t qualify for the $600 if you already have drug coverage from Medicaid, TRICARE for Life or an employer group health plan.)

    Medicare Advantage is the new name for Medicare + Choice plans. Medicare Advantage rules and payments are improved to give you more health plan choices and better benefits. Plan choices might have improved already in your area. To find out more, call 1-800-MEDICARE (1-800-633-4227).

    Starting in 2005:

    New Preventive Benefits will be covered, including:

  • A one-time initial wellness physical exam within 6 months of the day you first enroll in Medicare Part-B.

  • A one-time initial wellness physical exam within 6 months of the day you first enroll in Medicare Part-B.

  • A one-time initial wellness physical exam within 6 months of the day you first enroll in Medicare Part-B.

    These benefits add to the preventive services that Medicare already covers, such as cancer screenings, bone mass measurements and vaccinations.

    Starting in 2006:

    Prescription Drug Benefits will be added to Medicare in 2006. All people with Medicare will be able to enroll in plans that cover prescription drugs. Plans might vary, but in general, this is how they will work:

  • You will choose a prescription drug plan and pay a premium of about $35 a month.

  • You will pay the first $250 (called a "deductible").

  • Medicare then will pay 75% of costs between $250 and $2,250 in drug spending. You will pay only 25% of these costs.

  • You will pay 100% of the drug costs above $2,250 until you reach $3,600 in out-of-pocket spending.

  • Medicare will pay about 95% of the costs after you have spent $3,600.

    Some prescription drug plans may have additional options to help you pay the out-of-pocket costs.

    Extra Help Will be Available for people with low incomes and limited assets. Most significantly, people with Medicare in the greatest need, who have incomes below a certain limit won’t have to pay the premiums or deductible for prescription drugs. The income limits will be set in 2005. If you qualify, you will only pay a small co-payment for each prescription you need.

    Other people with low incomes and limited assets will get help paying the premiums and deductible. The amount they pay for each prescription will be limited.

    Medicare Advantage plan choices will be expanded to include regional preferred provider organization plans (PPOs). Regional PPOs will help more people with Medicare have multiple choices for Medicare health coverage, no matter where they live. PPOs can help you save money by choosing from doctors and providers on a plan’s “preferred” list, but usually don’t require you to get a referral. PPOs are among the most common and popular plans right now for working Americans.

    All of these options are voluntary. You can choose to remain in the traditional Medicare plan you have today.

    For the latest information about Medicare, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

    To get a copy of this information in Spanish, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Para una copia en español, llame gratis al 1-800-MEDICARE (1-800-633-4227). Los usuarios de TTY deben llamar al 1-877-486-2048.

  • Do you qualify for a Medicare-Approved Drug Discount Card?
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