Medicare Part D
by: Wyoming Legal Services - Lander Office
Medicare Part D
Medicare Part D is a prescription drug benefit that begins on January 1, 2006. It's supposed to pay for 50% of your drug costs. But it does not work like the rest of Medicare. The government does not cover your drugs. Private insurance companies cover drugs through their drug plans. If you want to benefit, you have to sign-up. Not everyone needs the benefit. Click here to see if you should get it.
Who may sign-up?
- Anyone enrolled in Medicare Part A and/or Part B
- Medicaid recipients
- People who get Supplemental Security Income (SSI)
How does Part D work?
Part D works just like private insurance. You have to pay for a plan. Wyoming seniors can choose from dozens of drug plans. Each plan may be different in a number of ways.
- Monthly premiums: This the the fee you have to pay every month.
- Deductible: This is how much you have to pay for drugs before the plan starts paying.
- Co-payments: This is how much you have to pay for each prescription.
- Gap-coverage: Some plans cover the gap, which is explained below.
- Drugs covered: Each plan covers different drugs. But each plan has to cover every type of drug (blood-pressure, high cholesterol, etc.). The offer brand name and generic drugs.
- Pharmacies: Plans choose which pharmacies you can use.
- Mail-order: Some plans let you get your drugs by mail.
Standard plans usually have the following:
- Premiums are around $37/month;
- You pay the first $250 of your drug costs for the year. This is the deductible;
- The plan covers 75% from $251-$2250 of your drug costs for one year;
- The plan does not cover the $2251-$5100 range of your yearly drug costs (this is the gap);
- The plan covers 95% of $5100 and above of your yearly drug costs.
Some plans offer more coverage if you pay a higher premium.
What if I can't pay for a plan?
Medicare offers Extra Help if you have limited income and resources. Medicare will help you pay your premium, deductible, and co-payments. Your resources can include second homes, bank accounts, cash-on-hand, and other things that can be easily sold for cash. Resources do NOT include your primary home, car, and household goods. You get extra help if
- You live in a nursing home;
- You are single and have an income less than $14,355. Your resources valued under $11,500;
- You are married and your combined income is less than $19,245. Your combined resources are valued under $23,000.
You have to apply for Extra Help. The Extra Help application is online at http://www.ssa.gov/prescriptionhelp/. Read everything carefully on the website. You can call 1-800-772-1213 (TTY: 1-800-325-0778) if you want a paper application or need help with the application.
If you get Extra Help, you have to be re-approved every year.
If you are denied, you can appeal.
When can I sign-up?
The plan begins on January 1, 2006. The sign-up period begins on November 15, 2005. It ends May 15, 2006. The next time to sign-up after that is November 15, 2006. But you have to pay a penalty if you sign-up after May 15, 2006.
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