Medicare prescription coverage: Basic Information

Medicare prescription coverage will begin in 2006, with all Medicare beneficiaries being able to enroll in plans that provide prescription drug coverage. Medicare beneficiaries will pay a premium estimated to be $35 a month, with a $250 deductible. Medicare prescription coverage will follow these guidelines:

Medicare will pay 75% of drug cost between the deductible ($250) and $2,250
Medicare beneficiaries will pay for drug costs between $2,250 and $5,100
Medicare will pay 95% of drug costs above $5,100

The Medicare prescription coverage benefit includes additional assistance for people with low income and limited assets. People with Medicare who are also fully eligible for Medicaid, with incomes below 100% of the federal poverty level (and with no separate asset test) will not have to pay the premium or the deductible, and they will have minimal co-payments for each drug. Other low-income beneficiaries will receive premium and deductible assistance, and also have limited cost sharing.

In 2004, Medicare Advantage will replace the Medicare private health plan option known as Medicare + Choice. Changes made to the manner in which Medicare pays these Medicare Advantage plans, will help to ensure that beneficiaries receive access to more healthcare choices as well as better benefits.

In 2006, Medicare advantage plan choices will be expanded to include regional preferred provider plans (PPO's). A PPO is a Medicare + Choice plan (soon to be referred to as Medicare Advantage plans) which use doctors, hospitals, and providers that belong to the plan's network. You can use doctors, hospitals and providers outside of the network for an additional cost. Regional PPO's will help ensure that beneficiaries in rural and urban areas have multiple choices of Medicare health coverage.

In 2005, Preventive Benefits coverage will expand, including:

One-time initial preventive physical exam within six months of when a person first enrolls in Medicare Part B.
Screening blood tests for early detection of cardiovascular diseases
Diabetes screening tests for people at risk for diabetes

In 2006, when the Medicare prescription coverage benefit goes into effect, Medigap plans, which are private insurance plans to help pay for what Medicare does not, will include two new plans to help beneficiaries with out-of-pocket costs, but no new Medigap policies with drug coverage may be sold.

For more information about Medicare reform legislation, or the new Medicare prescription coverage, you may call 1-800-Medicare, 1-800-633-4227. For the hearing-impaired, TTY users should call 1-877-486-2048 or visit the Medicare website at www.medicare.gov for review of frequently asked questions about Medicare reform and Medicare prescription coverage.

Information from the Missouri Chapter of the National Association of Social Workers' Newsletter.

Information provided by Senior Care Psychological Consulting