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Medicare Prescription Drug Coverage (as of 05/05/06) As A Reminder.
A summary of the Medicare prescription drug coverage.
Online tool to compare & enroll in Medicare prescription drug plans.
Protecting against Medicare fraud.
Information about Extra Help.
Online tool to apply for Extra Help.
My Medicare Matters, 7 simple steps to understanding Medicare drug coverage.
Illinois Cares Rx financial assistance.
Printer friendly version of this information.
Current Medicare beneficiaries have until May 15, 2006 to enroll in a Medicare-approved drug plan. After May15, 2006, the next enrollment period for beneficiaries is between November 15th and December 31st.
People new to Medicare have seven months to enroll in a drug plan (three months before, the month of, and three months after they become eligible for Medicare).
Medicare’s prescription drug coverage is available for anyone with Medicare, regardless of income.
There are many different drug plans available in Illinois. These drug plans are approved by Medicare, but administered by private companies.
The Medicare website has a “Compare Medicare Prescription Drug Plans” and “Enroll in a Medicare Prescription Drug Plan” links (see links above) which anyone can use to find out which drug plan best fits their needs and pocketbook. Not all drug plans cover every drug, and the monthly premium and deductible varies depending on the plan chosen. Senior centers in Southern Illinois have been equipped with a high speed Internet connection in order to help senior adults make their decision about Medicare’s approved prescription drug plans.
Use the links above to apply for financial assistance via the Social Security Administration, and Illinois Cares Rx for residents of Illinois.
If you still have questions about Medicare prescription drug coverage and the Illinois Cares Rx program, call your local senior center or the Senior Health Insurance Program (SHIP).
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Summary of Medicare Prescription Drug Coverage
In order to meet individual prescription drug needs, Medicare allows private companies to issue many different Medicare approved prescription drug plans which requires the beneficiary to choose the one plan which best fits their needs.
There are over 40 different drug plans in Illinois from which beneficiaries will choose the plan which best fits their needs.
Plans do not cover all prescription drugs. There are 112 different illness/injury/affliction categories. Drug plans must offer at least two prescription drugs in each category. Therefore, not every drug may be covered by every drug plan. Beneficiaries should choose the plan that includes all of their prescription drug needs.
The different drug plans can charge a different monthly premium than the standard Medicare plan.
The initial Medicare Prescription Drug Plan drug benefit enrollment period ends May 15, 2006.
Here are some basic rules to remember:
Beneficiaries pay a monthly premium for their drug plan. The exact premium amount will depend upon which prescription drug plan beneficiaries choose.
Beneficiaries are not required to enroll in Part D, but if they enroll later they will pay a higher monthly premium.
Medicare Beneficiaries who decide to enroll later than their initial enrollment period will have their monthly premiums cost 1 percent more per month that they wait to enroll (for example, if a beneficiary waits 6 months past their initial enrollment period to enroll, their monthly premium will always pay 6 percent more than what others pay for the same drug plan).
The premium penalty does not apply to beneficiaries who have comparable coverage from another source (such as retirement health plans) which have certified in writing as “credible coverage” or coverage that is at least “as good as Medicare” (includes VA and FEHB beneficiaries).
Beneficiaries with a group health plan which includes prescription drug coverage should receive a letter from their plan administrator which announces whether their group drug coverage will be continued, and if so, whether it is as good as Medicare’s coverage ... or if their group drug coverage will end, whether their health plan will offer subsidies to retirees to supplement Medicare’s prescription drug coverage out-of-pocket costs.
Although there are some drug plans with no annual deductible, most drug plans require that beneficiaries pay an annual deductible before Medicare pays anything (see row 1 in the chart below).
Beneficiaries pay 25% of the costs up to a certain amount (see row 2 in the chart below). Some drug plans charge less than 25%.
The beneficiary pays the full amount for most drug plans once a beneficiary has reached the “donut hole” (see row 3 in the chart below). Again, there are some plans which cover drugs in this “donut hole.”
The beneficiary pays 5 percent of the drug costs after the annual drug costs have exceeded the amount described row 4 in the chart below.
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