print this page

The Medicare's Rx drug benefit will begin January 2006. The drug plan, a centerpiece of the controversial 2003 Medicare law, is an intricate web of private insurance companies providing coverage to Medicare's 40 million beneficiaries.

What is it?
Insurance companies and private plans will work with Medicare to offer prescription drug coverage to people on Medicare.

When is it available?

Starting January 1, 2006

What should I be aware of?

·         Drug coverage is not automatic for most people on Medicare; you will choose a drug plan based on your needs and income.

·         Drug plans will vary across the country and may not include all the medications you need.

·         Carefully research the plans available to you and decide which best meets your needs.

·         Medicare drug coverage is not necessarily the best plan. If you have existing drug coverage from a former employer or union, check with your health plan's benefits administrator before considering a Medicare drug plan.

How much will it cost?

·         Monthly premium, about $37, depending on the drug plan

·         $250 annual deductible

·         Co-payments based on annual drug costs. You pay:
•           25% of drug costs up to $2,250
•           100% of drug costs between $2,250 and $5,100
•           $2/generic, $5/brand or 5% of drug costs over $5,100

·         You will pay more if you enroll in a drug plan after the initial six-month period.

·         If you need drug coverage beginning January 1, 2006, enroll between November 15 and December 31, 2005

·         If you enroll between January 1, 2006 and May 15, 2006, drug coverage will begin the month after you enroll.

·         You may be eligible for help in paying for your prescriptions if you have an annual income below $14,355 (single) or $19,245 (couples) and resources less than $11,500 (singles) or $23,000 (couples)

Key dates to remember

·         May to August 2005: If you have limited income, you will receive information on getting extra help with your drug costs.

·         October 2005: Look for "Medicare & You" with information on the new drug benefit in the mail. Information about various prescription drug plans is posted on Medicare’s website; free counseling also available through State Health Insurance Assistance Programs (SHIPs)

·         November 15, 2005 - May 15, 2006: Enrollment in Rx drug plans

·         January 1, 2006: Drug coverage begins for those enrolled.

It is important to remember that the Medicare drug coverage is not necessarily the best plan. If you have existing drug coverage from a former employer or union, check with your health plan's benefits administrator before considering enrolling in a Medicare drug plan.

For information and help with Rx plans and enrollment

Medicare: 1-800-Medicare (800-633-4227; TTY 877-486-2048)
www.medicare.gov