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Who qualifies for the prescription benefit plans that became effective January 1, 2006!
Anyone on part A or B of Medicare is eligible to purchase the prescription benefit plan. The letter many of you received from Social Security stating you don't qualify only meant that you did not fit within Social Security's financial guidelines to receive assistance. You are responsible for 100% of the cost of the plan and co-pays.
What is the Government plan for Part "D" of Medicare?
There has been a tremendous amount of confusion on the issue of the Government plan verses one of the many offered by insurance companies. There IS NO GOVERNMENT PLAN! Through governing agencies set the parameters, Part "D" of Medicare is purchased through private industry. These insurance companies design plans that fit within the guidelines set by Medicare but have the right to set prices and typically will offer two or more options from which to choose. Checking with an insurance agent who specializes in Medicare issues will simplify your life tremendously.
Who can and should enroll in Part "D"?
The key to your choice of plans and whether to buy or not to may include your age, your monthly prescriptions costs, are those prescriptions mostly brand or generic or do you even use prescription drugs? One of the deciding factors could be the $5.00 generic as opposed to the $100.00 cholesterol lowering drug. And, if I decide to purchase a plan now, should I consider a plan that waves the deductible? A person 85 years old would obviously, have completely different considerations that would a 65 year old when entertaining waiting.
Does HICAP sign up enrollees for insurance?
HICAP is a very worthwhile Senior Advocacy facility where volunteers work hard to accommodate the informational needs of that group of people enrolled in Medicare. Whether you are 95 or 45, if you're on Medicare HICAP is there to assist, answering questions and giving information. HICAP never sells, recommends a company, an agent or otherwise suggests solicitation for the sale of Medicare supplements whether it's Part "D" or standard medi-gap plans. Some meeting attendees are still under the impression that because they presented a list of their medications at their local HICAP office, they have actually signed up for a prescription plan. This is absolutely NOT SO!
Which two Government Agencies work in concert with you and your prescription plan?
That would be social security and "The Center for Medicare Services." These two agencies coordinate with your insurance company when you enroll in a Medicare supplement. When you enroll in "Part D" of Medicare, your insurance carrier forwards the applicable information to Social Security where it has determined whether or not you have qualified for assistance with your premium and co-pay for prescriptions. The CMS or center for Medicare services confirms you are enrolled in A or B of Medicare. If you are on an HMO this may be costing you more money than you are saving!
How does the Part "D" penalty affect you?
Medicare's Part "D" prescription plan encourages enrollees to act timely to avoid penalty. The purpose of this penalty is to entice well people to participate in order to spread the risk and cost of the program. How the government participates in the cost is by subsidizing insurers and certain enrollees who qualify as poor. this penalty can cost you dearly if you live long enough - at the rate of 1% of the national average cost for Part "D" which is somewhere between $30 to $32 a month or 12% per year, costing you in the neighborhood of about $3.50 a month more than your neighbor who enrolled in a timely manner. That "timely manner" varies depending upon your particular situation. the question is "How does that timeliness apply to you?"
What the heck is the donut hole?
So what is the "Donut Hole." When we're talking about Part "D" of Medicare it's not a scrumptious little sweet morsel you wash down with a sip of coffee. The donut hole is a place that may or may not apply to you, depending upon which company and which plan you purchase. The donut hole is the gap that begins after the total cost of prescriptions incurred by both you and your insurance company. You are on you own for 100% of the cost of your prescriptions until you have spent a certain amount of money out of your own pocket. Some companies and plans protect you in that donut hole. Do you know which ones and how much the plans cost? However, if you're on an HMO you will most likely have no choice regarding plan options.
What is "Lock-In" and "Lock-Out"
When applied to the prescription drug plan we know as Part "D" of Medicare, there are timeliness issues with different applications to unique situations. You may be working at age 70 and have benefits through your employer. Your spouse, on the other hand may not. if your spouse does not purchase a plan during open enrollment he or sh will be locked out until the next "Open Enrollment." conversely, if the spouse has enrolled timely and the open enrollment period has ended, that spouse is locked in until the next open enrollment period. Do you know the exceptions to the rule?
How many prescription plans or Part "D" are you allowed?
With the inception of Part "D," which is the prescription portion of Medicare, according to Medicare rule, just like a medigap plan, you may only purchase on prescription benefit plan. The old standard Medicare plans that included a prescription benefit are no longer available for purchase. However you may keep what you have if you prefer. In most cases this is probably costing you more than necessary. If you are enrolled in an HMO, you are confined to the rules of the HMO and the plan offered. this may be a good time to reconsider the purchase of a standard Medicare supplement if you are still able to qualify. And, remember, there are exceptions to every rule!