2006-03-03 / Columnists


On Elderlaw Understanding Medicare Part D
By Nancy J. Brady, RN, Esq. And Linda Faith Marshak, Esq.

On Elderlaw

Understanding Medicare Part D

By Nancy J. Brady, RN, Esq.
And Linda Faith Marshak, Esq.

Everyone who is Medicare eligible should be aware of the new Medicare Part D for prescription drug coverage by now. The goal of the program is for everyone receiving Medicare to have access to prescription drug coverage beginning January 1, 2006. The rules governing the program, are somewhat complex, and you must be aware of certain regulations and deadlines to make sure you are receiving the maximum drug coverage for your situation.

Medicare has a website (http://www. medicare.gov) with a link to the most common situations and what you need to do if one of those examples matches your situation. Three of the situations most of our clients fall into are described below.

1. Medicare only with no drug coverage- you MUST opt for a plan by May 15, 2006 to avoid any late fees or penalties. If you take an “average’’ amount of prescription drugs, over half of your costs may be covered. If your costs are “high’’, up to 95% may be covered, AFTER you spend $3600 out of your own pocket.

2. Medicare with drug coverage from former employer/union- your former employer must choose some options, and should have already sent these choices on to you. If you have not received information you should contact your benefits administrator as soon as possible EVEN IF YOU ARE NOT CURRENTLY TAKING PRESCRIPTIONS, so that you do not miss any deadlines for coverage.

3. Dual eligibles- or those who receive both Medicare and Medicaid- Medicaid will no longer be providing your prescription drug coverage, Medicare will. If you did not select a plan before the end of last year, Medicare has assigned you one. MOST of your prescriptions will be covered. (In the past ALL of your prescriptions were covered under Medicaid).

So, essentially, while everyone will have access to SOME prescription drug coverage, it seems like almost everyone will have some out of pocket costs. What most people don’t know:

For those receiving Medicare and Medicaid, if your income is below a certain level, you can increase your drug coverage. You should speak to an elder law attorney about a Pooled Income Trust. Enrollment in this type of trust can reduce your surplus income, so that you will be eligible for greater prescription drug coverage.

For those of you with limited income (below $1196 a month for a single/ $1603 a couple) and assets (below $10,000 for single/ $20,000 for couple) you are eligible for a low income subsidy, or extra coverage. ANYONE ELIGIBLE for the subsidy should sign up as soon as possible and enroll in drug plan by May 15, 2006 EVEN if they have no drug costs presently, to avoid losing out on benefits if prescriptions are required at a later date. EPIC will continue to be available for those over age 65 with income below $35,000 for singles, $50,000 for couples to pay some prescription drug costs. EVERYONE who is eligible should apply for EPIC before May 15, 2006 to avoid penalties, and because any costs paid by EPIC can be applied to the $3600 threshold mentioned earlier.

Some types of drugs will NOT be covered by the new plan AT ALL. They include benzodiazepines and barbiturates (for treatment of anxiety, epilepsy, muscle spasms and insomnia); non-prescription vitamins and cough and cold medicine; all over the counter drugs; fertility drugs; drugs affecting weight; prescription vitamins and prescription cough and cold medicines.

Important dates to keep in mind:

January 1, 2006: Coverage begins for those who enrolled by Dec. 31, 2005. Medicaid ends for dual eligibles.

April, 2006: Medicare will send reminders to those who have not yet enrolled in a plan.

May 15, 2006- LAST DAY to enroll in a plan until November 15, 2006 (unless you first become eligible in the meantime).

January 1-June 30, 2006- Period during which you can switch plans (ONCE) without penalty.

January 1-March 31, 2007- annual one time switch period.

The attorneys can be reached at (718) 945-7777. Please contact our office if you are interested in attending one of our upcoming seminars.

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