Frequently asked questions about Medicare Part D
Which drugs will be covered under Medicare Part D?
Plans will establish their own list of covered drugs. However, each plan is required to include at least two drugs within each therapeutic category and class of covered Medicare drugs.
Do I have to sign up for Medicare Part D to have coverage?
Yes, enrollment in Medicare Part D is not automatic.
Do I need to pay a premium to both Part D and to the drug plan I enroll in?
No. Medicare has contracted with private companies to offer Part D. It's important to note that enrolling in a plan is how you enroll in Medicare's Part D.
What if my doctor says I need a drug that is not covered under my Part D plan?
Each drug plan will have a process to allow people to challenge the exclusion of a specific drug from its formulary (list of covered drugs). Plans must grant exceptions when they determine it is medically necessary to do so.
Will I still be able to get my prescriptions at my local pharmacy?
Probably yes, since most retail pharmacies will participate in Medicare Part D. However, before signing up for a plan, check its list of participating pharmacies to ensure your local pharmacy is part of the plan's network. You also will have the option to receive your maintenance medications through mail-order service.
Is the government setting the prices for the prescription drugs as part of Part D?
No, although the private companies contracted to provide the Part D benefit will negotiate with the drug companies to receive better deals on the prescription drugs.
Is the Medicare prescription drug program only for poor people?
No, the Medicare prescription drug plan is for everyone who is eligible for Medicare.
If I continue my Trust medical plan, how much will my premium be?
The premium for WEA Trust medical coverage varies depending on your specific plan. Call the Trust's Eligibility Services Department at (800) 279-4000 for specific information about your premium.
How much will Medicare prescription drug insurance cost?
Monthly premiums for Medicare prescription drug plans available to Wisconsin residents range from $13.70 to $102.70 ($164.40 to $1,232.40 annually). How much you pay out-of-pocket for deductibles, coinsurance, and copayments will depend on your annual prescription drug usage.
How will I pay premiums for Medicare prescription drug coverage?
Payment can be deducted from your Social Security check, or you can make payments directly to the insurance company you select to provide your Medicare prescription drug insurance.
I'll be eligible for Medicare this year. When can I join a Medicare Part D prescription drug plan?
You can enroll in Medicare Part D during the seven-month period surrounding your 65th birthday. The seven months consists of the three months before the month of your birthday, the month of your birthday, and the three months after your birthday. This time frame is called your Initial Enrollment Period for Part D (IEP for Part D).
Example: Jane Smith's 65th birthday is May 27, 2009. She is eligible for Medicare Part A, and her Part B and D initial enrollment period begins on February 1, 2009, and ends on August 31, 2009.
When will my Medicare Part D plan become effective?
If you are turning age 65 and you enroll during your initial enrollment period, your effective date depends on when you enrolled.- If you made a request to enroll in Medicare Part D before the month of your 65th birthday, then your effective date is the first day of the month of your birthday.
- If you made a request to enroll during or after the month of your 65 birthday, then your effective date is the first of the month following the month you made the request.
Examples: - Jane Smith’s 65th birthday is May 27, 2009. She makes an enrollment request on March 3, 2009. Her effective date is May 1, 2009.
- Jane Smith’s 65th birthday is May 27, 2009. She makes an enrollment request on May 1, 2009. Her effective date is June 1, 2009.
What happens if I do not sign up for Medicare Part D during my initial enrollment period?
Then you will not have prescription drug coverage. Any prescription drugs you purchase will be at your own cost and you will likely pay full retail price for them. When you do join, your premium cost will be increased at least 1% per month for every month that you do not have Medicare Part D coverage.
Example:
Jane Smith’s 65th birthday is May 27, 2009. Her initial enrollment period ends on August 31, 2009. She does not enroll in Medicare Part D during this time. Her next opportunity to enroll is November 15 through December 31. Jane enrolls in November and her Medicare Part D coverage becomes effective January 1. Jane will pay a 4% penalty on all future Part D premiums (i.e., 1% of each of the four months of September, October, November, December).
If I don’t enroll during my initial enrollment period, when would be my next opportunity to enroll in Medicare Part D?
You will have to wait until the Annual Coordinated Election Period (AEP), which goes from November 15 to December 31 of each year. When you join during the AEP, your Part D plan becomes effective on January 1 of the following year. You will be assessed a 1% penalty for each month that you do not have Medicare Part D coverage.
Can I change my Medicare prescription drug coverage later?
Yes. Every year, your new private insurer will have an open enrollment period. During that time, you can change providers, change plan coverage, etc.
What is the Medicare Advantage Plan?
Medicare Advantage is the new name for Medicare C (Medicare plus Choice), an insurance plan (HMO, PPO, or a Private Fee-for-Service plan) that combines Medicare Parts A & B, and that will now include Medicare prescription drug coverage. |
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To learn more about Medicare Part D
www.medicare.gov
Watch for the Medicare & You 2008 handbook which is mailed out by Medicare to each beneficiary in October and lists all the Part D plans for 2008.
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