Medicare Prescription Drug Benefit (Medicare Part D) FAQ : Human Services : Arlington, Virginia

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Medicare Prescription Drug Benefit (Medicare Part D) FAQ

Medicare Prescription Drug Coverage (Medicare Part D) Began January 1, 2006

• Who is eligible?: Individuals who are enrolled in Medicare Part A or enrolled in Medicare Part B, regardless of income.
• If you are eligible for Medicare Part D,: You must make some important decisions about your prescription drug coverage and you may need answers to at least some of these questions:
• Am I eligible for financial assistance?: If your current annual income is below 150% of the Federal Poverty Level and you have limited assets, the answer may be “yes.” Contact your local Social Security Office or call 703-228-1700 and ask to speak to a VICAP Medicare Counselor for more information.
• If I believe I am eligible for financial assistance, how do I apply?: At your local Social Security office, online at www.socialsecurity.gov or call 703-228-1700 and ask to speak to a VICAP Medicare Counselor.
• What if I receive Medicaid?: Dual eligibles (Medicare and full Medicaid) will be enrolled in a Plan with the full subsidy. Partial eligibles (QMB, SLMB, QI-1) will be deemed eligible for one of the levels of a subsidy and will also be enrolled in a plan.
• What if I have retiree health insurance?: The company will notify each beneficiary at least by October 15 each year, whether the policy’s drug benefit is “creditable,” as good as or better than the Medicare Prescription Drug Benefit for the upcoming year.
• What if I have Tricare, VA benefits, or a Medigap policy?: Tricare For Life has a creditable benefit. VA is creditable. Federal Government plans are creditable. Old Medigap plans with prescription drug coverage are not creditable.
• What if I am new to Medicare?: You have an initial enrollment period from the time you are entitled to Part A or enrolled in Part B. You have the same 7-month period that begins 3 months prior, the month of, and through the 3 months after you are eligible.
• What if I am in a Medicare HMO?: The Medicare HMO will have to inform their members as to whether or not the drug benefit that is part of the HMO is creditable.
• How much will Part D cost?: For basic benefits, there may be a deductible (up to $325 in 2013) and a monthly premium. You also have co-payments for medication until the total retail cost paid by you and the plan together reaches $2,970. At that point, you are in the coverage gap ("donut hole") and will pay 47.5% of the plan's cost for covered brand-name prescription drugs and 79% of the plan's cost for covered generic drugs until your total out-of-pocket costs reach $4,750. After that, you will pay 5% or $2.65 for generics and $6.60 for brand name drugs, whichever is greater. However, Part D plans vary greatly in what they cost, how much they cover, and which drugs they cover. It is very important to study all the details before you choose a plan. For example, some plans have no deductible and some plans will cover some drugs in the "donut hole" and some plans may not charge you for generic drugs.
• When does enrollment begin?: Every year, open enrollment begins October 15 and lasts through December 7.
• How will I enroll in a Part D plan?: Only "dual eligibles" (those with full Extra Help) will be auto-enrolled. Medicare will assign ("auto-enroll") plans randomly. The plan you are enrolled in may not cover your prescriptions. Call the plan or a VICAP counselor when you find out what plan you are in. All others should choose their own plan when they become eligible. Everyone is strongly encouraged to use the Plan Finder each Open Enrollment because plans may change coverage and costs every year.
• Will the drugs I need be covered under Part D?: Each plan will have a formulary of prescription drugs covered. Special exceptions will be made in some circumstances.
• How will I find out what plans are being offered and what drugs are covered under each plan?: Plans will be announced by October each year. If you are enrolled in plan, you will receive your plan's Annual Notice of Change (ANOC) in September. It is very important to read this document.
• What happens if I do nothing?: If you do not have other “creditable” drug coverage and you decide not to enroll in a Part D Plan, you may be charged a penalty of 1% of the national base premium amount for every month you were not enrolled from the time you first became eligible.