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Information for Consumers:
Helping Consumers Navigate the New Medicare Drug Benefit
If you have Medicare for health care coverage, you are eligible for Medicare's prescription drug benefit, which began on January 1, 2006. With this new benefit, you have to make a lot of choices—ideally, those choices should have been made before the benefit began.
Here's some basic information—click on the section or sections that most apply to you.
- For most people in Medicare
- If you have Medicare and also have Medicaid
- If you don't have Medicaid, but the state helps pay for your Medicare premiums or you receive Supplemental Security Income (SSI)
- If you have limited financial resources
- If you need personalized help
- Bilingual Assistance
1. For most people in Medicare
- Voluntary benefit. You can choose to sign up for the Medicare drug benefit or not. Click here to learn more about what's covered by the basic drug benefit. You'll get extra help if you have both Medicare and Medicaid, if the state helps pay for your Medicare costs, or if you have limited resources. If you fall into one of these categories, check the section below that most applies to your situation to learn about the benefits you might receive.
- Enroll in a drug plan. You need to enroll in a Medicare prescription drug plan to get the drug benefit. In October 2005, you started getting information about the drug plans available in your area, and you you could have enrolled in a drug plan starting November 15, 2005. Click here to learn more about how to choose a drug plan.
- Possible penalties for late enrollment. Medicare's initial enrollment period ends May 15, 2006. If you don't sign up by then but decide to sign up later, you may have to pay a penalty for every month that you delay enrolling. Click here to learn more about whether you might be subject to a late enrollment penalty.
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Have questions about how the drug benefit will affect you? | Contact your State Health Assistance Insurance Program. They can give you individualized attention. You can also call 1-800-Medicare or visit the official Web site at www.medicare.gov. If you have general questions, feel free to contact us. | |
2. If you have Medicare and also have Medicaid (in some states, Medicaid is called Medical Assistance or, in California, MediCal)
- Medicaid's drug coverage ends December 31, 2005. Your state Medicaid program will stop paying for your prescription drugs on December 31, 2005.
- You will still have prescription drug coverage, but it will be through Medicare's new drug benefit.
- You get additional help automatically. You'll automatically be approved for added help with your drug costs beyond what Medicare pays through its basic benefit. If you haven't received a letter from Medicare by July 2005 saying they know you are in both Medicare and Medicaid, you should call 1-800-MEDICARE. Click here to learn more about Medicare's benefit for people who also have Medicaid.
- If you do receive a letter, you don't have to do anything until the fall.
- Enroll in a drug plan. In the fall, you will need to enroll in a Medicare drug plan. Click here for more information on Medicare drug plans and how to enroll.
- You may be assigned to a plan. If you don't enroll in a drug plan in the fall, you should automatically be assigned to a plan. If you are assigned to a plan that you don't like, you can change. Click here for more information on changing plans.
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3. If you don't have Medicaid but the state helps pay for your Medicare premiums or you receive Supplemental Security Income (SSI)
- You'll get added help. You should automatically be approved for added help with your drug costs beyond what Medicare pays through its basic benefit. Click here to learn more about Medicare's added help.
- Call if you don't get an approval letter. If you don't receive a letter from Medicare by July 2005 saying that you're approved for added help, call 1-800-MEDICARE.
- If you do receive a letter, you don't have to do anything until the fall.
- In the fall, you'll have to enroll in a drug plan. Click here for more information on Medicare's drug plans.
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4. If you have limited financial resources
You may qualify for extra help if your income and resources are limited. If your 2006 income is below $14,700 for an individual ($1,225/month) or $19,800 for a couple ($1,650/month), and your financial resources are less than $11,500 for an individual or $23,000 for a couple, you may qualify for added help. Click here for information.
- You don't have to count all resources. Medicare counts only liquid assets. When calculating your resources, you can leave some things out, like your home, car, and personal property like jewelry. If you aren't sure of the amount of your resources, contact your state Medicaid or local Social Security office.
- You have to apply for extra help. You should apply even if you're not sure if you're eligible. Medicare's extra help can reduce your drug costs, and applying is free. Contact your Medicaid or Social Security office to apply, or go to http://www.ssa.gov/prescriptionhelp/.
- Apply for extra help right away. You can apply for extra help any time during 2006, even after the regular enrollment period has ended (May 15, 2006). If you are approved for extra help and join a plan after May 15, you will not be penalized during 2006 for enrolling late.
- You still need to enroll in a drug plan after you are approved for extra help. If you do not select a plan after being approved for extra help, Medicare will assign you to a plan. You should select a plan yourself to make sure it meets your needs. Click here for information on Medicare drug plans. You can also get more information about the specific plans on the Medicare Web site at www.Medicare.gov.
**Medicare's extra help with drug costs can make prescription drugs much more affordable. It is important that you apply for extra help if you think that you might qualify. Applying is free.**
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5. If You Need Personalized Help
If you want to discuss your situation or discuss whether or not you qualify for added help, you can contact your local State Health Insurance Assistance Program counselor who will be able to give you individualized assistance. Click here to get information on how to contact a counselor.
You can also call 1-800-MEDICARE or look on the Medicare Web site on the Internet: http://www.medicare.gov/. Starting October 13, 2005, the Web site should have information on Medicare's drug plans.
6. Bilingual Assistance
The National Alliance for Hispanic Health has created a bilingual hotline to assist individuals with the Medicare Part D enrollment process. Individuals can receive one on one counseling, assistance in applying for low income subsidies, and help in finding a plan to meet their individual needs. Hotline is available Monday - Friday from 8:00 - 6:00 p.m. ET. The number to call is 1-866-783-2645.
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