People with Medicare who want to receive the drug benefit will need to enroll in a Medicare Part D plan. Beneficiaries must choose one of the following:
- A stand-alone Medicare Prescription Drug Plan (PDP): Medicare PDPs offer only the prescription drug benefit. Individuals who enroll in these plans can continue to receive coverage for hospital care, physician services, and other medical care through traditional fee-for-service Medicare.
- A Medicare Advantage Plan (such as a Medicare HMO), which will cover medical care as well as prescription drugs.
Hundreds of private companies are providing drug coverage, and there are major differences between plans. This has made picking a plan and counseling those in Medicare very difficult. Because the program gives plans a great deal of latitude in how they set up and manage the drug benefit, there are also concerns about how well the plans are serving beneficiaries.
On this page, we provide many resources on the Medicare Part D drug program. Most of the information in this section covers the standard drug benefit. If you want information on Medicare's added help for low-income individuals, see the Low-Income Help page.
Resources that can help you sort through issues related to Medicare Part D:
The Medicare Drug Benefit: How Much Will You Pay? These tables can help you estimate what you'll pay for prescription drugs under the Medicare drug benefit, including those enrolled in Medicaid. (updated April 2009)
Extra Help for Your Drug Costs: Do You Qualify? helps low-income beneficiaries determine whether they will be able to receive extra help with drug costs under the new law, whether they are or are not also enrolled in Medicaid (updated March 2007).
Will You Be Eligible for Low-Income Assistance in 2007? A Decision Tree Chart is a flow chart that can help beneficiaries sort out the confusing eligibility requirements for different levels of low-income assistance. (updated March 2007)
The following sites have numerous resources that can be helpful for advocates, consumers, and state legislators:
Resources Specifically for Consumers:
The following resources are designed to help consumers understand the benefit or make choices about whether to sign up and which plan to join.
- The Access to Benefits Coalition Web site, http://www.accesstobenefits.org, can help you figure out if you’re eligible for low-income help and can direct you to other resources.
- The Eldercare Locator, a service of the Administration on Aging, has dedicated a section of its Web site to helping those with Medicare understand the new drug benefit. That section can be found at http://www.eldercare.gov/Eldercare/Public/medicare.asp.
- The Kaiser Family Foundation produces a weekly Q&A column explaining the basics of the new Medicare prescription drug benefit. The columns provide advice for people on Medicare and their families. Site visitors can send questions to the Foundation, which will respond to some of them in future columns. You can access these columns online at http://www.kff.org/medicare/QA/index.cfm and send your questions to MedicareQ@kff.org.
- The main Medicare Web site, www.medicare.gov, has several resources for consumers. You can also call Medicare at 1-800-MEDICARE. Many consumers have had trouble using the Medicare Web site. If you find the information on this Web site confusing or incomplete, you should contact counselors in your state. You can locate counselors online at http://www.healthassistancepartnership.org/ship-locator/.
- The Medicare Access for Patients-RX is a coalition of patient, family caregiver, and health professional organizations committed to safeguarding patients with chronic diseases and disabilities under the Medicare Part D program. The site, at http://www.maprx.info, has numerous links, both general and state-specific, that can put you in touch with organizations that might be able to help you sort through plan choices.
- The Medicare Rights Center has resources to help those in Medicare understand the drug benefit http://www.medicarerights.org/101.html and to help with selecting a drug plan http://www.medicarerights.org/comparing_plans_flier.pdf.
- The National Mental Health Association has prepared a consumer workbook that is available online at http://www.nmha.org/federal/MedicareConsumerWorkbook.pdf.
- State Health Insurance Assistance Program (SHIP) counselors can provide individualized counseling and help you assess what drug plan—if any—might be best for you given your situation. You can find the program in your state online at
http://www.healthassistancepartnership.org/ship-locator/.
- United Cerebral Palsy has published a guide to help people with disabilities maximize their Medicare Part D drug coverage. "Navigating the Medicare Part D Prescription Drug Coverage Program: A Guide for People with Disabilities, Benefits Counselors, Disability Organizations and Others on Ensuring Adequate and Appropriate Access to Prescription Drugs" is available online at http://www.ucp.org/ucp_channeldoc.cfm/1/16/10527/10527-10527/6618.
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 the low-income subsidy, and help in finding a plan to meet their individual needs. The number is 1-866-783-2645. The hotline is available Monday-Friday from 8:00-6:00 p.m. ET.
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