Medicare Rx Basics

What is Medicare Rx
Starting January 1, 2006, the Medicare program will provide a new prescription drug benefit to all people in Medicare. This new program (sometimes called Part D) will help pay for some or all of participants’ drug costs.

Dates to Know
  •Enrollment starts: November 15, 2005
  •Medicare Rx begins: January 1, 2006
  •First enrollment deadline: May 15, 2006

Who Gets Medicare Rx
Two groups of people can get the new benefit:
  1. Medicare beneficiaries (with Part A or B coverage)
  2. People with both Medicare and Medicaid coverage (known as dual eligibles).

How Medicare Rx Works
Medicare Rx is an insurance program. Two types of insurance plans will provide the drug benefit:
   1. Private insurance prescription drug plans (PDPs) that people can join to add
      drug coverage to their current Medicare benefits; and
   2. Medicare Advantage prescription drug plans (MA-PDs) that also offer other
       health services.

You will be able to choose one of these plans and sign up to reduce your prescription drug costs. Each plan will decide what drugs to include on their list of covered drugs, known as a “formulary.”

Costs
People who sign up for a Medicare prescription drug plan will pay a monthly premium, co-payments for each medication, deductibles and co-insurance. People with low-incomes will have much lower costs if they apply for Extra Help. This chart outlines the basic costs of the program.

How to Sign up
Information about the prescription drug plans offered in your region will be sent to you in October. Use this information to choose a plan and sign up starting November 15, 2005.

If you have Medicare and Medicaid you will be automatically enrolled into a plan. You will receive a letter at the end of October with details of the plan chosen for you. You may sign up for a different plan in your region before January 1, but you must pay for any higher premium costs.

Extra Help Program
The government will help pay for many of the costs of the new drug program, including premiums, deductibles and co-insurance if you apply for the Extra Help program. Dual eligibles and some limited income Medicare beneficiaries are automatically signed up for the Extra Help program and do not need to apply.

You may apply for Extra Help now. People who meet the income guidelines (below 150% of the federal poverty level) should have received an application in the mail this summer. Dual eligibles should have received a letter informing them that they are automatically enrolled in the program. If you have not received a letter about the Extra Help program, call 1-800-Medicare (633-4227) or call your local Social Security Administration Office.

Tips to Get Ready for Medicare Rx

• Talk to your doctor or case manager about your medications. Talk about which drug plan will work for you and how to enroll in the program.
• Apply for Extra Help.
• Keep your current benefits. Do not drop out of any of your current programs when you get notices from the government.
• Know your options. Use the NMHA consumer workbook (see below) and CMS’s plan finder (www.medicare.gov) to help you choose a plan in October.
• Sign up. Reach out for help from friends, family, and Mental Health Associations.
• Get organized. Keep all letters, notices and fact sheets about Medicare Rx.
• Tell others. Share the resources below with someone you know who may need the Medicare prescription drug program.

More NMHA Resources

• The New Medicare Drug Benefit: What Consumers Need to Know
• Medicare Prescription Drug Benefit: Getting Enrolled Consumer Workbook
  

To get these resources or for more information:
Please contact the Advocacy Resource Center at 1-800-969-NMHA (6642), option 6 or www.nmha.org/medicare

Get Educated, Get Enrolled
NMHA’s Medicare Rx Benefit Campaign

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