Medicare Part D questions & answers

On Monday, May 15, the deadline to enroll in a Medicare Part D prescription plans came and went for an estimated 5.7 million Americans, who did not enroll. The Queens Courier lets you know when you are eligible to enroll again and how much you will have to pay for missing the deadline. Moreover, if you were one of the 37 million Americans who did sign up for a plan, this section answers questions about your new plan and when you can change it.
1. If I missed the deadline, can I still enroll?
If you are eligible for Medicare Part D and you didn’t sign up for a prescription drug plan by Monday, May 15, the next chance you have to enroll is between November 15 and December 31. This period is called “open enrollment,” and signing up during this time would give you coverage starting January 1, 2007. However, you will have to pay a penalty each month.
2. What is the penalty?
For every month after the May 2005 deadline, one percent of your monthly premium will be tacked onto your bill. Therefore, if you enroll in November, you will be charged an additional seven percent every month. If the average monthly premium is $32, you can expect to pay an added $2.25 every month for the rest of your life.
3. Can I switch prescription plans?
If you enrolled in a Medicare Part D prescription plan by May 15, you must wait until November 15 to switch plans.
4. What if I am eligible for Medicare Part D, but I already have a prescription plan through my former job?
If you already have a prescription plan that is equal to or better than the coverage that you would get through Medicare Part D, you can remain with that plan. If you choose, you can switch plans without paying the penalty during the open enrollment period, which will run from November 15 to December 31 each year. However, if your plan is not as good, you will be charged the penalty if you decide to switch plans.
5. What do I do if my plan does not cover the drugs that I need?
Most prescription plans come with a 30-day grace period to continue the drug that you need – even if the plan does not pay for that particular medication. During those 30 days, you should talk to your doctor about finding a new drug that can substitute or file an appeal saying that you cannot find an adequate substitute and need your plan to cover the medication.
6. What drugs are prescription plans required to cover?
All insurance drug companies are required to cover two drugs in each category. According to the Medicare model formulary developed by the United States Pharmacopeia (USP), there are 41 therapeutic categories, most of which have drug classes. For example, “cardiovascular agents” is one category of medication, which has 10 associated drug classes ranging in strength. The only categories that Medicare Part D plans are not required to cover are barbiturates and benzodiazepines.
7. Can my prescription plan switch the drugs that it covers?
Prescription plans can drop or pick up medications from their coverage at any time, but your drugs may be “grandfathered” in to your individual prescription coverage. The best way to find out if your coverage will continue is to contact your prescription plan.
8. Can I still apply for extra help to pay for my prescription plan?
The government has extended the deadline to apply for extra help from the Social Security Administration to pay for your prescription plans. To check and see if you are eligible, go to www.socialsecurity.gov.
9. My prescription drugs were covered by Medicaid. Do I have to enroll in a prescription plan, and will I have to pay the penalty?
All dual eligible – that is Medicaid and Medicare eligible people in the country – were already enrolled by the government in a prescription plan. Therefore, if this applies to you, you will not have to pay the penalty. In addition, there are different rules for those who had Medicaid, concerning when you are able to switch plans. Former Medicaid and Medicare recipients can switch their plans about once per month.
10. Why wasn’t the deadline extended?
The government has worked toward this deadline for several months and believes that Medicare Part D recipients had ample time to find a new prescription plan and make sure that their medications were covered.
11. How many people in New York have signed up for a plan?
According to the Center for Medicaid and Medicare Services, almost 85 percent of people have signed up in New York. However, this number does not include people who already had coverage as good as or better than Medicare Part D.