Rose-Red: New Medicare Prescription Plan Info

Discussion in 'Fibromyalgia Main Forum' started by Bailey-smom, Sep 9, 2005.

  1. Bailey-smom

    Bailey-smom New Member

    OK - I will try my best to explain some of the info given to me yesterday regarding the Medicare prescription plan. I don't know it all or even claim to but I have been trying to help my clients understand the plan.

    Around October 1st people whom are Medicare age will be bombarded with a ton of junk mail because the plan is actually not done though the gov’t. This plan will be handled a lot like Medicare supplement policies - the gov’t sets the restrictions and coverage of the plan but you would get them through a private insurance company. The only difference from one insurance company to another will be the premiums that will be charged as each company will set it’s own premium structure.

    Open enrollment will begin on Nov. 15th and stop on Dec. 31st. This just means that if you sign up between those dates your premium will be lower than if you wait. Your premium would be 1% higher each month after that time if you do not sign up during the open enrollment time frame.

    The Medicare plan goes like this. . .

    You pay the first $250 in prescriptions (your deductible) then you will pay 25% of your drug costs between $251 - $2250 and your plan pays 75% of those costs. You will then pay 100% of the cost of your medication between $2251-$3599. When you have $3600 or more in prescription costs you will pay 5% of the cost & your plan will pay 95%. This is every calendar year.

    It seems to me that the only difference in the different plans that will be offered by the private insurance companies is the kind of drugs you choose to have covered under your plan. The more coverage you want the more expensive your premium will be. The new plan does not offer coverage of all drugs but coverage can be purchased on a different plan.

    The drugs that are covered under Medicare part B will still be covered under part B. The Medicare approved drug card will be phased out by, I believe, March of 2006.

    Let me know if you have other questions. I don’t know it all but I may be able to give you more info.

    Kelly

    [This Message was Edited on 09/09/2005]
  2. Bailey-smom

    Bailey-smom New Member

    Bumping for Rose Red:)
  3. Rose_Red

    Rose_Red New Member

    Too bad I don't have $3600 stashed away. Medicare'll be being 95% after 3 months.

    thanks for the info. It's a lot more than you can find on their website right now.

    Keep us posted if you here anything new?

    hugs,
    michele
  4. wiseeagle

    wiseeagle New Member

    There also is a income requirement. One for singles, and one
    for married people. You must first fall into that income
    requirement before your accepted. CHeck this out first! It's takes alot of time and energy just to get medicare on phone to
    apply. I personally think it's the governments way of throwing a crumb at the people on medicare!! I really is almost not worth it.

    Valerie
  5. Bailey-smom

    Bailey-smom New Member

    There is additional help for those that are lower income. This info can be found on the medicare web-site but I have copied it here

    You may automatically qualify for extra help.
    You may get a letter from Medicare saying that you automatically qualify for extra help and don’t have to fill out the application from the Social Security Administration (SSA).
    You automatically qualify for extra help and don’t need to apply if you

    *have Medicare and full coverage from a state Medicaid program that currently pays for your prescriptions. You should join a plan that meets your needs by December 31, 2005 because Medicaid will no longer pay for prescription drugs. If you don’t, Medicare will enroll you in a plan effective January 1, 2006 so you don’t miss a day of coverage. You can drop the plan or switch to another any time.

    *get help from your state Medicaid program paying your Medicare premiums (belong to a Medicare Savings Program). You should join a plan that meets your needs by December 31, 2005. If you haven’t signed up by May 15, 2006, Medicare will enroll you in a plan effective June 1, 2006 so you don’t have to pay a penalty. You can drop the plan or switch to another any time.

    *get Supplemental Security Income. You should join a plan that meets your needs by December 31, 2005. If you haven’t signed up by May 15, 2006, Medicare will enroll you in a plan effective June 1, 2006 so you don’t have to pay a penalty. If Medicare enrolled you in a prescription drug plan, you can switch to another plan one time before December 31, 2006.

    You may apply and qualify for extra help.
    If you didn’t automatically qualify, the Social Security Administration (SSA) sent people with certain incomes an application for this extra help. If you got this application, fill it out and send it back to SSA as soon as possible. If you didn’t get an application but think you may qualify, call 1-800-772-1213, visit www.socialsecurity.gov on the web, or apply at your State Medical Assistance office.

    You can also visit the website to get more information. After you fill out the application from SSA, SSA will mail you a letter telling you if you qualify for extra help in two to three weeks.

    I just want to encourage everyone to ask for info - don’t feel overwhelmed because it is confusing:) You will get through it. Don't believe everything you hear - you know how rumors get started!

    I am not convinced it is as good of a deal as it is being made out to be but it should help.

    Kelly

    [This Message was Edited on 09/10/2005]