Your Medicare Drug Benefit Information Sheet

The new Medicare drug coverage – Medicare Part D - began on January 1. This is especially important for New Yorkers enrolled in Medicaid because, since January 1, Medicaid stopped paying for prescription drugs. You will have to use a Medicare drug plan to get prescription drugs, but Medicaid will still cover all other Medicaid benefits.

Don’t feel alone if you are confused about this. Many people are. If you have a problem with Medicare Part D, call 212-614-5400.

Dual Eligibility

Those who are enrolled in Medicaid and Medicare Part D are considered “dual eligible.” But the drug coverage of Medicare Part D is provided by private insurance companies. If you have Medicaid and did not choose a Medicare drug plan, you have been randomly assigned to a plan offering the prescription drug benefit. Dual eligibles should have received a yellow letter from the Center for Medicare and Medicaid Services that tells them what plan they are in.

It’s quite possible that the plan you were randomly enrolled in may not include your drugs or your local pharmacy. If so, you can switch to another plan. If you do not know which plan you are enrolled in, you can call 1-800-633-4227 to find out.

“Extra Help”

The drug coverage offered by Medicare Part D costs money each month, a combination of co-insurance, deductibles, premiums, and co-payments. But some people may be eligible for “Extra Help,” a subsidy for people with low incomes that pays for most of these costs. You will automatically qualify for the Extra Help subsidy if you are a dual eligible or are already enrolled in a Medicare Savings Program. But you must fill out an application to get Extra Help; it is available at any Social Security office.

Only people who have both Medicaid and Medicare have to join a Medicare drug plan; for everyone else the program is voluntary. If you do not have any drug coverage now, a Medicare drug plan may help you pay for your drugs. You have until May 15 to sign up for a plan. After that, you can still join a plan but you will pay a penalty, a higher cost for your drugs.

However, if you have drug coverage now that you believe is as good or better than Medicare Part D, you do not have to enroll in a plan. Your coverage is considered “creditable.” Examples of “creditable coverage” are retiree insurance, veterans insurance, employer insurance, or coverage through your spouse. You do not need to figure out if your current coverage is creditable. Your insurance should have sent you a letter stating that its coverage is creditable.

Not all plans are creditable. Make sure that you have received this letter, or call your drug plan to find out if your coverage is creditable. Hold on to the letter. If for any reason you lose your current creditable coverage, you will have 63 days to sign up for the Medicare drug coverage without a penalty.

Choosing the right plan can be tricky. Not every plan offers every drug. Many plans charge more if you use a name brand drug rather than a generic drug. Plans charge different monthly premiums. Each includes a limited number of pharmacies.

Unless you are enrolled in both Medicaid and Medicare, you can change plans only once a year. It is important that you do not sign up with a plan until you know that it is the best one for you. Each plan will try to get people to enroll. They will be advertising, calling on the phone, and mailing information. You do not need to talk to these people. You do not want to accidentally enroll in a plan that does not meet your needs.

Do not give out your Social Security or credit card number to people who contact you about enrolling in a drug plan. If you are contacted by phone, you can ask to get materials sent to you in the mail.

If you have problems or questions about the drug benefit, the Community Service Society (CSS) can help. CSS operates the New York City Managed Care Consumer Assistance Program – known as NYC MCCAP - which has a network of 29 community organizations that provide people with assistance in figuring out managed care.

If you are having a problem with Medicare Part D or need help choosing a plan, call NYC MCCAP at 212-614-5400. Or you can go online at www.nycmccap.org. The site includes the location of all MCCAP agencies.

MCCAP was a specific effort of CSS, created by the City Council with support from the Health Committee, chaired by Christine Quinn. Today, MCCAP is the nation’s largest health care ombuds program.

MCCAP not only assists people in getting health coverage; it educates them on how to use their health insurance and it provides one-on-one assistance to help them exercise their rights and resolve problems with their plans. MCCAP provides help in 18 languages. Over the years, MCCAP has helped over 300,000 New Yorkers get access to the health care they need. We can help you.

From the New York Amsterdam News
January 12 - 18, 2006