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Medicare
Frequently asked questions about Medicare Part D
What are the benefits of Medicare Part D?
What if I cannot afford insurance?
Is enrollment voluntary?
What if I want to switch plans after enrolling?
Where can I get my prescriptions filled?
How can Mooney's Pharmacy help?
Why is there a late enrollment fee?
Who is eligible for Medicare Part D Prescription drug coverage?
How do I know if I should sign up?
How do I get the specific information I need to make a decision?
How do I find out if I qualify for help?
What assets will be counted to determine if I am eligible for help?
How will I know if the drugs I currently take will be covered?
Who decides which drugs will be covered on formulary?
What drugs are excluded from Medicare Part D plans?
Will Medicare Part D cover drugs purchased from Canada?
Can premiums be deducted from Social Security checks?
What is creditable coverage?
Will Part D coverage only be available through a private company, or will I be able to get coverage directly from Medicare, the
same way that I get Part A and Part B coverage?
I have drug coverage through the Veteran’s Administration (VA). Can I continue to get my prescriptions through the VA in 2006?
I take several different prescription drugs. Will there be help with managing all my medications?
What are the benefits of Medicare Part D?
If you've been paying cash for your prescriptions, Medicare Part D will save you money.
Each provider's plan must be approved by Medicare, which means you have the security of
reliable prescription insurance, no matter which plan you choose.
What if I cannot afford insurance?
If you're worried you may not be able to afford a Medicare Part D drug plan, you may qualify for extra
help. Contact you local Social Security Administration office for details, visit the agency online at
www.ssa.gov/prescriptionhelp/ or call 1-800-772-1213. You may qualify for other drug discount programs.
Talk with your pharmacist at Mooney's Pharmacy for more information.
Is enrollment voluntary?
Yes. However, the longer you wait to sign up, the higher your premium will be. If you don't sign up for
a Medicare Part D plan by May 15, 2005, you will pay a 1% penalty per month - up to a 12% penalty for each
year you wait. If you think you might need Medicare Part D later, you could save by signing up now. (If you
are currently covered by a prescription drug plan through your employer, this may not apply to you.)
What if I want to switch plans after enrolling?
No problem. Every year there will be an open enrollment period from November 15 through December 31. You may change
Medicare Part D plans at that time.
Where can I get my prescriptions filled?
At Mooney's Pharmacy or any pharmacy within your network. Most Medicare Part D plans will charge the same co-pay, as
long as you go to a network pharmacy. Each network will have several pharmacy options. Mooney's Pharmacy can conveniently
provide these services for you.
How can Mooney's Pharmacy help?
Our knowledgeable pharmacists are a great source of information and will be happy to discuss the Medicare Part D program with you.
They will explain and compare the different plans and answer any questions you might have.
Why is there a late enrollment fee?
Congress believes that unless you already have creditable prescription drug coverage, Medicare Part D plans are a great way to help
you with the cost of prescription drugs. The created the rules to encourage people to enroll in the beginning instead of waiting to
join only when health problems develop and drug costs rise. The late enrollment fee gives people a reason not to postpone the decision
to join.
Who is eligible for Medicare Part D Prescription drug coverage?
All individuals with Medicare Part A or Medicare Part B are eligible to enroll regardless of age, income or health conditions.
How do I know if I should sign up?
You will need to review your options carefully to see if a Medicare Part D plan is right for you. Part D plans are designed to
provide financial savings to most people with Medicare. As insurance plans, they provide protection against future, unexpected
costs. They also provide additional financial assistance for people with lower incomes.
How do I get the specific information I need to make a decision?
Beginning in October of 2005, information was sent out regarding your options available to you. First you will receive the 2006
Medicare & You handbook from CMS, which will include all the plans available in your area. Second, in October of 2005, the plans
started releasing specific information, including plan costs, the list of covered drugs (formulary), and the list of network pharmacies.
Information will also be available at www.Medicare.gov, the Medicare website.
How do I find out if I qualify for help?
If you have both Medicare and Medicaid, you already qualify for low-income assistance. If you don't qualify for Medicaid, you may
still qualify for some assistance if your annual income is below $14,355 for an individual or $19,245 for a couple. (Examples of
2005 figures will also vary in Alaska and Hawaii.) In some cases, the government will also review the value of the assets you own.
If you think you might qualify, contact your Social Security Administration office. You have nothing to lose by applying.
What assets will be counted to determine if I am eligible for help?
Cash or any property that can be converted to cash within 20 days. This includes checking accounts, savings accounts, certificates
of deposit, retirement accounts (like IRAs or 401ks), stocks, bonds, mutual fund shares, promissory notes, mortgages and life insurance
policies. Property that is not counted includes your primary home, burial plots or burial agreements. Certain funds set aside for
burial expenses, up to $1,500, will not be counted as well.
How will I know if the drugs I currently take will be covered?
Each Medicare Part D plan will provide its own formulary or list of covered drugs. This information will be available through the
plan's website, customer service center and through marketing materials.
Who decides which drugs will be covered on formulary?
All Part D plans must meet formulary requirements set by Medicare. The formulary will include both generic and brand name drugs.
Each plan must use a Pharmacy and Therapeutic Committee, which includes doctors and pharmacists, to establish its formulary.
This process assures you access to a number of drugs, although not necessarily all drugs.
What drugs are excluded from Medicare Part D plans?
Drugs used for anorexia, weight loss, or weight gain
Drugs used to promote fertility
Drugs used for cosmetic purposes or hair growth
Drugs used for the symptomatic relief of cough and colds
Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations
Non-prescription drugs
Inpatient drugs
Barbiturates (sleeping pills)
Benzodiazepines (central nervous system depressants)
In addition, a drug cannot be covered under a Medicare Part D plan if payment for that drug is available under Parts A or B or Medicare,
such as drugs administered in a hospital or a physician’s office. Also, each Part D prescription drug may have its own specific
exclusions.
Will Medicare Part D cover drugs purchased from Canada?
No. Only drugs sold in the United States are eligible for Part D coverage.
Can premiums be deducted from Social Security checks?
Yes, you will have the option to have the premium deducted from your Social Security check (just like your Medicare Part B premium).
If applicable, you or your former employer can pay your premium directly to the private company.
What is creditable coverage?
Creditable coverage is coverage from a plan other than a Medicare Part D plan that meets certain Medicare standards.
If you already have prescription drug coverage that is considered creditable coverage, you may keep that coverage and wait to
enroll in a Part D plan. If you later decide to enroll in a Part D plan, you will not have to pay a late enrollment fee.
Will Part D coverage only be available through a private company, or will I be able to get coverage directly from Medicare, the
same way that I get Part A and Part B coverage?
No. Part D coverage will not be available directly from Medicare. Although you will be able to have your premium deducted from your
Social Security check, you must purchase Part D coverage from a private company that has been approved by Medicare to offer coverage.
I have drug coverage through the Veteran’s Administration (VA). Can I continue to get my prescriptions through the VA in 2006?
Medicare beneficiaries who currently have prescription drug benefits through the VA will be able to continue to obtain their
prescriptions through the VA.
I take several different prescription drugs. Will there be help with managing all my medications?
Yes. The help is designed to make sure that your medications work well together and reduce the risk of a bad reaction.
You might also hear this called medication therapy management.
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