Answers to Frequently Asked Questions

Why haven’t I heard about Medicare prescription drug coverage?

Because it’s new; beginning January 1, 2006, Medicare prescription drug coverage will be available to all people with Medicare.

Most people will be able to get this coverage through Medicare prescription drug plans. Medicare will also work with employers and unions to ensure that people who currently receive drug coverage through their former employer or union can continue to do so.

Why should I make any changes to my current Medicare coverage? Why would I want to get prescription drug coverage?

Medicare prescription drug coverage is important. It protects from high out-of-pocket costs.

Medical practice has come to rely more and more on new drug therapies to treat chronic conditions, and out-of-pocket spending on drugs has increased dramatically in recent years.

Most people with Medicare currently need or will come to need prescription drugs to stay healthy.

Can anyone with Medicare get this drug coverage? Are people with Medicare automatically enrolled in a Medicare prescription drug plan?

Medicare prescription drug coverage is available to those who have either Medicare Part A (hospital insurance) or Medicare Part B (medical insurance). There will be at least two Medicare prescription drug plans to choose from.

But people with Medicare are not automatically enrolled. Most people will need to choose and enroll in a Medicare prescription drug plan to get prescription drug coverage.

What if I already have prescription drug coverage?

If you already have prescription drug coverage, you should talk to your plan, benefits administrator, or insurer before making any changes. You will be notified about any changes in your current coverage so you can decide if you should join a Medicare drug plan.

What happens if I choose not to join a Medicare drug plan by May 15, 2006? Can I join later?

If you don’t join a plan by May 15, 2006, and you don’t currently have a drug plan that, on average, covers at least as much as standard Medicare prescription drug coverage, you will have to wait until November 15, 2006 to join. When you do join, your premium cost will go up at least 1% per month for every month that you wait to join. Like other insurance, you will have to pay this penalty as long as you have Medicare prescription drug coverage.

If you join after May 15, 2006, the next open enrollment period is November 15, 2006 to December 31, 2006. However, coverage for people who enroll during this period will not take effect until January 1, 2007.

My mother is 83 and on Medicare but Medicaid pays for her prescriptions. Will Medicaid continue to cover these costs after the new Medicare drug benefit begins?

Medicaid will stop covering prescription drugs for people who are on Medicare as of Dec. 31, 2005. When the new Medicare benefit goes into effect, individuals with both Medicare and Medicaid will continue to be eligible for other Medicaid benefits but, beginning Jan. 1, 2006, will get prescriptions covered under new Medicare prescription drug plans instead.

When and how often can I switch my Medicare drug plan?

Generally if you join a Medicare Prescription Drug Plan, you can only change plans under certain circumstances. You can choose to switch your current plan from November 15 through December 31 of every year.

Enrollment is generally for the calendar year. In certain cases, such as if you move or enter a nursing home, you can switch your plan at other times.

If you have both Medicare and Medicaid, you can change plans at any time.

Answers to Other Common Questions