Your Current Coverage
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If you use an average amount of prescription drugs, Medicare’s new prescription drug coverage could pay over half of your drug costs next year. If you have very high drug costs, Medicare will pay up to 95% of these costs after you spend $4,550 out-of-pocket in a year.
What you need to do - To get this drug coverage, you can join a Medicare Prescription Drug Plan that covers prescription drugs only and keep your Original Medicare coverage the way it is. Or you can join a Medicare Advantage Plan or other Medicare Health Plan that covers doctor and hospital care as well as prescriptions. Medicare Advantage Plans usually give you extra benefits and/or lower costs, but only if you use the doctors and hospitals that participate in the plan’s “network.”
Medicare prescription drug coverage will generally provide significant savings compared to what you are paying in co-payments for drugs under your Medigap plan, and will generally provide much better protection against high drug expenses as well.
What you need to do - Decide between keeping your Medigap policy with drug coverage or joining a Medicare plan that offers prescription coverage. Look for more information from Medicare and the plans offering drug coverage in your area in the fall, and compare the drug coverage from your Medigap plan to the new Medicare coverage. Unlike Medigap, most of the cost of Medicare drug coverage is paid by Medicare, and will never run out if you have high drug costs. If you opt for Medicare prescription drug coverage, tell your insurer and the drug portion of your Medigap policy will be removed.
Medicare will help employers or unions continue to provide retiree drug coverage that meets Medicare’s standard. Your former employer or union has choices about how they will work with Medicare.
What you need to do - Look for information coming from your former employer or union this fall. This information will explain how they will work with Medicare on prescription drug coverage and what decisions you will have to make. If you do not hear from them, visit their website or call your benefits administrator.
Medicare is working with Medicare Advantage and other Medicare Health Plans to help them provide even more coverage and/or lower costs. Your plan will let you know about the prescription drug options they will offer. You can also choose to switch to another Medicare Advantage Plan or Medicare Health Plan. Or you could choose Original Medicare and join a Medicare Prescription Drug Plan.
What you need to do - In October, look for information in the mail explaining any additional prescription drug coverage your plan will offer.
Almost 1 in 3 people with Medicare will qualify for extra help that will cover most of the costs of their drugs. Most people who are eligible for this extra help will pay a reduced, or no, premiums, no deductible, and no more than $6.30 for each prescription. The amount of extra help is based on income and resources (including savings and stocks, but not counting your home or car.) You may qualify if your resources are less than $12,510 if you are single (with no dependents), or $25,010 if you are married and living with your spouse (with no dependents).
What you need to do - People who may qualify will receive an application in the mail from the Social Security Administration. Or you can call 1-800-SSA-1213 for more information. If you think you may qualify, you should apply. Complete the application as soon as possible. If you qualify, you will need to join a plan this fall for your coverage to start January 1, 2010. This fall Medicare and the Medicare plans offering drug coverage in your area will send you information, and you’ll get help with deciding which plan works for you.
* Rules are different for people living in the territories.