:: Medicare Part D

New Medicare Prescription Drug Benefit to Go Into Effect in January 2006 .
Those currently on Medicare, but getting their medications through Medicaid, will be switched to the new program .
Last Updates: July 11, 2005

As part of the new Medicare law, Medicare beneficiaries will have the right to purchase private Medicare prescription drug coverage starting on January 1, 2006. As a result of this new program, people who are currently enrolled in both Medicaid and Medicare – those who are dually eligible -- will lose their Medicaid drug benefit on December 31, 2005 and the new Medicare drug coverage will replace it.

Below is some basic information to help Medicare beneficiaries with HIV and AIDS prepare for the new drug benefit. Details of the program are still being worked out, so this document will be updated periodically to reflect the latest information available. Check the TAEP website at www.taepusa.org for up-to-date information.

Apply For A Low-income Subsidy

The new drug benefit includes a low-income subsidy program that offers financial assistance to low-income individuals. This program is being marketed as “extra help” as it can eliminate or greatly reduce premiums, co-payments or deductibles. In late May 2005, the Social Security Administration began sending notices to 20 million Medicare beneficiaries informing them that they may be eligible for this extra help. The subsidy level depends on your income and the level of assets you have. If your income is below 150% of the federal poverty level you may be eligible for extra help. Please refer to the chart below to determine if your income is below 150% of the federal poverty level. If your income is even close to this level, be sure to apply for extra help as not all income is counted. (So you may qualify, even if you think your income is too high.) More on Low Income Subsidy

What Else You Can Do Right Now

• Be sure to read carefully and save any paperwork received from the Social Security Administration, the Centers for Medicare and Medicaid Services (the federal agency that oversees Medicaid and Medicare), or your state Medicaid program. Be on the look out for information on changes to coverage, applications for the Low Income Subsidy or extra help, and drug plans in your area.
• Talk to your health care providers, case managers and pharmacists about enrolling in the new benefit. They can help you compare drug plans and select the one that’s right for you.
More on Choosing the Right Plan
• If you have Internet access, frequently check the TAEP website (www.taepusa.org), the Center for Medicare Advocacy website (www.medicareadvocacy.org) and the Centers for Medicare and Medicaid Services website (www.medicare.gov), for updated information.

What You Will Need To Understand By January 1, 2006

• The Medicare Part D prescription drug plan you are assigned to.
• How to switch plans. Enrollment is voluntary, but dual eligibles will be randomly assigned to plans to ensure they have coverage. Even if you are put in a plan, it is best for you to make a personal decision about which plan is the right one for you.
• The name and location of pharmacies you can use to fill prescriptions under your plan.
• The drugs covered under your plan’s drug formulary.
• What to do if one or more of your drugs is not covered under your plan’s drug formulary, or what you and your medical provider can do if you have a problem getting the drugs you need.
• What your premiums, deductibles and co-payments will be.

This Is A Summary Of The Timeline For Implementation Of The New Medicare Drug Benefit

• May-June 2005 – Low-income subsidy letters and applications mailed to many eligible clients over an 8-week period.
• July 2005 – Those currently on Medicare and receiving their medications through Medicaid (dual eligibles), Medicare Savings Program participants, and other eligible individuals will be notified that they are approved for the low-income subsidy. Individuals can also start applying for extra help at their local Social Security office or their Medicaid office. Applications will also be available online and by telephone.
• October 2005 – CMS will release a list of approved prescription drug plans.
• October-November 2005 – Dual eligibles will be automatically assigned to a local plan.
• November 15, 2005-May 15, 2006 – Open enrollment period for all Medicare beneficiaries. Dual eligibles may elect to switch their randomly assigned plan before January 1, 2006 and once per month thereafter without penalty.
• January 1, 2006 – Medicare Part D prescription drug coverage goes into effect. Dual eligibles will lose their Medicaid drug coverage and start their newly assigned Medicare Part D drug coverage.