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Confused by Medicare D?

At MemoryCare we have wondered if the D should stand for "distressed" to reflect the frustration our caregivers have felt over applying for Medicare's new prescription drug coverage for their loved ones. One of the clearest summaries we have seen of the program was written by Jacquie Buttles with the Buncombe County Council on Aging. The Council on Aging has generously agreed to share her article from their recent newsletter. They can be a wonderful resource for direction if you get "distressed" by the application process. See their contact information at the end of the piece.

Medicare Drug Coverage by Jacquie Buttles, Assistant to the Director

Prescription drug coverage (Medicare Part D) will be available to all Medicare enrollees, regardless of age or income, beginning January 2006. Medicare Part D is different from the medication discount cards offered by providers such as Senior Care Card, U-Share Card, Together Rx, etc. Only companies licensed to sell insurance in North Carolina are eligible to offer the coverage. Enrollment with approved providers will begin November 15 th and run through May 15 th 2006. There are two types of coverage: Basic and Subsidized.

The BASIC Medicare Part D benefit is as follows:

• Monthly premium of approximately $32
• Annual deductible of $250
• Once the deductible has been met, Medicare will pay 75% of the monthly drug bill and the beneficiary pays 25%.
• Once $2,250 has been expended in total drug costs there is no more coverage until $5,100 in total drug spending has been reached. During this time of no drug coverage the beneficiary must continue to pay the monthly premium
• Once a total of $5,101 has been spent, Medicare will pay 95% of drug costs and the beneficiary will pay 5% through the end of the calendar year.
• At the beginning of the new calendar year (January), the expenditure cycle begins again.

NOTE: Companies offering coverage may restructure benefits to offer more choice. They are permitted to do this as long as the provided coverage is as good as or no less than the basic benefit.

The SUBSIDIZED PLAN offers "extra help" coverage for those with lower incomes. Enrollees in the subsidized program will have reduced premiums as well as deductibles and they will only pay 15% of the full cost of the medicine, or may even be eligible for co-pays of only $2 and $5. Income eligibility for the subsidized version is as follows:

• $1200 or less income per month for an individual with not more than $11,500 in assets.
• $1600 or less income per month for a couple with no more than $23,000 in assets.

To apply for the extra help an application from Social Security must be completed; notification of eligibility is received within a few weeks.

Medicare participants receiving their medications through the Veteran's Administration, those with employer-sponsored drug insurance coverage, and enrollees of TRICARE will probably not need Medicare Part D, as their current coverage is as good as or better than the Medicare plan. These persons will receive a letter verifying this from their current insurer.

NOTE: If you are on Medicare and have no other drug coverage and you choose not to enroll by May 15, 2006, you will be subject to higher premiums if you do enroll later. There will be a 1% penalty applied to the current average monthly premium for every month you waited. So, if you wait 3 years and at that time the average premium is $50 you will pay 36% more than that ($68), for the rest of your time on Medicare Part D.

The Council on Aging is holding outreach events throughout the county to inform Medicare beneficiaries about this plan and to help those who are eligible for the extra help fill out the application. For more information on Medicare Part D or to find out about outreach events in your area, call the Council on Aging at (828) 277-8288. The outreach is funded by a grant from the Office of Rural Health.

Contact Us:

MemoryCare™
100 Far Horizons Lane
Asheville, North Carolina 28803
828.771.2219
office@memorycare.org

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