Medicare Part D 2010: Facts You Should Know

What is Medicare?

  • Medicare is a U.S. government health insurance plan. Medicare provides hospital, medical, and prescription drug coverage.

Who qualifies for Medicare?

  • People aged 65 years and older
  • People who are permanently disabled
  • People with kidney disease.

What is Medicare Part D?

  • Medicare Part D is the short name for Medicare Prescription Drug Coverage.
  • Medicare Part D is a prescription drug plan available to everyone with Medicare.
  • Medicare Part D is an optional plan so you must sign up for a plan to receive coverage of your prescription drugs.
  • When you sign up for a plan:
    • You may pay an amount of money each month to be a part of the plan (called the premium).
    • You may pay an amount of money toward the cost of each prescription you have filled (called the co-payment).

How do prescription drug plans work?

  • When you sign up for Medicare Part D, you need to choose a specific prescription drug plan.
  • A prescription drug plan is an insurance plan that helps you pay for your prescription drugs.
  • Depending on where you live, you might have many plans from which to choose.
  • Plans differ in many ways, such as:
    • The prescription drugs that are covered by the plan (called the formulary)
    • The amount of money you must pay each month to be a part of the plan (called the premium)
    • The total amount of money you must pay before your plan begins to pay for your medicines (called the deductible)
    • The amount of money you must pay toward the cost of each prescription you have filled (called the co-payment)
    • The list of pharmacies that can fill your prescriptions
    • The amount of extra coverage (if any) the plan offers through the Medicare Part D gap in prescription drug coverage (called the doughnut hole).

Which prescription drugs are covered under Medicare Part D?

  • Each prescription drug plan is different and covers different drugs.
  • Every plan includes at least 2 drugs to treat a specific health problem. For example, every plan covers at least 2 drugs to treat high blood pressure.
  • With some plans, you might have the option to pay more money every month (your premium) in order to have more drugs covered by the plan or to pay a lower amount of money (your co-payment) for certain drugs.

How do I sign up for Medicare Part D?

  • You can only join a new Medicare Part D plan or change your current plan at certain times of the year (called open enrollment periods).
  • Every year, the open enrollment period is from November 15 through December 31st. During that time, you can choose a plan that will be effective January 1st.
    • There are few ways to sign up:
      • You can visit the Medicare website (www.medicare.gov) and use the online enrollment center.
        or

      • You can telephone 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) and talk to a Medicare customer service representative.
        or

      • You can contact the insurance company that offers your chosen plan and ask to have an application mailed to your home. You can visit the insurance company’s website and you might be able to apply online.

No matter how you sign up, you will need your

  • Medicare card or card number
  • The date you first enrolled in the program
  • A list of the names, dosages, and quantities of your prescription drugs
  • The name and location of your preferred pharmacy
  • The zip code of your home address.

What is the coverage gap, or “doughnut hole” for 2010?

  • You reach the “doughnut hole” when the total cost of your prescription drugs for the year falls between $2,830.00 and $6,440.00.
  • For some Medicare Part D plans, when you reach $2,830.00 you might have to pay the full cost of your prescription drugs.
  • When your total drug costs for the year is $6,440.00 most Medicare drug plans will begin to help you pay for your medications.

Do all beneficiaries have the “doughnut hole”?

  • People who are eligible for Medicare and Medi-Cal do not have coverage gaps in their drug plans.
  • People who qualify for a low-income subsidy from Social Security do not have coverage gaps in their drug plans.

How much will a Medicare Part D prescription drug plan cost me?

  • The amount of money that you pay each month (called the premium) will vary depending on the plan you choose.

What if I need help paying for my Medicare drug plan or my prescription drugs?
There is extra help for people with low incomes such as:

  • Single adults who make $1,353.75 or less per month and have $12,510 or less in resources (such as bank accounts, stocks, and bonds)
  • Married couples who make $1,821.25 or less per month and have $25,010 or less in resources (such as bank accounts, stocks, and bonds)
You can telephone 1-800-SSA-1213 (1-800-772-1213) or go to www.ssa.gov on the internet to apply.

What important dates should I know?

  • October:
    • Medicare and other drug plans will begin mailing out program information about coverage for this calendar year.
    • Medicare will mail the “Medicare and You Handbook” that explains all of the Medicare options available to you.
  • November 15th through December 31st:

What could change about my plan each year?
Each year, your plan could change. Changes could include:

  • The prescription drugs that are covered by the plan (called the formulary)
  • The amount of money you must pay each month to be a part of the plan (called the premium)
  • The total amount of money you must pay before your plan begins to pay for your prescription drugs (called the deductible)
  • The amount of money you must pay toward the cost of each prescription you have filled (called the co-payment)
  • The list of pharmacies that can fill your prescriptions
  • The amount of extra coverage (if any) the plan offers through the Medicare Part D gap in prescription drug coverage (called the doughnut hole).

It is very important to look carefully at your current plan and any changes expected for the following year before deciding if you will keep your current plan or change to a new plan.


Who can I contact for more information about choosing the right plan for me?
To compare plans, you can:

  • Telephone 1-800-MEDICARE (1-800-633-4227). Have your Medicare card available.
  • You will also need a list of the names, dosages, and quantities of your prescription drugs.
  • You can get this information from your pharmacy.
    or

  • Visit the Medicare website (www.medicare.gov) and use the “Compare Prescription Drug Plans” tool.
    or

  • Telephone the Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222. HICAP is a volunteer-led group that provides unbiased information about Medicare.