Facts about the Medicare Prescription Drug Benefit

• The Medicare Prescription Drug Benefit is the newly created Medicare Part D.
• The full prescription drug benefit will begin January 1, 2006.
• Individuals who are entitled to Medicare Part A or who are enrolled in Medicare Part B qualify for prescription drug coverage.
• Enrollment in Medicare Prescription Drug Benefit

1. During the initial sign-up period, most eligible Medicare Part D
   beneficiaries can choose a Medicare Part D plan starting
   November 15, 2005, and ending May 15, 2006.
2. Dual eligibles who are Medicare beneficiaries also receiving state Medicaid benefits will be auto-assigned to a prescription drug plan beginning October 2005. They can choose a different plan before January 1, 2006, and every 30 days after that date.
3. Medicaid drug coverage for dual eligibles will be terminated on December 31, 2005.
4. Low-income beneficiaries must complete a pre-screening income and asset application from the Social Security Administration (SSA). After approval from SSA, the beneficiary must choose a Medicare Part D plan after November 15, 2005.
5. For every month a Medicare beneficiary does not have creditable
   coverage, he/she will incur a permanent penalty of approximately one percent (1%) per month.
6. If a Medicare beneficiary has creditable coverage that is equivalent or better than Medicare Part D (i.e. employer or retirement plan), the penalty will not apply.

• Standard Benefit Design
  1. Monthly premium is approximately $32.
  2. Annual deductible is $250.
  3. After deductible, beneficiary will be responsible for approximately 25% of drug costs until he/she reaches $2,250 in drug spending (not including their monthly premium).
  4. After total spending of $2,250 (not including their monthly premium), the beneficiary will be responsible for 100% of drug costs until they reach $3,600 true out-of-pocket costs (approximately $5,100 in total costs).
  5. Beneficiary will be responsible for about 5% of drug costs after
     spending $3,600 out-of-pocket.

Ask your pharmacist, if you are confused about the Medicare Drug Benefit.