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Medicare is a voluntary government insurance program for adults 65 and over, certain people with disabilities, and people with
end-stage renal disease. This program has a prescription drug benefit called "Part D." If you are already receiving Medicare Part A (hospital
insurance) or Medicare Part B (medical insurance), you are automatically eligible for Part D, which pays for part of the cost of prescription
drugs. The program is available to you regardless of income, illness, or cost of drugs.
Find a Plan
If you choose to participate in the program, you will need to select a plan in your local area that fits your needs. Plans can differ by cost,
what drugs are covered, and what pharmacies are used, so it’s best to compare plans to see which one is right for you. Each year, you can review
your plan choices for the coming year and either rejoin your current plan or choose a new one. The open enrollment period begins November 15 and ends December 31 of each year.
Apply for Extra Help
People with low incomes who are participants in a Part D program can also apply for extra help, called a low-income subsidy, or LIS. If you
qualify, you will need to fill out an application. With this benefit, qualified low-income Medicare recipients pay lower premiums, deductibles,
and co-payments. Additionally, this benefit offers coverage through the gap, known as the "donut hole," in Part D. The subsidy is available
to beneficiaries with annual individual incomes at or below 150% of the federal poverty level and assets of no more than $11,500 for individuals and $23,000 for married couples.
If you are a Medicare beneficiary who was automatically enrolled in the Medicare prescription drug benefit and received a subsidy toward
premium costs this year, you will have to apply to receive the subsidy for subsequent years. Some beneficiaries who were automatically enrolled in the subsidy
last year are no longer enrolled in Medicaid or other federal assistance programs and therefore will not automatically qualify for the subsidy.
Help Through State Programs
Medicare recipients and non-Medicare recipients may also fill in insurance coverage gaps through a state program. Not all states offer these programs so click here for a list of states and contact information.
Some programs, called State Pharmaceutical Assistance Programs, are designed to help with the cost for a Medicare Part D plan. These State
Pharmaceutical Assistance Plans could provide financial support to assist you with paying your deductible and/or co-pay. Each state that offers
a plan has a unique prescription drug benefit program or programs for its citizens with its own eligibility requirements. Contact your state officials to learn what resources may be available to you.
You can also visit www.medicare.gov, or call the Medicare office at 800-MEDICARE (800-633-4227) for more information. |
