WNY Legal Services for the Elderly - Medicare Part D - The Essentials and Medicare Savings Program Application

Medicare -> Medicare Part D - The Essentials and Medicare Savings Program Application

Medicare Part D - The Essentials

by Prof. Tony Szczygiel, SUNY at Buffalo Law School

The new Medicare Prescription Drug Benefit (Part D) is:

A) very helpful to many, but not all, Medicare enrollees and

B) so complicated that many Medicare enrollees will miss out on the benefits.

The key to dealing with this new Medicare benefit is a step-by-step approach.

Step 1 - List your medications, the full cost, the coverage you now have and how much it pays.

Step 2 - Keep drug coverage that is better than Part D, or enroll in such coverage if that is available to you. Go to Step 3 only if a Part D plan will improve your coverage.

Keep “creditable” drug coverage from your former employer or your union. If you have this coverage, your employer or union should have sent you a letter recently. It tells you their coverage is at least as good as Part D.

Keep or apply for prescription drug coverage as a veteran. The VA drug benefits are better than Part D - no monthly premium, no deductible and a limited co-pay.

Keep or apply for EPIC. This New York State program is better than Part D. Unlike other creditable coverage, EPIC can work with Part D. Some of you will be better off with EPIC and a Part D plan.

Step 3 - Apply for Extra Help or a Medicare Savings Program. These will reduce your cost under a Part D plan. The federal Social Security Administration handles the Extra Help applications. Your county Department of Social Services handles the Medicare Savings Program applications. You will not be eligible for these programs if your monthly income is much more than $1,225 for a single person, or $1,650 for a couple.

Step 4 - Special rules apply if you are a “dual eligible,” that is a person who is enrolled in both Medicare and Medicaid. Medicare should have sent you a letter telling you the Part D plan into which they enrolled you. Be sure you have a Part D plan; that it covers the drugs you need and that your $29.83/month Extra Help credit covers the monthly premium.

Step 5 - Special rules apply if you are in a Medicare Advantage plan -, e.g., SeniorChoice, Senior Blue, Encompass65, Preferred Care or Evercare. If you enroll in Part D, you must choose from those offered by your Medicare Advantage plan, or switch plans.

Step 6 - If your drugs cost less than about $900/year, decide whether you are better off enrolling in a Part D plan now, or waiting.

Step 7 - Pick a Part D plan from those available to you. Be sure that it covers the drugs you need, preferably at the lowest annual cost.