Medicare offers prescription drug coverage (Part D) to everyone with Medicare. To get Medicare drug coverage, one must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.

There are two ways to get Medicare prescription drug coverage:

1.         Medicare Prescription Drug Plans.

These plans (sometimes called “PDPs”) add drug coverage to Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.

2.         Medicare Advantage Plans (like an HMO or PPO) or other Medicare health plans that offer Medicare prescription drug coverage.

The client gets all of the Part A and Part B coverage, and prescription drug coverage (Part D), through these plans.

Why Join a Medicare Drug Plan?

Clients need to know that even if they don’t take a lot of prescription drugs now, they should still consider joining a Medicare drug plan.  If they decide not to join a Medicare drug plan when first eligible, and they don’t have other creditable prescription drug coverage, they will likely pay a late enrollment penalty (higher premiums) if they join later.

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Extra Help Paying for Medicare Prescription Drug Coverage (Part D)

Many of our clients will qualify for Extra Help, also called the low-income subsidy (LIS) from Medicare to pay prescription drug costs if their yearly income and resources are below the following limits in 2010:

Income Limits:

Full Subsidy – 135% of poverty for family size

Partial Subsidy – 150% of poverty for family size

Resource Limits:

Full Subsidy - Single/Married no dependents -        $8,100/$12,910

Partial Subsidy: Single/Married no dependents - $12,510/$25,010

Beginning January 1, 2010, changes in the law will make it easier for some people to qualify for Extra Help with their Medicare prescription drug plan costs. Under the Medicare Improvements for Patients and Providers Act:

• SSA will no longer count as a resource any life insurance policy; and
• SSA will no longer count as income the help received regularly from someone else to pay household expenses—food, mortgage, rent, heating fuel or gas, electricity, water, and property taxes.

Clients receiving Extra Help (LIS) will receive the following:

·       Help paying the Medicare drug plan’s monthly premium, or there may be no premium.

·       Help paying any yearly deductible.

·       Help paying coinsurance and copayments for prescription drugs that are on the plan’s formulary (list of covered drugs).

·       No coverage gap.

People automatically qualify for Extra Help if they have Medicare and meet one of these conditions:

• full Medicaid coverage.
• the state Medicaid program pays the Part B premiums (belong to a Medicare Savings Program).
• Get Supplemental Security Income (SSI) benefits.

Even if the client is eligible, they still must join a Medicare drug plan to get this Extra Help.  If not, Medicare may enroll the client in one.  Different plans cover different drugs. Clients should check to see if the plan covers the drugs used.  If the client has  Medicaid, Medicare will provide prescription drug coverage instead of Medicaid. Medicaid may still cover some drugs that Medicare prescription drug coverage doesn’t cover.