12.6.4 Medicare Part D - Prescription Drug Plan
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) created Medicare Part D as an optional outpatient prescription drug benefit for individuals who are entitled to or are enrolled in benefits under Medicare Part A, Part B or both. The Medicare Prescription Drug Benefit Program (PDP) went into effect on January 1, 2006.
In Medicare Part C, we brought your attention to the six-month initial enrollment period that commenced on November 15, 2005 for both Part C and Part D. You should be aware that if a Medicare beneficiary decided not to enroll during this initial enrollment period and decides to enroll later, the beneficiary will pay a 1% penalty for each month of delayed enrollment, unless that person has comparable coverage from another source, such as a private or group plan.
Under the standard benefit, Medicare beneficiaries pay a monthly premium which varies from plan to plan and a $295 annual deductible (2009; $275 annual deductible in 2008). Once the annual deductible is satisfied, beneficiaries will be responsible for 25% of the first $2,700 (2009; $2,510 in 2008) of prescription drug costs (Medicare will pay the other 75%) of prescription drug costs, and coverage then stops. However, if a beneficiary's total drug costs are more than $6,153.75 (2009; up from $5,726.25 in 2008) after the beneficiary has spent another $4,350 (2009; up from $4,050 in 2008), then coverage starts again and beneficiaries pay copayments of $2.40 (2009; up from $2.25 in 2008) for generic drugs and $6.00 (2009; up from $5.60 in 2008) for brand name drugs or 5% of total costs, whichever is higher. Premiums and deductibles for Medicare Part D increase annually.
On December 27, 2005, Tom Gallagher, then DFS Chief Financial Officer, issued an informational bulletin to all companies and insurance agents marketing Medicare Part D and Medicare Advantage plans urging review and compliance with the CMS Medicare Marketing Guidelines. Among other things, these guidelines prohibit soliciting Medicare beneficiaries door-to-door before receiving an invitation from the beneficiary to provide assistance in the beneficiary's residence. The guidelines also require Medicare Part D solicitors to comply with the National Do-Not-Call Registry, honor "do not call again" requests, and abide by federal and state calling hours.
The CMS Medicare Marketing Guidelines can be accessed at the following web address:
http://www.cms.hhs.gov/ManagedCareMarketing/03_FinalPartCMarketingGuidelines.asp
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Medicare patients have a lifetime reserve of ______ of hospital coverage. |
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After the Medicare Part B annual deductible is satisfied, Part B will pay _____ of covered expenses. |
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Medicare Part C is a specialty plan that provides services that focus care on the management of a specific disease or condition and replaces the need for long-term care insurance. |
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Medicare Part D premiums and deductibles are scheduled to increase annually. |
