Frequently Asked Questions

Medicare prescription drug coverage is insurance. Private companies provide the coverage. You choose the drug plan and pay a monthly premium. When you join a plan, Medicare helps pay the bill.

- It provides you with insurance coverage for prescription drugs.
- It pays for both brand name and generic drugs.
- It offers a choice of plans

As with any insurance program, you have options. Although these plans will meet Medicare's stringent requirements, they may differ in terms of costs and coverage. If you already have good drug coverage through a retiree plan or Medicare Advantage Plan, Medicare can provide help with its cost. As with other types of insurance, your monthly premium and out-of-pocket costs may vary with different plans.

Everyone who is eligible for Medicare is eligible for prescription drug coverage regardless of income level, pre-existing conditions, or current prescription expenses.

What is the Donut Hole?

Medicare drug plans may have a "coverage gap," which is sometimes called the "donut hole." A coverage gap means that after you and your plan have spent a certain amount of money for covered drugs (no more than $2,510), you have to pay out-of-pocket all costs for your drugs while you are in the "gap." The most you have to pay out-of-pocket in the coverage gap is $3,216.25. This amount doesn't include your plan's monthly premium that you must continue to pay even while you are in the coverage gap. Once you've reached your plan's out-of-pocket limit, you will have "catastrophic coverage." This means that you only pay a coinsurance amount (like 5% of the drug cost) or a copayment (like $2.15 or $5.35 for each prescription) for the rest of the calendar year.
 

Extra help is available for people with limited income and resources. People who may qualify will receive an auto-enrollment application by mail. Qualified people will have almost no drug expenses.

Enrollment begins November 15, 2005 and ends May 15, 2006. If you do not sign up with a plan by May 15, 2006, you will have to pay a percentage penalty for every month that you were eligible and did not sign up. Your next chance to sign up will not be until November 15, 2006 and your coverage  will not begin until January 1, 2007.

You must join a plan if you want this coverage. Some people will be automatically enrolled for basic coverage. Please contact Medicare to see if you qualify for auto-enrollment.

All prescription drug discount cards will no longer be valid as of
January 1, 2006.

For an easy to understand, short and to the point explanation on how Medicare Part D will work for you CLICK HERE