Short, Easy-to-Read Information About the
New Medicare Part D Prescription Drug Plan

There is a new Medicare drug benefit, which began on January 1, 2006. If you receive both Medicare and Medicaid benefits, Medicare calls you “dual eligible”.  As a person who is dual eligible, you will have your Medicaid drug benefit replaced by the new Medicare drug benefit. This is called Medicare Part D.

The information about this new drug plan has been hard for many people to understand. This short, easy-to-read information gives the important, main ideas about the plan. To read a longer guide that gives more detailed information on this site, go to www.theDesk.info/PartD.

We are providing this short guide to give you the “big picture” and make it easier to find and understand more detailed information. There are places to click in this guide that will take you to more information. We suggest you read this once all the way through, and then go back and click on places where you want more information.

If you receive both Medicare and Medicaid, this information is very important for you to know. Please consider asking someone to support you if you need help understanding how the new drug plan works.

Who will have changes in their drug coverage?

• If you only receive Medicaid, your drug coverage will not change.
• If you receive services from both Medicaid and Medicare, you will receive drug coverage under the new Part D Medicare plan that started January 1, 2006.
• If you receive both Medicare and Medicaid, you must sign up with a Medicare Part D prescription drug plan (PDP) or you will not have drug coverage.

How does the new Medicare drug plan work?

• Private prescription drug plans (PDPs) will provide coverage.

• There are many PDPs to choose from. They are DIFFERENT in these ways:
  • Each plan covers different drugs, called a “drug formulary”.  More information.
  • Each plan has a list of different drug stores where you can get prescriptions filled
  • Each plan has a different cost. 

What are the costs of the new drug plan?

• Medicare will pay the premium (monthly fee) of a PDP up to an average or lower cost.  If you choose a plan that has a higher than average cost you will pay the amount over the average cost.
• You will not have a deductible (an amount each year before Medicare will begin paying for drugs). 
• If you live in a group home, institution or nursing home, you will not have to pay anything for your prescriptions.
• If you live anywhere else, you will pay between $1.00 and 5.00 for each prescription.  This is called a co-pay.  The amount you pay will depend on your income and the drugs you receive.
• You will not have a gap in drug coverage like people who only receive Medicare.  More information.

How do I sign up for the Medicaid drug plan?

• Medicare will automatically sign you up with a PDP.  You will receive a letter about this.
• If you want, you can change to a PDP that better fits your needs.
• The best way to switch to a different PDP is simply to enroll in the new PDP.
• You can switch PDP’s any time. The change goes into effect on the first day of the month after you switch.  More information.

How will I be able to decide which PDP best fits my needs?

• Look at the drugs each PDP covers, the drug stores you can use, and the cost of each plan.  Call 1-800-MEDICARE (1-800-644-4227), or check the website, www.medicare.gov.
• Most people find the information about the drug plan hard to understand. Get help from your family or support people if possible. More information.

What other things do I need to know?

• There are some medications the Medicare drug plan will not cover. More information.  Even more information.
• If your PDP does not cover a drug your doctor prescribes, ask your doctor if they can prescribe a different drug or help you ask for an exception.  More information.
• PDPs can change the drugs they cover.  They must tell you 60 days before they change.
• PDPs must provide a transition plan if you cannot find a plan that includes all of the drugs you need. More information.
• There are some differences in how the plan works if you live in a group home, nursing home or institution.  More information.