COMPARISON BETWEEN COVERAGES

What are some of the most significant differences between Medicare’s prescription drug coverage rules governing dual eligibles and the rules for the other Medicare beneficiaries?

·        Dual eligibles will be auto-assigned to a Medicare PDP.  Other Medicare beneficiaries will not be auto-assigned.

·        Because dual eligibles are auto-assigned in a PDP they will not be subject to any late enrollment penalties.  General Medicare beneficiaries may be required to pay if not enrolled during the specified enrollment period.

·        Dual eligibles will not have to pay a monthly premium (if they retain their auto-assigned plan or choose a plan at or below the average).  Other Medicare beneficiaries will pay approximately $32.

·        Dual eligibles will not have any deductibles.  Other Medicare beneficiaries will have a $250 deductible.

·        Dual eligibles will not have a gap in coverage.  For other Medicare beneficiaries the coverage gap refers to the annual drug spending from $2,250 to $5,100.  In this period, PDPs provide no coverage, and individuals must pay 100 percent of their drug costs.

·        Dual eligibles can switch prescription drug plans at any time.  Other Medicare beneficiaries can switch only once a year.

Can a person with a developmental disability who receives Medicare but does NOT receive Medicaid benefits receive extra help in paying for their prescription drugs?

If a Medicare beneficiary’s resources are limited (annual income below $14,355 a year for individuals and $19,245 a year for couples in 2005) and their assets are low (less than $11,500 for individuals and $23,000 for couples) he or she may be eligible for extra help paying for their Medicare drug costs (premiums, deductible and co-pays).

Medicare beneficiaries must apply for this extra help through the Social Security Administration (SSA) by using either the SSA’s paper or online application (available at www.ssa.gov). Beneficiaries may also call SSA at 1-800-772-1213 or visit their local SSA office. After the SSA determines eligibility for extra help in paying for Medicare’s prescription drug costs, beneficiaries must choose and enroll in a Medicare prescription drug plan (PDP).  Visit www.medicare.gov or call 1-800-Medicare (1-800-633-4227) for more information.