May 15 Medicare Drug Benefit Deadline

Prescription Drug Coverage for People with Medicare: Enrollment Deadline of May 15 Rapidly Approaching

If you have Medicare whether because you are 65 or older or because you are considered disabled by Social Security you can now get prescription drug coverage through Medicare.

However, you may be better off not joining a Medicare plan if you already have other drug coverage that is as good or better than a Medicare plan (creditable coverage). If you have prescription drug coverage now through a spouse, for example, or through a former employer, you should have received a letter telling you whether or not the coverage is creditable. If it is creditable, as long as you keep it, you do not have to think about Medicare enrollment deadlines. If it is not creditable or if you do not have any prescription drug coverage now, Medicare's prescription drug plans may benefit you.

Medicare's prescription drug coverage, known as Part D, is a voluntary or optional program. Hence, unless you have Medicaid and Medicare or unless you were in a Medicare Advantage plan with some drug coverage at the end of 2005, you must choose and enroll into a plan if you want the Part D coverage.

The enrollment deadline for 2006 is Monday, May 15. (If you applied for "extra help" or the low-income subsidy through the Social Security Administration or through your state's Medicaid office and did not enroll in a plan, you should have received a letter a few weeks ago telling you what plan you have as of May 1. If that plan does not cover your medications or if for any reason you do not like the plan, you should be able to switch plans at least once before May 15.)

Most people will pay a monthly premium for Part D (just as there is a premium for Medicare Part B which covers many out-patient services). Many people with low incomes and certain limited assets (like a savings accounts) can get help paying the costs of Part D.

There are also numerous plans with very low monthly premiums, though these are not always the best choice for people with high drug costs. There are many plans available around the country, and because there are so many plans with different costs and different lists of drugs covered (formularies) and different rules on prior authorization, quantity limits, and step therapy, it can be extremely difficult to choose a Part D plan that is right for you.

Moreover, under the law, Part D plans cannot cover certain categories of drugs, including the benzodiazepines that are sometimes used by people with RSD (such as clonazepam or Klonopin and alprazolam or Xanax). Yet if you have Medicare and no prescription drug coverage (or limited drug coverage, such as a standard Medigap prescription drug coverage plan), you may still find Part D valuable.

Just remember that if you already have prescription drug coverage that is as good or better than a Medicare plan (creditable coverage), including a retiree plan, signing up for Part D may mean that you and any of your dependents (such as a spouse or a child) on that policy can lose that entire health coverage permanently.

If you do not enroll in a Part D plan by May 15 and you do not now have other drug coverage that is as good or better than a Medicare plan (creditable coverage) and you cannot get a special enrollment period, you will not be able to get drug coverage through Medicare until January, 2007. In addition, the law says that you will pay a penalty higher Part D monthly premiums for as long as you have a Part D plan.

If you have any questions about Medicare's prescription drug coverage, you can contact Christin Engelhardt, who is working on health insurance issues for the RSDSA, at rsdsa-dc@hotmail.com.