Medicare Part D Drug Benefit

Part D basics

Medicare works with insurers and other private companies to offer different prescription drug plans that vary in cost and drug formularies. During the Medicare Part D annual open enrollment period, Medicare beneficiaries can enroll in a drug plan. Beneficiaries already enrolled in a Part D drug plan can change to a different plan during this period. The enrollment period typically begins in the fall.

Key things to consider when choosing a drug plan:

• Will the drug plan pay for all or most of the drugs you take now?
• Are your Alzheimer's drugs on the formulary? Check the 2013 prescription drug plan chart (PDF).
• Does the plan cover the doses of the drugs that you take?
• Does the plan's rules limit coverage of your Alzheimer's drugs and/or your more costly drugs by requiring "prior approval"? Check the 2013 prescription drug plan chart (PDF).
• Does the plan's rule require you to try a less expensive, similar drug ("step therapy") before the plan will pay for your drug(s)?
• Are there limits on the number of pills that a prescription may cover ("quantity limits") over a specific period of time?
• What will the plan cost you? Be sure to compare all of the costs for each plan, including the deductible, copayments and co-insurance, not just the amount of the monthly premiums.
• Is my local pharmacy in the plan's pharmacy network? If you prefer to use mail order for your drugs, does the plan offer it as an option?

Learn more:
Things to Consider when Choosing a Medicare Drug Plan (PDF)
Extra Help for Medicare Beneficiaries in Paying for Prescription Drugs (PDF)
Open enrollment Questions and Answers (PDF from MapRx)
Timeline for Medicare Prescription Drug Mailings (PDF from Centers for Medicare and Medicaid)

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Re-assignment for Medicare-Medicaid and "extra help" enrollees

Medicare beneficiaries who receive "extra help" or who receive Medicaid benefits were sent letters from the Centers for Medicare & Medicaid Services (CMS) regarding their current plan.

If you received a blue letter: Beneficiaries were sent a blue letter because their current plan either: 1) is leaving the Medicare program in 2013 or 2) their current plan will charge a higher premium in 2013. The letter informs beneficiaries that CMS will automatically reassign them to another plan unless the individuals select new plans.

If you received a tan letter: Medicare beneficiaries who receive "extra help" were sent a tan letter from CMS. These individuals are called "choosers" because they selected and joined their previous or current drug plan on their own. Their plans' premium is increasing in 2013, and this group will have to choose a new plan with a lower premium on their own or they will pay a portion of their monthly premium in 2013. CMS will not automatically assign "choosers" to new plans

In 2013, there has been a 2 percent decrease in plans (327 nationwide) for "extra help" beneficiaries (also called benchmark plans). The slight decrease in benchmark plans is primarily the result of the loss of benchmark status for most plans offered by UnitedHealth. However, beneficiaries receiving the "extra help" subsidy or on Medicaid will still have options of plans from which to choose in most states.

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Special Needs Plans (SNP) for Alzheimer's disease

For 2013, there are two Medicare Special Needs Plans (SNPs) for individuals with dementia, including Alzheimer’s disease. SNPs are Medicare Advantage plans that specialize in care and coverage for beneficiaries with dementia. Only Medicare beneficiaries with dementia can enroll in these plans. They are:

• Universal Health Care: Universal Secure Choice, an HMO available in 21 counties in Florida
• Medica Complete Solution – Dementia, an HMO available in 22 counties in Minnesota

Extra help paying for prescription drugs

People with Medicare who have limited income and resources may qualify for extra help paying for prescription drugs. The Social Security Administration (SSA) and CMS are working together to provide this extra assistance.

• People with both Medicare and Medicaid (called "dual eligibles") will automatically qualify for extra help.
• Other individuals may apply for extra help from the SSA. Apply online at www.socialsecurity.gov, or call 800.772.1213 for a paper application or to make an appointment.

• Money Matters (PDF)
• Planning for Care Costs
• Insurance
• Tax Deductions and Credits
• Legal Plans (PDF)

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