About Lupus

What You Need to Know About Medicare Part D

Medicare Part D Starts January 1, 2006
If you get help paying for your medicines through Medicare or a combination of Medicaid and Medicare (dual-eligibles), your coverage will be through a different system—called Medicare Part D—starting on January 1, 2006.

Medicare Part D is still a government program, but prompts you to select one of numerous private prescription drug plans (PDP) to get drug coverage.

As a person with a chronic illness, you probably take many different medicines. Your goal is to pick the company that lists all (or most) that you take in its formulary (drug list), and sells them at a good price. You also want to make sure that the prescription drug plan you choose will distribute the drugs through a pharmacy that is convenient to you.

Medicare Part D is complex and confusing to many people. The S.L.E. Lupus Foundation and its programs can help you understand it and guide you through some important decisions you have to make.

Important Points

  • Everyone on Medicare can get drug coverage. No one can be denied coverage for health reasons or income level. If you have Medicare, or both Medicare and Medicaid, drug coverage will be available through Medicare Part D as of January 1, 2006.
  • The program is voluntary for those with Medicare only. You may have good drug coverage from another plan, for example. If you do not currently have drug coverage ("credible coverage") and you enroll in Part D after the deadline of May 15, 2006, you will be charged a higher monthly premium.
  • Dual-eligibles are required to receive drug coverage through Medicare Part D (no longer Medicaid). They will be automatically enrolled in a PDP starting January 1, 2006. You can switch plans at any time.
  • There are different Medicare Part D plans. To get coverage, you must enroll in one of the approved PDPs. The Lupus Cooperative can help you choose the right plan.
  • It's important to compare plans. Each plan selects which drugs it will pay for (its formulary), which pharmacies it will work with (its network) and how much it will charge (either monthly or per prescription). Choose one that fits your needs.
  • Some people are eligible for extra coverage. If you have limited income, you can apply for assistance through the Social Security Administration at www.ssa.gov or by calling 1-800-772-1213.

The End of Drug Discount Cards
Medicare-approved drug discount cards were offered as a transition step to help people with Medicare save money on prescription drugs until the prescription drug plans became available. You can use the card until May 15, 2006—or until you join a Medicare prescription drug plan (whichever occurs first).

Know Your Options

  • Keep all letters and other communications that you receive from Medicare, Medicaid and drug companies.
  • Make a list of all the drugs you take, how frequently you take them, the dose you take, and how much they cost (both for brand name and generic).
  • Ask the pharmacist you currently use which drug coverage plans they will accept starting in January 2006.

Access plan information at www.medicare.gov, or by calling 1-800-633-4227.