Medicare Part D FAQ

Medicare Part D became effective Jan. 1, 2006, as the result of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Medicare Part D is a prescription drug benefit provided by private insurance companies and other providers approved by Medicare and contract with the federal government.

Who qualifies for Medicare Part D?
You can join a Medicare Part D plan if you are entitled to Medicare Part A and/or enrolled in Medicare Part B and live in the plan's service area. This is your Initial Enrollment Period (IEP).

When can I sign up?
Your participation in Part D is not automatic. The annual enrollment period (AEP) begins Nov. 15 and ends Dec. 31, with coverage taking effect Jan. 1 of the following year. Provided you maintain continuous coverage, individuals enrolled in Medicare Part D are allowed to switch plans every year between Nov. 15 and Dec. 31, to take effect Jan. 1 of the following year.

What are the benefits of Part D?
Whatever plan you choose, Medicare prescription drug coverage assists with your expenses for brandname and generic drugs.

How much does it cost?
Although Medicare pays a substantial portion of the cost, you must enroll in a Part D plan by paying a small monthly premium. Additionally, you may pay a deductible, depending on which plan you choose and in which state you live. You also are responsible for a copayment/coinsurance for your prescription drugs, which varies too, depending on which plan you choose and in which state you live.

Can I qualify for extra help?
If you have limited income and financial resources, you may qualify for assistance in the form of reduced or eliminated premiums and/or deductibles. You can apply for or get more information about this assistance by calling Medicare at 1-800-633-4227 (TTY/TDD: 1-877-486-2048) or the Social Security Administration at 1-800-772-1213 (TTY/TDD: 1-800-325-0778).

Am I protected against increased drug costs?
Enrollment in Part D could buy you the protection you need if your drug costs become very high. Remember, using generics can help keep down prescription drug costs.

Do I get a discount on prescription drugs?
You have access to discounted prices if you join a Medicare prescription drug plan and use the plan's pharmacy network. Part D plans use various networks, so be sure to check to see if your preferred pharmacy is in the network.

Will I pay more if I enroll late?
You pay a late enrollment if you don't join a Medicare prescription drug plan when you are first eligible to join during your Intial Enrollment Period (IEP), and there is a period of 63 or more continuous days during which you don't have creditable prescription drug coverage as good as Medicare.

Your penalty is calculated when you first join a Medicare drug plan. To estimate your penalty, take 1% of the national average premium for the year you join (The 2010 national average premium is $31.94). Multiply it by the number of full months you were eligible to join a Medicare prescription drug plan but didn't. This is your estimated penalty amount, which is added each month to your Medicare prescription drug plan's premium, for as long as you have the plan. If you qualify for extra help, the penalty is different. For help figuring out how much your penalty will be, call 1-800-MEDICARE/1-800-633-4227 (TTY/TDD: 1-877-486-2048), or call your State Health Insurance Assistance Program.

Are the drugs I need covered by Medicae Part D?
Covered drugs can vary from plan to plan, so be sure to review each plan's formulary information, which is available at www.medicare.gov beginning in October. You may want to consider switching your prescription to an equivalent drug if a drug you are currently using is not available through a particular plan.

How do I know if I'm getting the best value?
Enrollees should be able to compare prices of the different Medicare Part D plans on Medicare's website (www.medicare.gov).

How can I be sure your plan offers pharmacies that are convenient?
You can learn which pharmacies are 'in-network' for each plan — offering the best prices for medications and the lowest costsharing rates. If the 'in-network' pharmacies available in a plan are not local, you may find using a mail order pharmacy to obtain medications is the most cost-effective option. Of course, you may choose to eliminate local pharmacy fulfillment altogether and use the mail order pharmacy option from the beginning as the most convenient and cost-effective method.

What should I know if I have prescription drug coverage from a former or current employer or union?
Medicare will help employers or unions continue to provide retiree drug coverage that meets Medicare's standards. Your or your spouse's former or current employer or union will send you information about how your current coverage compares to the Medicare standard prescription drug coverage. This information is important because it can affect the decision you need to make this fall regarding if and when you sign up for Medicare prescription drug coverage.

If your or your spouse's employer or union determines that your current coverage, on average, is at least as good as the Medicare standard prescription drug coverage (called creditable prescription drug coverage):

• You can keep it as long as it is still offered by your employer or union.
• You won't have to pay a penalty if your employer or union stops offering prescription drug coverage as long as you join a Medicare drug plan within 63 days after the coverage ends.

Caution: If you drop your employer or union coverage, you may not be able to get it back. You also may not be able to drop your employer or union drug coverage without also dropping your employer or union health coverage.

If your employer or union plan is not as good as Medicare prescription drug coverage, find out about your options from your Benefits Administrator. You may be able to:

• Keep your current employer or union drug plan and join a Medicare drug plan to give you more complete prescription drug coverage.
• Drop your current coverage and return to the original Medicare plan. Join a Medicare prescription drug plan.
• Join a Medicare Advantage plan or other Medicare health plan that covers prescription drugs. See the caution above.

What should I know if I have drug coverage from TRICARE, the Department of Veteran's Affairs (VA), or the Federal Employee Health Benefits Program (FEHB)?
Contact your Benefits Administrator or FEHB insurer for information about your TRICARE, VA, or FEHB coverage before making any changes. It is almost always to your advantage to keep your current coverage without any changes. If you lose your TRICARE, VA, or FEHB coverage, in most cases you won't have to pay a penalty, as long as you join a Medicare drug plan within 63 days of losing TRICARE, VA, or FEHB coverage.

How does healthcare reform affect Medicare Part D?
Healthcare reform law will reduce the amount Medicare Part D enrollees are required to pay for prescriptions when the coverage gap (donut hole) is reached. Beginning in 2011, Part D enrollees who reach the coverage gap will receive a 50% discount on the total cost of their brand-name drugs in the gap, as agreed to by pharmaceutical manufacturers.  Medicare will gradually phase in additional subsidies in the coverage gap for brand-name drugs (beginning in 2013) and generic drugs (beginning 2011).  By 2020, Part D enrollees will receive a 50% discount on brand-name drugs from pharmaceutical manufacturers, plus a 25% federal subsidy (beginning in 2013).  Part D enrollees will be responsible for only 25% of the total cost of their drugs out of pocket.  Also by 2020, 75% of the cost of generic drugs in the gap will be subsidized by Medicare (beginning 2011), while beneficiaries will pay the remaining 25% out of pocket.  Between 2014 and 2019, healthcare reform law will reduce the out-of-pocket amount that qualifies an enrollee for catastrophic coverage, further reducing out-of-pocket costs for those with relatively high prescription expenses. In 2020, the level will revert to the amount it would have been, absent the reductions in the intervening years.

Sources:  Focus on Health Reform, The Kaiser Family Foundation, March 2010; Closing the Prescription Drug Coverage Gap, CMS, May 2010.

How do I end my membership in your plan?
Usually, to end your membership in our Part D Plan, you simply enroll in another company's Medicare prescription drug plan during one of the enrollment periods. However, there are a couple of exceptions:

• One exception is when you want to switch from our plan to Original Medicare without a Medicare prescription drug plan. In this situation, you must contact our Company's Customer Service department and ask to be disenrolled from our Plan. Call us toll-free: 1-866-524-4171 (First UA Part D) or 1-866-299-3407 (First UA Part D Silver). Hearing-impaired callers using TTY/TDD equipment call toll-free: 1-866-524-4172.
• Another exception is if you join a Private Fee-For-Service plan without prescription drug coverage, a Medicare Medical Savings Account Plan, or a Medicare Cost Plan. In this case, you can enroll in that plan and keep our Plan for your drug coverage. If you do not want to keep our Plan, you can choose to enroll in another Medicare prescription drug plan or to drop your Medicare prescription drug coverage.

The information below further explains how you can end your membership in our Medicare Part D prescription drug plan.

If you would like to switch from our plan to:

Another Medicare prescription drug plan
Enroll in the new Medicare prescription drug plan. You will automatically be disenrolled from our Plan when your new plan's coverage begins.

A Medicare Advantage plan
Enroll in the Medicare Advantage plan. With most Medicare Advantage plans, you will automatically be disenrolled from our plan when your new plan's coverage begins. However, if you choose a Private Fee-For-Service plan without Part D drug coverage, a Medicare Medical Savings Account plan, or a Medicare Cost Plan, you can enroll in that new plan and keep our Plan for your drug coverage. If you want to leave our plan, you must either enroll in another Medicare prescription drug plan or contact our Company's Customer Service Department, or Medicare, and ask to be disenrolled. Call us toll-free: 1-866-524-4171. Hearing-impaired callers using TTY/TDD equipment call toll-free: 1-866-524-4172. Or, contact Medicare and ask to be disenrolled: 1-800-MEDICARE (1-800-633-4227).

Original Medicare without a separate Medicare prescription drug plan
Contact our Company's Customer Service Department and ask to be disenrolled from the Plan. Call us toll-free: 1-866-524-4171. Hearing-impaired callers using TTY/TDD equipment call toll-free: 1-866-524-4172. Or, contact Medicare and ask to be disenrolled: 1-800-MEDICARE (1-800-633-4227). TTY users: 1-877-486-2048.

 

 

 

updated 10/1/10

FIRST UNITED AMERICAN Part D Prescription Drug Plans