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Frequently Asked Questions about the Medicare prescription benefit

1. Who is eligible for Medicare Part D prescription drug coverage?
   All people who have Medicare Part A and/or Part B are eligible to enroll regardless of age, income or existing health conditions.
2. Is participation mandatory?
   No. It's up to you to decide whether or not you enroll in a Medicare Part D prescription drug plan.
3. How does Medicare Part D prescription drug coverage work?
   Private insurance companies are working with Medicare to develop or fine tune prescription drug plans. Each plan must meet Medicare's standard of care guidelines. The plans differ, so you will have to consider what coverage you need, if any, to determine which plan will be best for you.
4. Can Medicare Part D prescription drug coverage be purchased directly from Medicare? No. All plans are available through private insurance companies that have contracted with Medicare to provide this benefit.
5. Do people who receive prescription coverage through the VA have to change plans?
   No.
   Medicare Prescription drug coverage will have no impact on VA benefits.
6. Will Medicare Part D prescription drug coverage be available in the US territories? Yes.
7. Are prescriptions available free of cost?
   No. Just like other insurance plans, you will pay a portion of the cost. Typically, Medicare pays 75% and you pay the other 25% co-payment after an initial deductible. In addition, you will have to pay a monthly premium depending on the plan you select.
8. How much will people have to pay for Medicare Part D prescription drug coverage?
   Many plans have a yearly deductible of $295. In addition, the typical monthly premium is about $36 in 2009. Plus, participants pay a portion of the cost (a co-payment) for each prescription based on the plan you select. Once a beneficiary has paid the entire deductible amount of $295 (where applicable), Medicare will pay up to 75% of prescription drug costs. You pay the other 25% until total drug expenditures reach $2,700. In other words, you pay $601.25 for the next $2,405 of expense!
9. When can I enroll in, or change Medicare Part D prescription drug plans?
   Open enrollment for newly eligible beneficiaries and for those who wish to change their plan begins November 15, 2008 and ends December 31, 2008.
10. I'm a new enrollee. When does my Medicare Part D coverage begin?
    Your coverage with a Medicare Part D prescription drug plan begins on January 1, 2009.
11. What is creditable coverage?
    Creditable coverage refers to coverage from an employee or union plan that is on average at least as good as Medicare's standard level of coverage. If you are enrolled in a plan that has creditable coverage, you can wait to enroll in a Medicare drug plan. Your current plan will notify you if your retiree benefit provides you with creditable coverage.
12. Where can people get more information?
    Call Medicare at 1-800-MEDICARE or visit Medicare's web site at www.medicare.gov.
13. What is a formulary?
    A formulary is a list of drugs that each particular plan covers, and it differs from plan to plan. Be sure to request a formulary from the plans you wish to compare by calling each plan's benefits administrator. You will want to choose a plan that best suits your prescription drug needs.
14. What should I know about formularies?
    You should know that the cost of medications varies from plan to plan, as do their formularies. You will want to determine if the deductible and co-payments for the plan that best covers your prescription needs fits in with your budget. It's also important to know that some plans offer coverage for the doughnut hole, and others have no deductible or co-payments. Some formularies may not include one or more of the medications you take. If one or more of your medications isn't listed in the formulary of a particular plan, you may want to consider a different plan. Alternately, your doctor might be able to write you a new prescription for a medication that is equal in therapeutic value and is included in the particular formulary of your chosen Part D prescription drug plan.
15. How do Medicare beneficiaries get started?
    You can begin by writing down a list of the medications you take, how many times a day you take your medications and the strengths of each drug. Then, you can call any of the drug plans in your area or national plans to request a copy of their formulary. It's important to note that financial help is available to those who need it. So, after you have determined which plan is best for you, you can make your selection. Liberty's representatives can also be of assistance. Call them toll free at 1-800-597-8635.
16. What is a Medicare Advantage Plan?
    Medicare Advantage Plans and other Medicare Health Plans are offered by organizations such as HMOs, PPOs and Managed Care Plans. These plans manage all your healthcare needs by combining Medicare Part A (Hospitalization), Part B (Doctors and Medical Supplies) and Part D prescription drug coverage. In the past, you would have known them by the name "Medicare plus Choice".
17. What is a stand-alone Medicare Part D prescription drug plan?
    A stand-alone Medicare Part D prescription drug plan covers only prescription drugs. If you join a stand-alone Medicare Part D prescription drug plan you will need to continue your Part A and Part B coverage separately.
18. How do Medicare Part D prescription drug plans differ?
    All Medicare Part D prescription drug plans must meet Medicare's standard level of care criteria. However, some plans may offer more coverage and additional drugs, usually at a higher premium. Plans differ on which drugs will be included in their formularies. Additionally, there may also be differences in which pharmacies you can use to get your medications.
19. Are all drugs covered?
    No. Each plan will have a Medicare-approved list of drugs that are covered, called a formulary. Formularies vary from plan to plan, so it's important to compare each formulary to find the plan that best meets your prescription medication needs.
20. Which drugs are excluded from the Medicare Part D coverage?
    Certain drugs are excluded from Medicare Prescription drug coverage by law. The list includes drugs used for:
    • anorexia
    • weight loss
    • weight gain

    Also excluded are:

    • Non-prescription drugs
    • Prescription vitamins and mineral supplements (except prenatal vitamins and fluoride preparations)
    • fertility medications
    • Hair growth medications
    • Cough and cold remedies
    • Drugs taken while an in-patient
    • Inpatient drugs
    • Barbiturates (such as sleeping pills)
    • Benzodiazepines (such as Xanax^® and Valium^®
    Note: some plans may choose to cover these drugs as an added benefit.
    
    
21. Is medication management available?
    Yes. Help is available to ensure that your medications work well together to help avoid negative drug interactions. It's called "medication therapy management."
22. Will participating pharmacies buy drugs from Canada?
    No. Only drugs approved by the FDA for sale in the United States of America will be eligible for coverage.
23. Can I have my premiums deducted from my Social Security check every month?
    For the most part, yes. Just like your Part B premium, you can have your Part D prescription drug plan premium deducted from your Social Security check.
24. Is help available for people with limited income and resources?
    Yes. If you are single and your income is below $15,600 and your savings, investments and real estate (other than your home) are valued at no more than $11,990, you may qualify for extra help from the government.
    
    If you are married and living with your spouse and your income is below $21,000 and your savings, investments and real estate (other than your home) are worth less than $23,900, you may qualify.
    
    In some cases, people with limited income and resources will not have to pay premiums or co-insurance for a Medicare Part D prescription drug plan. Income amounts may be higher in Alaska or Hawaii.
25. What assets are counted to determine if one is eligible for assistance?
    Assets, including cash or property that can be converted to cash within 20 days, may be counted. Property excluded from the count includes the primary home, burial plots or burial agreements, and funds up to $1,500 that are set aside for burial arrangements.
26. When and how should people apply for extra assistance from the government?
    You may get an application in the mail from SSA for extra help paying for a Medicare Part D prescription drug plan. It is very important that you fill out this application and return it to SSA. If you don't get an application in the mail and think you may qualify for this help, call SSA at 1-800-772-1213. TTY users should call 1-800-325-0778. You can also visit www.socialsecurity.gov. SSA's application process provides you with the quickest decision. You can also go to your State Medical Assistance office to apply.
27. Once I've enrolled in a Medicare Part D prescription drug plan, can I change plans?
    Yes. Each year you can change plans from November 15 through December 31. Another circumstance that may give you the right to change plans would be if you moved outside of your plan's service area. You could then choose a plan that services your new location.
28. Will people who don't spend very much each year on prescriptions benefit from enrolling in a Medicare Part D prescription drug plan?
    Yes.
    Those who participate in a Medicare Part D prescription drug plan will have access to discounts on the medications they purchase, as well as peace of mind should they become ill in the future.
29. If I don't join a Medicare Part D prescription drug plan when I first become eligible, will I have to pay a penalty for waiting?
    Yes. If you don't join a Medicare drug plan when you first become eligible, you may have to pay a late enrollment penalty when you do join. Furthermore, you will have to pay this penalty as long as you are a participant in a Part D plan. This amount is different each year.
30. What types of Medicare Part D prescription drug plans can I choose from?
    

    There are three basic prescription drug plans for you to choose from. They are:

    Stand-alone Medicare Part D prescription plans
    - If you participate in a stand-alone Medicare Part D prescription plan, nothing will change with your Medicare Part A or B coverage. You will still have the freedom to choose whatever participating doctor you prefer, and you may fill your prescriptions through the participating mail order or retail pharmacy of your choice.

    Medicare Advantage Plan or other Medicare Health Plans with Prescription drug coverage (HMO or PPO)
    - If you choose to enroll in a Medicare Advantage Prescription drug plan, all aspects of your healthcare, including your Medicare Part A and Part B coverage, are managed for you. You will choose a healthcare provider from a list approved by your plan, and you must fill your prescriptions through pharmacies that participate in your plan.

    Employee Retirement Plan
    - This is a plan provided to you by your former employer, union or other third party. If the coverage offered by your plan is "creditable," (at least good as a standard Part D drug plan,) you may want to stay with that plan. All employee retirement plans are required by law to inform you if the plan is considered creditable.
31. What does the typical Medicare Part D prescription drug plan look like, dollar-wise?
    

    In addition to the premium you may pay, the benefits design for a basic plan has the following elements:

    • You generally have a $295 deductible.
    • The plan will pay 75% of your drug costs until you reach $2,700 - you pay 25% of the cost (total of $601.25).
    • You will then pay 100% of your drug costs until you reach a total out of pocket costs of $4,350 (or $5,451.25 in total drug spending).
    • After you have incurred $4,350 in out of pocket drug costs, the plan will pay 95% and you will pay 5%.

    Note: The above numbers apply annually. There will be many different plans, each offering different deductibles, co-payments and pricing.

32. Should I choose a regional or a national plan?
    It depends. Let's say you live in Michigan but you spend your winters in Florida. You would want to choose a national plan. If, on the other hand, you live in Michigan year-round, a regional plan would satisfy your needs as well as a national plan.

As you think about your prescription needs, keep in mind that we offer a complete mail order pharmacy that is staffed by licensed pharmacists. For most available Medicare drug plans, Liberty's pharmacy can fill your prescriptions, and you'll enjoy convenient home delivery with no charge for shipping.

† Meter offer available to qualified beneficiaries with diabetes. Not available to current Liberty patients. No purchase necessary. Meter shown for illustrative purposes only. Meter offer not applicable to all brands of meter. Commemorative keychain offer and free HealthMatters subscription dependent on patient enrollment. Combined offer available while supplies last. Terms and conditions apply.

* Up to 90 days from shipment (a longer period may apply based on law or regulation). Some restrictions apply. We are unable to accept returns of properly filled prescriptions.