Find out if you are eligible for additional help paying for a plan.
You may be eligible for assistance in paying for your prescription drug plan. To find out what the income guidelines are or to fill out an application for assistance, please call 1-800-MEDICARE (1-800-633-4227) or fill out an online application at www.socialsecurity.com or contact your State Health Insurance Assistance Program (SHIP). ou can speak with a SHIP counselor who will help you apply. After you apply for assistance, you will receive a letter in the mail letting you know whether or not you qualify and what steps to take next. Please SAVE THAT LETTER.
Find a Medicare Prescription Drug Plan.
Medicare offers a service to help you find a Medicare Prescription Drug Plan. Their Medicare Plan Finder at www.medicare.gov will help you access the drug plans available in your area. You can also call 1-800-MEDICARE (1-800-633-4227).
Select a plan.
Based on the medications you take, the cost of the plan, and whether you can continue to use your local pharmacy, select the plan that is the best fit for your needs. Considering the following questions may be helpful as you evaluate your options:
Each of these questions is important, some more than others depending on factors such as the medications you take and how you want to obtain your prescriptions.
If you are switching to a new Medicare drug plan you do not need to cancel your old Medicare drug plan or send them anything. Your previous Medicare drug plan coverage will end when your new drug plan begins.
Contact the Medicare Part D Plan for enrollment material.
Call the plan and ask for an enrollment package or go to the plan Web site and enroll online. Medicare Prescription Drug Plan phone numbers and Web sites are available on the Medicare Web site, or you can request them by contacting a Medicare representative at 1-800-MEDICARE.
Complete the enrollment package and mail.
If you are eligible for additional help, you must still send in an application to enroll in the plan that you choose.
Begin to use your prescription drug card.
Once you have received your prescription drug identification card, please remember to present the card to your pharmacy when having a prescription filled. Contact the plan with any questions about your coverage. Your pharmacist is always available to assist you in changing drugs or finding generic alternatives. If you have any questions or concerns about your medications, ask your pharmacist.
Open Enrollment begins October 15, 2012 and ends December 7, 2012
Last year’s open enrollment date change was a success, allowing Part D Plans and Medicare to process new enrollments and get welcome kits and membership cards out to members prior to the January 1st plan effective date.
5 Star Plan Special Enrollment Period
In 2012 CMS introduced a new Special Enrollment Period (SEP). The 5 Star Plan SEP will continue in 2013. Starting December 8, 2012 you can switch to a 5 star Medicare Prescription Drug Plan at any time during the year. This enrollment period will allow members to change plans once at any time during the year as long as you are switching to a 5 star rated plan. Plan ratings are displayed on the Medicare website at www.medicare.gov.
If you choose to switch plans and enroll in a 5 star plan after December 7, 2012, the effective date for your new plan will be the first of the month following the month the enrollment request is received.
Although this change may seem positive on the surface, just because a plan is rated 5 stars does not mean it is necessarily the best plan for their circumstances. You will still need to ensure that the plan is affordable and that all of your medications are included in the plan’s formulary.
**NEW** 2013 Special Enrollment Period (SEP) to Leave a Consistently Low Rated Medicare Drug or Health Plan
To promote high Medicare Part D and Medicare Advantage plan quality, in 2013, The Centers for Medicare and Medicaid Services (CMS) will alert plan members if their Medicare Part D drug plan or Medicare Advantage health plan has failed for three straight years to achieve at least a 3-star quality rating and offer a Special Enrollment Period (SEP), if desired, that will allow the member to move to a higher quality plan.
If you are satisfied with your 2012 coverage, do nothing.
You will be automatically re–enrolled in the plan you were in if you do not elect to enroll in a different Medicare D Plan for 2013.
When does the plan begin?
Medicare (and eligible Medicaid) participants may enroll in the plan beginning October 15th and the benefits will start January 1, 2013.
Between September 15 and September 30, 2012
Medicare began mailing the 2013 Medicare & You Handbook that includes valuable information about all areas of Medicare. Section 6 of the Handbook, pages 81–94, is all about the 2013 Medicare Part D Prescription Drug Plan.
October 15, 2012
Marks the beginning of the open enrollment period. This is the first day to enroll in a plan for 2013.
December 7, 2012
Last day of the annual enrollment period, this is the last day to make an enrollment change (with the exception of the 5 star plan change change and special enrollment period to leave a low rated plan).
December 8, 2012
Marks the beginning of the 5 Star Plan special enrollment period.
Monthly Premium: Costs vary by plan
Initial Deductible: You pay an annual deductible up to $325.00 (an increase from $320.00 in 2012, but plan deductibles vary).
Initial Coverage Limit: The initial coverage limit for 2013 is $2,970.00, which is the combined amount of prescription expenses paid by the plan and the co-payments (an increase from $2,930.00 in 2012).
Enter the Coverage Gap (a.k.a. Donut Hole): ): After the Initial Coverage Limit has been met, coverage stops and you pay all your prescription costs until your total prescription expenses reach $6,733.75. In 2012, Part D enrollees will receive a 52.5% discount on the total cost of brand name drugs and a 21% discount on the total cost for generics drugs while in the donut hole until you reach the end of the coverage gap.**
Once expenses reach a total combined amount of $6,733.75 (what the plan has paid and what you have paid, including the donut hole), catastrophic coverage begins and your Part D plan pays 95% of covered prescription costs.
**You may be able to choose a plan that will assist you with some of your out-of-pocket costs. Some plans offer additional coverage during the coverage gap, so please review the plans to determine the best plan for you.
If you have limited income or few assets, you may be able to get additional help from Medicare. You may be eligible for reduced co-payments, lower or no premiums, and a zero deductible. Please review Section 7, pages 95-102 of your Medicare & You Handbook for more details or ask your pharmacist for more information.
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