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Medicare Part D Update

September, 2005:

:: Important Update!
:: How would I decide if a Medicare Part D plan is the right choice for me?
:: Will the $3,600 annual out-of-pocket threshold always remain the same?
:: Still not sure about out-of-pocket costs? Use our free online Cost Calculator.
:: Which prescription drugs are covered under the Medicare Part D plans?
:: More on the "penalty" for enrollment after the May 15, 2006 deadline...
:: Will there be additional financial assistance based on personal need?

Important Update!

Medicare's approval date for Medicare Part D plans has been moved back to September 14th. Originally, the Centers for Medicare and Medicaid Services ("CMS") had planned to release details on the approved Medicare Part D plans on September 2nd.
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How would I decide if a Medicare Part D plan is the right choice for me?

Like any insurance coverage decision, the question of whether to join a Medicare Part D plan depends on your particular situation. There are however, certain simple factors that you can consider in preparation for this question.
For instance:
  • How much do I spend each year on prescription drugs?
  • What does the Medicare Part D plan cost each month?
  • Does the Medicare Part D plan cover your particular prescription drugs?
  • What are the Medicare Part D plan's co-payment and deductibles?
  • Do you qualify financially for any "Extra Help" programs?
Please note, as a rough guideline, it is estimated that if you spend as little as $68.00 per month on prescription drugs (or $810.00 per year), you could save money with a Medicare Part D plan (depending on the plan's monthly premium).

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Will the $3,600 annual out-of-pocket threshold always remain the same?

No, the annual estimated out-of-pocket threshold of $3,600 could increase annually based on average prescription drug expenditures.
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Still not sure about out-of-pocket costs? Use our free online Cost Calculator.

If you would like to calculate your "estimated" out of pocket prescription drug costs, we have built a free online Cost Calculator. You need only go to the link below, enter your yearly prescription drug costs and press the "Submit" button.

** Please note: No data will be collected by us and your information remains confidential.


:: Medicare Part D - Online Out-of-Pocket Cost Estimator
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Which prescription drugs are covered under the Medicare Part D plans?

As noted, the actual details for individual plans have not yet been released. However, every therapeutic category of prescription drugs will be covered under the Medicare Part D prescription drug plans.

Although, it is expected that not every plan will cover each drug. In other words, the prescription drug lists (that is, the type of medication covered by a Medicare Part D plan) probably will vary from plan to plan.

Medicare beneficiaries must therefore choose a plan that best accommodates all of their personal prescription drug needs and financial situation.


:: Do you have questions? Visit our FAQs and Customer Helpdesk
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More on the "penalty" for enrollment after the May 15, 2006 deadline...

As mentioned in our last Newsletter, the cost of the Medicare Part D plans will increase by 1% per month for each month after the close of the open enrollment period (May 15, 2006). This "penalty" will stay in effect for the life of the Medicare Part D plan.

As noted before, the decision to join a Medicare Part D plan depends on each person's personal situation. If you have no need for prescription medications or you are satisfied with your HMO's plan, you may decide not to join a Medicare Part D plan and simply save yourself the monthly premiums. The challenge will arise when, and if, you later require more prescription drugs or find it necessary to join a Medicare Part D plan at the "increased" premium level.

From the eMails that we have received from our Newsletter readers, many people are contemplating exactly this situation: "Do I join a plan now or wait, and maybe join a plan later at a higher monthly cost?"

As mentioned above, mathematically, if a Medicare participant spends as little as $68.00 on prescription drugs per month, then a Medicare Part D plan with a monthly premium of $35.00 would break-even. Premiums under $35.00 or expenditures higher than $68.00 per month would save you money. Once again, as more information becomes available, each person must consider his or her own personal situation and whether a Medicare Part D plan makes sense.

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Will there be additional financial assistance based on personal need?

The Federal Government will provide an extensive program for people needing financial assistance with the Medicare Part D program. Depending on your income level (or available financial resources), Medicare will provide "extra help" that may cover 85% to 100% of prescription costs and may also pay a part or all of your Medicare Part D premiums. The Social Security Administration may also be able to provide more information (1-800-772-1213). (Please note, your State may also provide additional financial assistance plans.)
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Last updated on: 07/18/2008

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