Community pharmacists are the most accessible health care providers for patients and can be a great resource and useful guides for beneficiaries attempting to navigate through the Medicare Part D program.
Background on Part D
The voluntary drug benefit for Medicare beneficiaries known as Medicare Part D developed as a result of The Medicare Modernization Act, or MMA. Medicare does not provide the coverage directly. Private health insurance companies contract with Medicare to provide this coverage to beneficiaries.
Eligibility
Beneficiaries must be entitled to the Medicare benefits under Medicare Part A and/or enrolled in Part B to be eligible for Part D. Everyone with Medicare is eligible to join a Prescription Drug Plan (PDP), regardless of income, health status or how much they currently spend on prescription medicines.
Enrollment
There are specific times when beneficiaries can sign up for Medicare prescription drug coverage or make changes to existing coverage.
People turning 65 years old, who are eligible for Medicare, can join a PDP as soon as three months before and as late as three months after their 65th birthday. Those who wait or choose not to sign up for prescription drug coverage may have to pay a penalty if they decide to enroll later.
Every year, beneficiaries can changes to their prescription drug coverage for the following year during the Annual Enrollment Period. Beginning in 2011, the Annual Enrollment Period will run from Oct. 15 through Dec. 7. This is a change from previous years, when the Annual Enrollment Period took place from Nov. 15 through Dec. 31.
Beneficiaries covered under Medicaid and Medicare qualify for a Special Enrollment Period and can switch plans each month.
Plan Selection
Your local community pharmacist can help educate you about the factors to consider when choosing a Medicare plan. Budgetary factors that you will need to take into consideration include how much you want to pay each month for coverage (your premium), how much you want to pay out of pocket for medicines before coverage kicks in (your deductible), how much you want to pay at the pharmacy for each prescription (your co-pay or coinsurance) and which plan(s) cover the drugs you are taking.
Additional Items to Discuss with your Pharmacist
Selecting a plan can be a daunting process. Your pharmacist can help you use the Medicare Plan Finder Web site at www.medicare.gov, help you apply for assistance with your prescription drug costs, and tell you about other helpful resources in your community.
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