The Medicare Prescription Drug Plan – A Brief Overview

The Centers for Medicare and Medicaid Services (CMS) are the agencies of the U.S. government that administer the Medicare program. Medicare provides health insurance coverage to citizens who are at least 65 years old. Specific criteria must be met for a person younger than 65 to be eligible for the CMS Medicare program. 

New CMS Medicare drug plans were made available to all Medicare members on January 1, 2006.  These plans were made possible through insurance companies and private interest working with CMS Medicare.  Discounts on drug prices are possible through this partnership.  CMS Medicare members must research and choose a drug plan suitable to their situations.

These new drug plans are not free, like the CMS Medicare Part A plan.  Members of the new CMS Medicare drug plan must pay a monthly fee and a fraction of their prescription drugs.  This out-of-pocket fraction varies by drug plan.

Each new CMS Medicare drug plan must provide a minimum standard of coverage.  Some of the plans offer more coverage than the minimum, but those plans also cost more.  The plans also vary in which drugs are covered, how much the insured person pays, and what pharmacies the CMS Medicare beneficiary can use.

Current CMS Medicare Part A or B members were eligible join a drug plan between November 15, 2005 and May 15, 2006.  Coverage began on January 1, 2006 for those who joined on or before December 31, 2005.  The window of opportunity to join a CMS Medicare drug plan or change plans occurs each year between November 15 and December 31 of that calendar year.

Those eligible persons who use few or no prescription drugs should still consider joining the CMS Medicare drug plan as soon as possible.  Those who did not join by May 15, 2006 may now be paying an extra penalty if they joined afterwards.

CMS Medicare drug plan financial aid is available to certain persons who might have trouble paying for a new drug plan.  Those who are eligible for this CMS Medicare aid can have some or all of their monthly drug plan premiums paid.  Those with the most need can receive more aid.

What should you do if your employer’s drug plan is at least as good as the standard CMS Medicare prescription coverage?  If you wish, you can keep your current plan.  If your current plan ends, you won’t pay a penalty if you join a CMS Medicare drug plan within 63 days.  Note that if you discontinue your current employer plan in favor of a CMS Medicare plan, it may not be possible to reinstate your employer plan.

There are several resources to assist you in choosing one of the new CMS Medicare drug plans.  You should have received the CMS Medicare handbook titled “Medicare & You 2006.”  You can access the CMS Medicare Prescription Drug Plan Finder online at Medicare.gov.  You can also call your local Social Security office for free help.

Choosing the CMS Medicare plan that includes most or all of your prescription drugs, maximizes your coverage, and minimizes your costs takes effort.  With the aid of family, friends, and Medicare or Social Security help, you can find the best CMS Medicare plan for you.

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