1. Compare & enroll in Medicare prescription drug plans
2. Extra Help application
3. Extra Help information
4. Illinois Cares Rx
5. Medicare fraud
6. Medicare prescription drug coverage
7. Medigap insurance plans
8. My Medicare Matters, understanding Medicare drug coverage.
9. Prescription Drug Programs - non-Medicare
10. Printer friendly version of this information.

Medicare prescription drug plans are available for anyone with Medicare, regardless of income or age. There are many different drug plans available in Illinois. These drug plans are approved by Medicare, but administered by private companies.

Each year between November 15^th until December 31^st, Medicare beneficiaries who haven’t sign up will have another opportunity to enroll in a drug plan, and currently enrolled beneficiaries can change plans if there is one which better meets their drug needs. Beneficiaries who are satisfied with their prescription drug plan do not have to re-enroll to retain their current coverage.

People new to Medicare have seven months to enroll in a drug plan (three months before, the month of, and three months after they become eligible for Medicare).

A crucial part of deciding which drug plan to choose involves knowing which prescription drugs are covered by the different plans. The only easy way to compare drug plans is on the Internet. The Medicare website (see link above) has a “Compare Medicare Drug Plans” link which anyone can use to find out which drug plan best fits their needs and pocketbook. This comparison tool is needed since not all drug plans cover every drug, and the monthly premium and deductible varies depending on the drug plan chosen.

For those individuals who do not have access to the Internet, senior citizen centers in Southern Illinois have high speed Internet connections in order to help senior adults make their decision about Medicare’s approved prescription drug plans.

For many Medicare beneficiaries, the monthly premium and drug co-pay amounts are financially difficult. Programs to help low and moderate income beneficiaries pay these costs are Extra Help, via the Social Security Administration, and Illinois Cares Rx.

1. The Extra Help application is available at any Social Security office (see link above), or by calling toll-free 1-800-772-1213 (for TTY, call 1-800-325-0778). Most senior centers have copies of the Extra Help application, as well.
2. The Illinois Cares Rx application is available at all senior centers, on the Internet (see link above), or by calling toll-free 1.800.252.8966 (for TTY, call 1.888.206.1327).

If you still have questions about Medicare prescription drug coverage and the Illinois Cares Rx program, call your local senior center or the Senior Health Insurance Program (SHIP).

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Summary of Medicare Prescription Drug Coverage

1. In order to meet individual prescription drug needs, Medicare allows private companies to issue many different Medicare-approved prescription drug plans.
2. Drug plans do not have to cover all prescription drugs. There are over 100 different diagnosis categories. Drug plans must offer at least two prescription drugs in each of these categories. Beneficiaries should choose the plan that best covers their prescription drug needs.
3. Here are some basic rules to remember:
• Beneficiaries usually pay a monthly premium for their drug plan. The exact premium amount will depend upon which prescription drug plan beneficiaries choose. Each drug plan can charge a different monthly premium than the standard Medicare plan.
• Beneficiaries are not required to enroll in Part D, but if they enroll later they will pay a higher monthly premium.
• Medicare Beneficiaries who decide to enroll later than their initial enrollment period will have their monthly premiums cost 1 percent more per month that they wait to enroll (for example, if a beneficiary has to wait 7 months past their initial enrollment period until November 15th to enroll, their monthly premium will always pay 7 percent more than what others pay for the same drug plan).
• The premium penalty does not apply to beneficiaries who have comparable coverage from another source (such as retirement health plans) which have certified in writing as “credible coverage” or coverage that is at least “as good as Medicare” (this includes VA and FEHB beneficiaries). Beneficiaries with a group health plan which includes prescription drug coverage should receive (and keep) a letter from their plan administrator.
• Although there are some drug plans with no annual deductible, most drug plans require that beneficiaries pay an annual deductible before Medicare pays anything (see row 1 in the chart below).
• Beneficiaries pay 25% of the costs up to a certain amount (see row 2 in the chart below). Some drug plans charge less than 25%.
• The beneficiary pays the full amount for most drug plans once a beneficiary has reached the “donut hole” (see row 3 in the chart below). Again, there are some plans which cover drugs in this “donut hole.”
• The beneficiary pays 5 percent of the drug costs after the annual drug costs have exceeded the amount described row 4 in the chart below.

4. “Extra Help” financial assistance is available for low and moderate income individuals:
• In 2008, beneficiaries of Medicaid and Medicare (dual eligible) will automatically receive the following benefits. Medicaid eligible individuals who have Medicare may receive these benefits if they apply for “Extra Help”–
• No monthly premium or annual deductible.
• Beneficiary co-pays $1.05 for generic and $3.10 for brand name drugs.
• After $4,050 out-of-pocket, Medicare pays all other drug costs.
• Individual beneficiaries with incomes below $1,170 ($1,575 for couples, 135% of poverty level) may receive these benefits if they apply for “Extra Help”–
• No monthly premium nor annual deductible.
• Beneficiary co-pays $2.25 for generic and $5.60 for brand name drugs.
• After $4,050 out-of-pocket, Medicare pays all other drug costs.
• Individual beneficiaries with incomes below $1,300 ($1.750 for couples, 150% of poverty level) may receive these benefits if they apply for “Extra Help”–
• Monthly premium based on sliding fee scale.
• $56 annual deductible.
• After the deductible, beneficiary pays 15 percent of drug costs.
• After $4,050 out-of-pocket, beneficiary pays $2.25 for generic or $5.60 for brand name drugs.
• Apply for “Extra Help” at your local Social Security office or use their online tool to apply for Extra Help. Local senior centers have “Extra Help” paper applications and can help with the application process.
5. Medicare prohibits the selling, issuance, or renewal of existing Medigap supplemental plans H, I, & J which includes drug coverage to Medicare Prescription Drug Plan enrollees. This prohibition would not apply to renewal of these Medigap policies for persons who do not enrolled in the Medicare Prescription Drug Plan drug benefit. Persons enrolling in the Medicare Prescription Drug Plan drug benefit during the initial enrollment period could enroll in a Medigap supplemental plan without drug coverage. Also, persons could choose not to enroll in a Medicare prescription drug plan and continue with plans H, I, & J with the drug coverage, however if they switch to a Medicare prescription drug plan after their initial enrollment period they will have a penalty added to their premium.
6. Use the link at the top for more information on Medigap insurance plans.
• Medigap issuers are required to notify holders of plans H, I & J of these changes 60 days prior to the initial Medicare Prescription Drug Plan drug benefit enrollment period.
• Two new Medigap supplemental plans are available (plans K and L).
7. There are no provisions in the Medicare drug benefit law to contain drug costs. In fact, the legislation prohibits Medicare from using its purchasing power to negotiate lower drug prices for beneficiaries.
8. Re-importation of drugs from Canada is allowed, but only if their safety is certified by the Secretary of the U.S. Department of Health and Human Services (which has not happened to date).

This chart is from the Congressional Budget Office. Any amount followed by an * asterisk are the actual amounts announced by CMS.

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