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

Between October 15 through December 7, Medicare beneficiaries may enroll in a drug plan, and currently enrolled beneficiaries can change plans if there is one that better meets their prescription drug needs. Except under certain circumstances, beneficiaries will not have another chance to enroll or switch to a better drug plan until the following year at this time. Beneficiaries who are satisfied with their prescription drug plan do not have to do anything.

There are many different Medicare prescription drug plans available in Illinois. These plans are approved by Medicare, but administered by private companies.

A crucial factor when deciding whether your current Medicare prescription drug plan serves your medication needs is whether your medications will continue to be covered by your plan next year. Medicare prescription drug plans can change their medication list, also known as a formulary, with Medicare's approval.

Medicare's website, at www.medicare.gov, has a link to Health and Drug Plans that anyone can use to find the plan that best fits their medication needs and pocketbook. This is important since not all plans cover every medication. The formularies, monthly premium, and deductible vary from plan to plan.

Individuals who do not have access to the Internet can obtain information about plans by making an appointment at their local senior citizen center. The social service staff members at senior centers are trained to assist people with Medicare prescription drug plans.

For many Medicare beneficiaries, the monthly premium and co-payment amounts for the prescription drug plans are financially difficult. Two programs help low and moderate-income beneficiaries pay these costs. These programs are called Extra Help and Illinois Cares Rx. Local senior centers can help you determine if you are eligible for these programs.

Finally, local senior centers help low-income Medicare beneficiaries determine if they are eligible for other programs that help with Medicare's out-of-pocket costs for Part A and Part B; which covers hospital, doctor, and other medical costs. These programs are labeled QMB, SLMB, and QI for short. They help with the co-payment amounts for hospitals and/or monthly premiums and co-payment amounts for doctors and other medical costs.

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), and on their website at www.ssa.gov. All senior centers have access to 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 plan and the Illinois Cares Rx programs, call your local senior center or the Senior Health Insurance Program (SHIP).

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Summary of Medicare Prescription Drug Plan

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) that 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 that 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 that cover drugs in the 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, also known as LIS or Low-Income Subsidy, is financial assistance available for low and moderate-income individuals. The following information is for 2012 (incomes amounts below include $20 disregard for individuals and $40 for couples):
   • Beneficiaries on full Medicaid with Medicare (dual eligible) will automatically receive the following benefits.
   • No monthly premium (if drug plan meets national benchmark).
   • No annual deductible.
   • Beneficiary pays $1.10 for generic and $3.30 for brand name drugs.
   • After $4,700 out-of-pocket, Medicare pays all other drug costs.
   • Beneficiaries with incomes below $1,277 with assets below $8,180 (below $1,743 & assets below $13,020 for couples) may receive these benefits if they apply for them.
   • No monthly premium (if drug plan meets national benchmark).
   • No annual deductible.
   • Beneficiary pays $2.60 for generic and $6.50 for brand name drugs.
   • After $4,700 out-of-pocket, Medicare pays all other drug costs.
   • Beneficiaries with incomes below $1,277 with assets between $8,181-$12,640 (below $1,743 & assets between $13,021-$25,260 for couples) may receive these benefits if they apply for them.
   • No monthly premium (if drug plan meets national benchmark).
   • $65 annual deductible.
   • After the deductible, beneficiary pays 15 percent of drug costs until $4,770 out-of-pocket.
   • After $4,700 out-of-pocket, beneficiary pays $2.60 for generic and $6.50 for brand name drugs.
   • Beneficiaries with incomes between $1,277-$1,417 with assets below $12,640 (between $1,743-$1,932 & assets below $25,260 for couples) may receive these benefits if they apply for them.
   • Monthly premium based on sliding fee scale.
   • $65 annual deductible.
   • After the deductible, beneficiary pays 15 percent of drug costs.
   • After $4,700 out-of-pocket, beneficiary pays $2.60 for generic and $6.50 for brand name drugs.
5. Apply for Extra Help at your local Social Security office or use their online tool to apply for Extra Help. Local senior centers can help with the application process.

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