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  • Added for You - Making Sense of the Medicare Prescription Drug Plan

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    next $2,000 in drug costs with the Medicare Prescription Drug plan paying the other 75% of these costs.
  • There is also a coverage gap period, referred to as the “doughnut hole”, where the beneficiary pays 100% of the next $2,850 in drug costs.
  • After that, the beneficiary has a 5% co-pay for the rest of the calendar year
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    The newly added Medicare Prescription Drug Plan, also referred to as Part D, is due to go into effect January 1, 2006. And even with all the information that seniors had been inundated with this past fall, many are still left wondering how to make sense of this program. Very simply, beginning in January 2006, for the first time Medicare will provide prescription drug coverage for those that are eligible for the federal government’s Medicare health insurance program. However, the confusion starts here because enrollment in the Prescription Drug plan is optional, but if the beneficiaries do not enroll by the May 15, 2006 deadline, they risk paying a permanent surcharge on their premium, which increases at a rate of 1% per month. For instance, delaying enrollment for six months could increase the monthly premium by 6 percent.

    As a practical matter, the best place to start will be to look at how it affects your pocketbook. The Medicare Prescription Drug plans will be offered by insurance companies and other private companies approved by Medicare, and these plans will offer at least the standard level of coverage which consists of the following:

    • a monthly premium which will vary depending on the plan you choose.
    • a $250 annual deductible, which is the first $250 of the annual cost of the drugs.
    • a 25% co-pay for the next $2,000 in drug costs with the Medicare Prescription Drug plan paying the other 75% of these costs.
    • There is also a coverage gap period, referred to as the “doughnut hole”, where the beneficiary pays 100% of the next $2,850 in drug costs.
    • After that, the beneficiary has a 5% co-pay for the rest of the calendar year a
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      ll provide prescription drug coverage for those that are eligible for the federal government’s Medicare health insurance program. However, the confusion starts here because enrollment in the Prescription Drug plan is optional, but if the beneficiaries do not enroll by the May 15, 2006 deadline, they risk paying a permanent surcharge on their premium, which increases at a rate of 1% per month. For instance, delaying enrollment for six months could increase the monthly premium by 6 percent.

      As a practical matter, the best place to start will be to look at how it affects your pocketbook. The Medicare Prescription Drug plans will be offered by insurance companies and other private companies approved by Medicare, and these plans will offer at least the standard level of coverage which consists of the following:

      • a monthly premium which will vary depending on the plan you choose.
      • a $250 annual deductible, which is the first $250 of the annual cost of the drugs.
      • a 25% co-pay for the next $2,000 in drug costs with the Medicare Prescription Drug plan paying the other 75% of these costs.
      • There is also a coverage gap period, referred to as the “doughnut hole”, where the beneficiary pays 100% of the next $2,850 in drug costs.
      • After that, the beneficiary has a 5% co-pay for the rest of the calendar year
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        r premium, which increases at a rate of 1% per month. For instance, delaying enrollment for six months could increase the monthly premium by 6 percent.

        As a practical matter, the best place to start will be to look at how it affects your pocketbook. The Medicare Prescription Drug plans will be offered by insurance companies and other private companies approved by Medicare, and these plans will offer at least the standard level of coverage which consists of the following:

        • a monthly premium which will vary depending on the plan you choose.
        • a $250 annual deductible, which is the first $250 of the annual cost of the drugs.
        • a 25% co-pay for the next $2,000 in drug costs with the Medicare Prescription Drug plan paying the other 75% of these costs.
        • There is also a coverage gap period, referred to as the “doughnut hole”, where the beneficiary pays 100% of the next $2,850 in drug costs.
        • After that, the beneficiary has a 5% co-pay for the rest of the calendar year
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          private companies approved by Medicare, and these plans will offer at least the standard level of coverage which consists of the following:
          • a monthly premium which will vary depending on the plan you choose.
          • a $250 annual deductible, which is the first $250 of the annual cost of the drugs.
          • a 25% co-pay for the next $2,000 in drug costs with the Medicare Prescription Drug plan paying the other 75% of these costs.
          • There is also a coverage gap period, referred to as the “doughnut hole”, where the beneficiary pays 100% of the next $2,850 in drug costs.
          • After that, the beneficiary has a 5% co-pay for the rest of the calendar year
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            next $2,000 in drug costs with the Medicare Prescription Drug plan paying the other 75% of these costs.
          • There is also a coverage gap period, referred to as the “doughnut hole”, where the beneficiary pays 100% of the next $2,850 in drug costs.
          • After that, the beneficiary has a 5% co-pay for the rest of the calendar year after the $3,600 in out-of-pocket costs.
          Of all the features in the new Medicare Prescription Drug plan, the most confusing and probably the most controversial aspect appears to be this “doughnut hole” coverage gap period, where the beneficiary is responsible for not only 100% of the prescription drug costs, but also the monthly premium. And this is also why before enrolling in a plan, beneficiaries will want to crunch some numbers to determine which plan is best suited for their particular situation.

          The first thing beneficiaries will need to consider is the drug formularies that they will be using during the year. Before deciding on a Medicare Prescription Drug plan, beneficiaries will want to confirm that their drug formularies are covered by that plan, and they will want to compare the co-pays that will be required for their particular drug formularies. The Medicare website has a useful tool for comparing the various prescription drug plans.

          Here is an example of three Medicare Prescription Drug plans selected for comparison with the Prescription Drug Plan Finder tool found on the Medicare website, using the following assumptions:

          • Beneficiary is adding coverage to the Original Medicare fee-for-service plan;
          • is not eligible for additional help for

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