Issue Position: Prescription Drugs: Medicare Part D

Issue Position

Dear 11th District Seniors,

The 2007 Open-Enrollment Period for Medicare Part D has ended. The 2008 Open-Enrollment Period beings November 15, 2007 and ends December 31, 2008.

Medicare prescription drug coverage is available to all seniors, but seniors must choose to enroll. If you or a senior in your life would like to enroll in a Medicare Part D plan, you can visit www.Medicare.gov, call 1-800-MEDICARE, or contact my office. Seniors who enrolled in a Medicare prescription drug plan in 2006 also have the option of changing plans without penalty during the 2007 open-enrollment period.

It is my goal to ensure every senior in our district has affordable access to the medications they need to stay well. For seniors who have not yet enrolled, I encourage you to sign up now and start saving. Medicare Part D is saving seniors an average of $1,100 a year - $2,500 for low-income seniors.

I also urge seniors who have already enrolled to review their current plans using the "Three Cs": cost, coverage and customer service. If your plan costs too much, doesn't cover new medicines you'll need, or isn't performing up to your standards, you can find a new plan during the open season.

This year, Medicare has introduced several new tools to make it easy for seniors to get assistance with Medicare Part D enrollment. At the website www.Medicare.gov, seniors can access the Monthly Cost Estimator, a personalized chart showing a senior's projected drug costs for each month. Seniors can also use the website to compare plans by price, benefits and medications covered. Plans are available in Georgia with premiums as low as $17.40 a month.

For the majority of seniors who are satisfied with their Medicare Part D plans, no action is necessary during the open-enrollment period.

Recently, you may have heard discussion about the "coverage gap" or "donut hole" in Medicare Part D. Like many health insurance plans, some Medicare prescription drug plans have limits on how much is covered for prescription drugs (other plans in Georgia offer continuous coverage without gap).

The great news is that all Medicare plans provide coverage for unexpected, exceptionally high drug costs - this is called catastrophic coverage. Between a drug plan's standard level of coverage and the catastrophic coverage, seniors pay a reduced, out-of-pocket cost for their drugs - and this is called the coverage gap.

If you or a senior in your life is worried about the coverage gap, I have good news. First, the vast majority of seniors will not experience any gap in coverage - and NO low-income seniors will.

However, those seniors who do reach a gap in coverage can still get help with their prescription drug costs. Many pharmaceutical companies have introduced Medicare-approved programs to assist seniors with the cost of their medication. For more information, please call 1-800-MEDICARE or visit www.rxassist.org.

Additionally, please consult the free Medicare publication "Bridging the Coverage Gap," which includes important information on ways to avoid or delay the gap, and to continue saving money on drug costs if you have already entered it. The publication is available on Medicare's website.

Again, my office is here to assist you, so don't hesitate to contact me with your questions.

Sincerely,
Phil
U.S. Congressman Phil Gingrey, M.D.

MEDICARE PART D: PRESCRIPTION DRUG COVERAGE FOR SENIORS

Modern medicine has helped us understand the importance of preventative care and medication. In fact, today we know that access to the right medicine is one of the bedrocks of good health, especially for our seniors.

To fix this problem, Congress passed a new prescription drug benefit: Medicare Part D. This benefit will help seniors stay well - after all, if a beneficiary can afford heart medication, he might not need an invasive heart surgery. Medicare now helps seniors prevent illness as well as treat it.

Medicare prescription drug coverage is saving seniors an average of $1,100 a year - $2,500 for low-income seniors. In fact, one woman in Polk County saw her monthly drug costs drop by $900 - she now pays only $27 a month for her medications.

This is great news for our seniors, and I know seniors across the 11th District are finding success with Medicare Part D.

Below, I've listed some common questions and answers about Medicare prescription drug coverage. In addition, I invite you to view the Related Documents section below, where you can download brochures and information on Medicare Part D.

Q: How does Medicare Part D work?

A: > Medicare Part D is voluntary, so seniors must choose to sign up.
> Seniors will have a choice of plans with monthly premiums of about $33. Eighteen companies have been approved to offer prescription drug plans in Georgia, with plan prices ranging from $17 to $71 a month.
> Medicare-approved plans must cover both generic and brand name drugs, and be accepted at local pharmacies.
> The standard Medicare plan has a $250 yearly deductible, after which Medicare pays approximately 75 percent of a senior's prescription drug costs up to $2,250 a year.
> If your yearly out-of-pocket drug costs are higher than $3,600, Medicare will cover 95 percent of your costs for the rest of the year.
> For seniors with individual resources of less than $11,500 or married resources of less than $23,000 a year, plans will have no deductible, and co-pays will be around $4.

Q: Why should seniors sign up now?

A: Seniors are encouraged to enroll as soon as they're eligible. After May 15, 2006, there will be a 1% premium increase for each month an eligible senior waits to enroll.

Q: What if a senior already has drug coverage under an employer, union, or Medigap policy?

A: If the coverage is at least as good as the coverage under Medicare Part D, they can keep it. Should they wish to sign up for Medicare Part D at a later date, they may do so without penalty. If their current coverage is not as good as Medicare Part D, they can sign up for Part D immediately. Employers will contact beneficiaries with this information.

Q: What information will seniors need to enroll in a plan?

A: Seniors should have the following information on hand when enrolling, to ensure they choose the plan that best meets their prescription drug needs:

* A list of the prescription drugs you are currently taking, including the names and doses.

* Information about any prescription drug coverage you currently have, be it an employer, union, or Medigap policy.

* The name and address of the local pharmacy you use to fill prescriptions.

* The out-of-pocket amount you spend on prescription drugs each year.

* Your Medicare enrollment information.

For additional information, please visit the website www.Medicare.gov.
In addition to allowing seniors to sign up for a Medicare Part D plan on-line, this website features several tools to help seniors choose the Medicare Part D plan that's right for them:

- Prescription Drug Plan Finder: allows seniors to compare plans and see a detailed list of the benefits and drugs covered in each plan.

- Demo of Prescription Drug Plan Finder: takes seniors step-by-step through the enrollment process, and advises seniors on what information they'll need to sign up.

- Formulary Finder: allows seniors to search for Part D plans by the medication they take.

- Brochures and fact sheets

- Benefits Check-Up Rx: allows seniors to get personalized information on:

*How your current insurance or other prescription drug coverage affects your options under the new Medicare Prescription Drug Coverage.

*Whether you qualify for extra help with your costs under the new Medicare Prescription Drug Coverage.

*If you are likely eligible for additional government benefits (VA, etc) that can save you money on your medications.

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