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Medicare Part D: Just the Facts

On January 1, Medicare officials rolled out a new prescription drug plan, known as Medicare Part D. While the various plans offered by each state can be helpful in easing the financial burden of prescription drugs, many people have found the task of choosing among plans to be very confusing. Here we provide information to guide you through the process of selecting a plan that best fulfills your needs.

What is Medicare Part D?

Medicare Part D is a voluntary federal prescription drug plan designed to provide assistance with paying for prescription drugs. To qualify for Medicare Part D, you must be currently eligible for Medicare or become eligible at some point in 2006.

Medicare recipients are given the choice of several plans in each individual state. In many states, there are numerous plans available. You may have already received advertisements in the mail or been telephoned by the plan providers. Pay attention to the details of the different plans and gather the necessary information discussed in this article to help you make a decision.

Note that May 15, 2006 is the deadline to enroll in a plan without incurring a penalty. If you sign up after this date (the next chance will be November 2006) you will be charged a one percent penalty for each month you delay, which means that November enrollees will pay a minimum penalty of six percent. This penalty will be computed and added to your monthly premium for the duration of your enrollment in the plan. This means that the longer you wait to sign up after May 15, 2006, the higher your premium will be - and that penalty will be added to the premium as well. If you are not yet eligible for Medicare by May 15, this penalty will not be applied.

Making the decision

Most plans have a basic structure with stages of coverage, monthly premiums, deductibles and co-payments. The average monthly premium is $32. You will probably see differences among premiums and co-payments, drug prices, the list of drugs that are covered and the list of pharmacies that participate in the plan.

When deciding on a plan, be sure to have a list in front of you of all the medications you are currently taking and all the medications that are available to treat Parkinson's. This will help you ensure that your current medications - and those you may be using in the future if you and your doctor make a change in your treatment regimen - are covered. You can obtain a list of the most-often used Parkinson's medications from the PDF website, www.pdf.org, or by calling our Parkinson's Information Service (PINS) toll-free at (800) 457-6676.

Keep in mind that the sponsor of a plan may change the formulary of drugs it covers, even after you have signed up. The sponsor is required to give 60 days notice of such changes and there is an appeals process. If you spend significant time each year in more than one state, ask the plan representative if the coverage is "nationwide," that is, if it is available in all 50 states, before you enroll.

Where to find help

If you are having trouble understanding the process, check out the resources that are available to assist you. Most of the information can be easily obtained on the Internet. At www.medicare.gov, use the Medicare Prescription Drug Plan Finder to compare the pros and cons of each plan. Additionally, you can go online to www.shiptalk.org, the website of the State Health Insurance Assistance Program, or SHIP, a national program that offers one-on-one counseling and assistance to people with Medicare and their families. Here you will find answers to frequently-asked questions and listings, by state, of offices that can assist you. If you are not comfortable with the Internet, ask web-savvy family members or friends to aid you in your research.

For more personal attention, there are organizations that understand the plans for your state and can help you make your decision. One is the National Association of Area Agencies on Aging, which has offices in several locations in each state. These professionals will meet with you and run plan comparisons for your specific situation so that you can make a financially wise decision. To find an office, call (800) 677-1116 and ask for the nearest Area Agency on Aging Office for your city and state. Most local senior centers, township offices or community centers can also help. To find their numbers, look in the local phone book or call your township office. You can also call the Medicare hotline at (800) 633-4227 for assistance.

The last word

It is important to note that Medicare Plan D may not the best option for everyone. For example, those who receive state assistance may be better off remaining with their existing programs. The same could apply to those who are in the military or who are veterans and federal employees. To determine this, call the following numbers: for veterans (877) 222-8387; military retirees (888) 363-5433; and federal employee retirees (888) 767-6738. And in all cases, talk with your doctor and pharmacist before making any decisions to be certain that you are choosing the most appropriate course of action.

Whichever plan you choose, remember that benefits of Medicare Part D in any one year are limited to the first $2,250; expenses above this will be out of your pocket until they reach $5,100. Beyond that point, Medicare will pay 95 percent of your expenses. This is especially important for the PD community, as the average person with Parkinson's annual drug costs fall in the gap between $2,250 and $5,100.