Medicare prescription drug insurance medicare part d
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Medicare Prescription Drug Insurance Medicare Part D. Presented By: Dupage County Senior Services 630-407-6500. Agenda. What is Medicare Part D? Extra Help (financial assistance) for people with limited income and resources

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Medicare Prescription Drug Insurance Medicare Part D

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Medicare prescription drug insurance medicare part d

Medicare Prescription Drug InsuranceMedicare Part D

Presented By:

Dupage County Senior Services 630-407-6500



  • What is Medicare Part D?

  • Extra Help (financial assistance) for people with limited income and resources

  • How Medicare Part D will apply to you, depending on your current drug coverage

  • How Medicare Part D will work with state programs (Senior Care and Circuit Breaker Pharmaceutical Assistance)

  • Questions

Medicare 2006

Medicare 2006

  • Part A-Hospitals

  • Part B-Physicians and equipment

  • Part C-Medicare Advantage plans

  • Part D (NEW)-Prescription Drug Assistance

What is medicare part d

What is Medicare Part D?

  • A government-sponsored insurance program for ALL people with Medicare Part A and/or Part B

  • Designed to decrease drug costs for recipients

  • Not intended to pay 100% of drug bills

  • Provides extra help for low income recipients

Medicare part d

Medicare Part D

  • Medicare will contract with private companies (17 Companies)

  • Prescription Drug Plans-Formularies

  • Medicare and You Handbook-More Information about plans

  • Pick a Plan that covers your prescriptions

Enrollment period


  • November 15, 2005 through May 15, 2006

  • Penalty if you enroll after May 15, 2006

Postponing enrollment

Postponing Enrollment

  • Higher premiums for people who wait to enroll

    • Exception for those with coverage as good as a Medicare prescription drug plan

  • Premium will increase 1% for every month that eligible but did not enroll

How the plans work

How the Plans Work

  • Must offer standard drug benefit

  • Can be flexible and offer supplemental or enhanced benefits

  • May offer several levels or tiers

Standard medicare prescription drug coverage cost

Standard Medicare Prescription Drug Coverage &Cost

  • $32.20 per month

  • $250 yearly deductible

  • Medicare covers 75% of Drug cost

    up to $2,250

  • $2,251 to $5,100 Client pays 100% of cost

  • $5,100.01 and up Medicare pays 95% of cost

Medicare plan options in illinois

Medicare Plan Options in Illinois

  • 9 plans will offer benefits nationwide

  • 1 plan will cost less than $20/month

  • 6 plans will cost under $24.99/month

  • 8 plans will cost under $29.99/month

  • 14 plans will cost under $34.99/month

Extra help

Extra Help

  • People on Limited Income are eligible for extra help to cover the cost.

  • “Extra Help” will pay for Premiums and Deductible

  • Complete an “Extra Help” Application

To get this extra help

To Get This Extra Help

  • Qualify for Extra Help

    • If resources are

      • Less than $11,500 (single)

      • Less than $23,000 (married)


      • Limited income

        • Less than $14,355(single)

        • Less than $19,245(married)

How will medicare part d apply to you

How Will Medicare Part D Apply to You??

  • The new Medicare prescription drug program will apply to individuals differently depending on current drug coverage.

Medicare and medicaid

Medicare and Medicaid

  • Prescriptions will now be paid for by Medicare

  • You do not need to fill out an extra help application

  • You will need to pick a plan

  • If you do not enroll in a plan before Dec.31st, 2005, one will be randomly assigned to you.

Medicare and ssi disability or medicare savings plans

Medicare and SSI/Disability orMedicare Savings Plans

  • You will automatically be eligible for “extra help”

  • You do not need to fill out application

  • You will need to pick a plan

Medicare and retirement plan

Medicare and Retirement Plan

  • You will receive a letter in the fall from your benefits administrator to let you know if your plan is as good or better than Medicare.

  • Must be notified before Nov. 15th

  • You make the decision to stay with your current plan or change to Medicare D

  • If plan is as good as Medicare you will not be charged penalty for enrolling at a later date

  • Be sure to keep letter in a safe place

Medicare and medigap h i and j plans

Medicare and Medigap (H,I and J Plans)

  • Supplemental plans with Drug Coverage

  • Will need to choose either to keep current plan or enroll in Medicare D

  • These plans are not considered to be as good as Medicare Part D.

  • Higher premiums will apply after May 15th, 2006.

Medicare drug discount cards

Medicare Drug Discount Cards

  • Current cards are valid until enrolled in Medicare Part D or May 15, 2006.

Illinois cares rx

Illinois Cares RX

  • Gov. Rod Blagojevich enacted Illinois Cares Rx, which Leaves No Senior or Person with Disabilities Behind, in June 2005.

  • It is the most comprehensive plan in the nation

  • Illinois Cares Rx will continue SeniorCare and the pharmaceutical portion of Circuit Breaker starting Jan. 1, 2006

  • Illinois continues to lead the nation in providing prescription drug benefits

Groups of illinois cares rx

Groups Of Illinois Cares RX

  • Group 1 (Old Senior Care)

    covers all classes of medically necessary drugs.

    $19,140 for single/ $25,660 for couple

  • Group 2 (Old Circuit Breaker)

    covers only specific drug classes:

    Alzheimers, Arthritis, Cancer, Diabetes, Glaucoma, Cardiovascular Disease, Lung and Smoking related diseases, Osteoporosis, Parkinsons, Multiple Sclerosis

    $21,218 for a single/ $28,480 for couple

Illinois cares rx1

Illinois Cares RX

  • Begins January 1, 2006

  • No enrollment fee

  • Co-payments

    • $2 generic

    • $5 brand name

  • $1750 in drugs then client pays 20% of cost of the prescription and any applicable co-payments

Illinois cares rx2

Illinois Cares RX

  • Everyone currently on Senior Care or Circuit Breaker Must submit Extra Help application to Social Security in order to continue coverage

    • *If you are not eligible for Extra Help, you will still be eligible for the state program*

Illinois cares rx continued

Illinois Cares RX Continued

  • Everyone currently on Senior Care and Circuit Breaker Pharmaceutical Assistance

    • will be automatically enrolled in Illinois Cares RX

    • You MUST enroll in one of the following Medicare prescription drug plans that coordinates with Illinois Cares Rx:

      • AARP Medicare Rx of United Health Care or

      • PacifiCare Saver Plan



  • Protect Yourself

  • Never give out personal account information or Social Security number to anyone over the phone or internet.

  • Ask for the person’s phone number and call them back. If you can call them back then its legitimate.

  • No door to door solicitations can occur

  • Telemarketers must comply with DO NOT CALL LISTS. (1-888-382-1222)

  • Fraud concern contact Attorney General

    (Lisa Madigan’s office) at 1-800-243-0618

Payments for medicare plans

Payments for Medicare Plans

  • Payments for plan premiums can be either deducted from Social Security check or paid directly to plan monthly.

Ways to enroll

Ways to Enroll…


  • 1-800-MEDICARE (1-800-663-4227)

  • Contact individual plan for an enrollment form

  • Enrollment events in your area

  • Contact local agencies for assistance

Phone numbers for help


  • Dupage County Senior Services

    • 630-407-6500

  • Medicare

    • 1-800-Medicare( 1800-633-4227)


  • Senior Health Insurance Program(SHIP)

    • 1-800-548-9034


  • Illinois Department on Aging

    • 1-800-252-8966


  • Social Security Administration

    • 1-800-772-1213

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