HHS Answers Your Prescription Drug Benefit Questions

ABC News asked viewers and readers to submit their questions on the new Medicare prescription-drug benefit for the Department of Health and Human Services. The following are several of those questions, and the answers from HHS.

Question from Jim: Sec. Leavitt [Sunday] on "This Week" said that "all" seniors should sign up with an insurance company for a new prescription-drug plan. Should he have added an exception for those, like myself, who are currently employed full time and have an employer health care and prescription-drug insurance plan?

Answer from HHS: If you currently have insurance coverage for your medications through an employer or a retiree plan that is "creditable coverage," -- meaning it is as good as or better than the Medicare prescription-drug coverage -- you do not need to enroll in a Medicare drug plan at this time. Your current or former employer should have sent you a letter stating whether its prescription-drug coverage is as good as that offered under Medicare. The best sources of information about your prescription-drug coverage are the communications you get from your current or former employer or union (or the plan that administers your prescription-drug coverage).

Medicare is working to support good quality retiree coverage by providing subsidies to employers who offer that coverage. That way, if you are a retiree with good coverage, you get to keep it.

You can sign up for a Medicare prescription-drug plan later without penalty if your current or former employer is offering creditable coverage.

Question from Eric: Is it true that, while a senior who selects a plan based on his medications is locked into that plan for one year, the plans may change the drug coverage they offer at any time, possibly making the senior's plan selection undesirable?

Answer from HHS: Enrollment in a Medicare prescription-drug plan is generally for the calendar year. You can choose to switch your current plan every year during the open-enrollment period between Nov. 15 and Dec. 31. In addition, in certain cases, such as if you move or enter a nursing home, you can switch your plan at other times.

If you have both Medicare and Medicaid, you can change plans at any time.

The prescription-drug plans approved by Medicare must cover all medically necessary treatments. Most plans will have a formulary, which is a list of drugs covered by the plan. In many cases, those limitations on those formularies will come when there are many drugs that treat common conditions. This list must always meet Medicare's requirements, but it can change when plans get new information. Your plan must let you know at least 60 days before a drug you use is removed from the list or if the costs are changing. In addition, Medicare requires that the plans cover all or substantially all of the drugs for conditions such as HIV/AIDS or cancer.

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