HHS Answers Your Prescription Drug Benefit Questions

As we age, most people need prescription drugs to stay healthy. For most people, joining now means you will pay your lowest possible monthly premium for as long as you have prescription-drug coverage. If you don't join a plan by May 15, 2006, and you don't currently have a drug plan that, on average, covers at least as much as standard Medicare prescription drug coverage, then you will have to wait until the next open-enrollment period to join. The next open-enrollment period is from Nov. 15 to Dec. 31 of 2006. When you do join, your premium cost will go up at least one percent per month for every month that you wait to join.

People who are fortunate enough now to not take many prescription drugs still may need the coverage as a form of protection against unforeseen higher costs in the future. In everywhere but Alaska, there are prescription-drug plans that offer this peace of mind for less than $20 a month.

Question from Darrell: What happens if sometime during the next year, you get a new prescription that is not covered by the plan you chose. What to do if your premium is more than your actual medicine expense?

Answer from HHS: If you need a drug that is not on the covered drug list, or that is on the list but you think it should be covered for a lower co-payment, you can do the following:

  • Contact the plan and ask for an exception. You will probably have to provide information from your doctor about why you need the drug your plan won't cover.
  • If your plan denies the exception, you can appeal. Your plan must give you information on how to appeal.

On your second question -- if you have very low drug costs, such that they are actually lower than your monthly premium, there are still two very good reasons to enroll. First, you will be avoiding the late-enrollment premium penalty in later years when you might have expenses that exceed your premiums. This penalty amounts to at least one percent per month, for every month that you wait to join, and it applies for as long as you have prescription-drug coverage. Second, should you ever have an unexpected illness or accident that requires you to begin using more medications; you will have the coverage you need at that point. In addition, there are also some very low-cost plan options available, with monthly premiums below $20 in every state but Alaska.

Question from John: I am 72. I don't use any drugs. Should I sign up? If so, which specific plan should I sign with?

Answer from HHS: If currently you don't use any prescription drugs, you should still consider joining a Medicare drug plan in 2006. As we age, most people need prescription drugs to stay healthy. For most people, joining now means you will pay the lowest possible monthly premium for as long as you have prescription-drug coverage. If you don't join a plan by May 15, 2006, and you don't currently have a drug plan that, on average, covers at least as much as standard Medicare prescription-drug coverage, you will have to wait to join until the open-enrollment period next year that runs from Nov. 15 through Dec. 31, 2006. When you do join, your premium cost will go up at least one percent per month for every month that you wait to join. Like other insurance, you must pay this penalty as long as you have Medicare prescription-drug coverage.

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