2011 Medicare Prescription Drug Q&A

November 15, 2010

Questions and Answers
2011 Medicare Prescription Drug
Annual Open Enrollment

The annual Open Enrollment for Medicare prescription drug coverage (Part D) is November 15, 2010 - December 31, 2010. This is the one time each year that all people with Medicare can join or change their Medicare drug plan.

ALL PLANS WILL MAKE CHANGES IN 2011!

In 2011, for the first time, people who enter the coverage gap (“donut hole”) will receive a 50% discount on brand-name drugs on their plan’s formulary while they are in the gap. Plans will also pay 7% of the cost of generics on their formularies in the gap. With these changes, your current plan may or may not be the best plan for you in 2011.

Q: In what ways could my plan change in 2011?

A. There are several ways:

• Monthly premium
• Annual deductible Your share of costs (co-pay or co-insurance)
• The list of drugs it covers (formulary)
• Additional coverage, if any, it offers in the coverage gap
• Use of policies that may restrict access to certain drugs

Q: How do I know what changes my plan is making in 2011?

A: You should have received a letter from your current plan called an “Annual Notice of Change” by October 31st.

Q: What is the “coverage gap?“

A: The coverage gap is also called the “donut hole.“ It is a period during which you have to pay at least half the cost of your drugs AND continue to pay your monthly premium to keep your coverage. If you get Extra Help (Low-Income Subsidy) paying your drug costs, you won’t have a coverage gap, but you will have to pay a co-pay or co-insurance amount for each prescription until you reach catastrophic coverage

Q: Has the coverage gap changed since last year?

A: Yes. In 2010, those who entered the coverage gap got a one-time rebate of $250. There is no rebate in 2011. In 2011, for the first time, people who enter the coverage gap (“donut hole”) will receive a 50% discount on brand-name drugs on their plan’s formulary while they are in the gap. Plans will also pay 7% of the cost of generics on their formularies in the gap. These changes do not apply if you already receive Extra Help.

Q: What does it mean if a plan offers “coverage in the gap?“

A: Some plans provide coverage in addition to the 7% discount for generic drugs and 50% discount for brand-name drugs. Before enrolling in such a plan it is important to check with the plan to make certain the drugs you need are covered in the gap.

Q: What happens if a drug I take is not on a plan’s formulary?

A: You must pay for the full cost for any drug not on the formulary. The money you pay for these drugs does not count toward the total amount that you must spend to qualify for catastrophic coverage.

Q: What do I have to do if I decide that I want to stay in my current plan for 2011?

A: Nothing. You will stay enrolled in your current plan unless you sign up for a new plan.

Q: If I decide to change plans, how and when should I do it?

A: You can enroll in a new plan by contacting the plan you want to enroll in or by calling 1-800-MEDICARE (1-800-633-4223) , by visiting www.medicare.gov or call JABA’s VICAP (434) 817-5222 for assistance.

Q: If I’m in a Medicare Advantage Plan, but am not happy with the health coverage, can I drop it and return to Original Medicare by itself and add a drug plan?

A: Yes, you can switch plans during the Part D Annual Open Enrollment Period from November 15 through December 31, 2010.

Q: If I previously applied and qualified for Extra Help (Low Income Subsidy), do I qualify in 2011?

A: Medicare beneficiaries who automatically qualified in 2010 but who will not automatically qualify in 2011 should have received a notice on grey paper from Medicare (CMS Publication No 11198) in September 2010.

Q: What if I did not join a Medicare Part D Plan when I was first eligible but I would like to join one now?

A: You can enroll in a plan during the Annual Open Enrollment. You may have to pay a premium penalty if you did not have coverage that is at least as good as Medicare’s coverage (“creditable coverage”) during the first/initial period that you were eligible to enroll. The penalty amount is calculated based on the number of months you were eligible but did not enroll.

Questions You May Have After Enrollment

Q: I enrolled in Part D but I haven’t heard anything. Is this normal?

A: No. Contact the plan right away to confirm that you are enrolled.

Q: I enrolled in a drug plan in December and got a letter welcoming me into the plan, but nothing else. I have nothing to show the pharmacist. How can I get prescriptions without a card?

A: If you need to get a prescription filled before your card arrives, bring the letter you received from the plan that confirms you have enrolled with you to the pharmacy.

Q: Will my plan cover a drug that I need to take even if it is not on their formulary?

A: Maybe. You, your authorized representative or your doctor can ask for a “coverage determination” (exception) to get your plan to cover a drug when it is not on the plan’s formulary. Your plan can tell you how and what you need to do.

Information in this flyer was condensed from a publication entitled “2011 Medicare Prescription Drug Annual Open Enrollment” published by Medicare Access for Patients, www.maprx.info

This summary prepared by JABA, www.jabacares.org, 434-817-5222.