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PRESCRIPTION DRUG Medicare’s new prescription drug coverage has created quite a stir and affects the State of Missouri’s prescription coverage as well – both Medicaid and MO RX.  This page will cover the basics, but it is indeed complicated and confusing so please feel free to contact our office for further information.  We have staff trained and ready to answer your questions and assist you.  You may call the numbers above, or contact our Aging Resource Consultant or I & A Manager by email.  Their addresses are on the staff page.  MEDICARE PART D WHO IS ELIGIBLE? ALL people with Medicare – Part A and/or Part B DO I HAVE TO ENROLL IN A PLAN? No, this is a voluntary program.  No one is required to participate.  If you have prescription coverage through a retiree plan, your spouse’s work or other programs AND the coverage is equal to or better than the Medicare Part D coverage, you do not need to pick a plan.  If at a later date, you decide to enroll in a Medicare prescription drug plan, you will not be penalized.  If you had coverage and the coverage was not as good as Medicare Part D AND you did not enroll in a plan by May 15th, 2006, you may have to pay a higher premium if you decide to enroll later on. HOW MUCH IS THE MONTHLY PREMIUM? Premiums in Missouri will vary.  As with all insurance, it depends on what coverage you need and want.  If you are on Medicaid, there are plans available that will have no premium – other plan premiums will be reduced.  You may also be able to get extra help through Social Security to help pay for your plan if your income is below $14,700 for a single person ($19,800 for a married couple living together) and your resources aren’t more than $11,500 for a single person ($23,000 for a married couple living together). IS THERE A DEDUCTIBLE? It depends on which plan you choose.  Some plans have deductibles and some have none at all. HOW MUCH WILL I PAY FOR EACH PRESCRIPTION? Again, it depends on which plan you choose and whether all the drugs you take are on the plan’s formulary.  As with all insurance plans, each one has a list of drugs it covers.  These plans must cover at least two drugs in each drug class.  Each plan also has different co-pays or coinsurance.  Medicaid clients, and those getting the extra help will pay less than the plan normally charges.  The higher tiered plans cover more than lower tier plans and so forth. HOW DO I PICK A PLAN? Many organizations have gone into partnership to help you--Centers for Medicare and Medicaid, Missouri RX, CLAIM as well as the Area Agency and others.  Your family can also help you.  We advise you to start with the Medicare web site (www.medicare.gov).  They have a plan comparison tool in which you can list the medications you take to find the plans that cover you the best and for the least overall cost.  If you are not computer savvy or do not have family or friends to help you, we are here to help.  Call the toll-free number above or contact our Aging Resource Consultant or the I & A Manager by email.  We will do the look-up on the web and help compare the best plans for you; however, it is up to you to choose a plan.  The Aging Resource Consultants in the ARCs can help you, if you live in their areas. WHEN DO I NEED TO PICK A PLAN? Annual enrollment will be every November 15th through December 31st for benefits to begin January of the following year.  You will begin accruing a penalty of 1% of the national average premium cost per month from May 15, 2006, until you enroll in a plan.  That penalty will be added to whatever plan premium you eventually choose. MEDICAID PRESCRIPTION DRUG COVERAGE Beginning January 1, 2006, Medicaid no longer pays for most prescription drugs if you are also on Medicare.  Medicare automatically took over coverage for Medicaid clients that were also on Medicare.  Medicaid clients were also auto enrolled in a plan if they did not choose and enroll themselves.  If the drug plan does not cover their drugs adequately, a Medicaid client can change plans once per month.  They are the only group allowed to change outside of enrollment periods.  MO RX? Beginning January 1, 2006, MO Senior Rx became MO Rx.  Clients who were members of MO Senior Rx were automatically transferred to the new MoRx.  Rather than giving discounts as the MO Senior Rx did, the new MO Rx helps pay deductibles, co-pays, etc.  They will not cover any premiums.  Enrollment is not currently available to new clients.  Plans are for new enrollments to begin in the Fall 2006.  Call MoRx for more information at 800-375-1406. OTHER PRESCRIPTION DRUG COVERAGE There are other ways to get help with your prescription drugs.  Patient Assistance programs and other charitable sources are still available.  Contact our staff for more information.  Access to Benefits Coalition- online service for Medicare beneficiaries with lower income.  www.benefitscheckup.org/link/nwmoaaa