We know there are a vast number of Colorado seniors who are
eligible for Medicaid but do not receive these benefits. Maybe you
are one of them.
Seniors! Inc. offers Medicaid application assistance for all
Coloradans free of charge. Contact Seniors! Inc. for application
assistance. We will help you complete the county Medicaid
application so that you may apply for your benefits.
We also know that much confusion exists regarding Medicare Part
D benefits - and we are happy to answer your questions about that
topic. Call (303) 300- 6978 and we will be happy to answer all your
questions.
Read current Medicare news.
The "Part D" Prescription Drug Benefit from Medicare -
What you need to do
On January 1, 2006, Medicare began sharing the cost of
prescription medications with you, the consumer. The benefit,
referred to as Pt. D of Medicare, is a component of the larger
Medicare insurance plan but offered to consumers by Medicare
approved private companies (stand-alones) and Medicare Health
Plans. In 2008, at least 22 companies offering 55 plan options have
been approved to offer Pt. D prescription drug plans to consumers
in Colorado.
Like other insurance plans, Pt. D prescription drug plans will
have co-pays, deductibles and monthly premiums. The dollar amounts
of these co-pays, deductibles and monthly premiums will differ
among the private companies and HMO's.
Because different Pt. D prescription drug plans cover some but
not all formulary medications and offer formulary medications at
different costs, always have a list of your medications available.
This practice will enable you to select a Pt. D plan that covers
all of your listed medications at the best prices.
General Costs
Among Pt. D plans in 2010, estimated monthly premiums will
average $30 per month. After you pay the $310 deductible*, Medicare
will share the cost of covered prescriptions from $311 to $2,830 by
paying 75% of the prescription cost. Your co-pay is the remaining
25% of the prescription cost. *Note: Pt. D prescription drug plans
offer different premium/deductible price mixes and offer
medications at different costs, so be sure to compare plans.
The Coverage Gap (Donut Hole) and Catastophic Coverage
After $2,830, Medicare cost-sharing stops. You alone must pay
100% of the next $3216.25 in drug costs until you have spent $4,550
in out-of-pocket costs. After you reach $4,550 in out-of-pocket
costs, you enter the catastrophic coverage level coverage and
Medicare again shares the cost by paying 95% of the prescription
cost. Your co-pay is the remaining 5% of the prescription cost.
Extra Help or (Low Income Subsidy)
Extra Help (or LIS) is a subsidy from Social Security that helps
low income Medicare beneficiaries pay for their medications.
Beneficiaries with gross monthly incomes below $1,353 monthly or
below $1,821 for a married couple, living together and resources
less than or equal to $11,990 for an individual or $23,970 for a
married couple, living together, could be eligible for this
benefit. Contact Seniors, Inc. for eligibility screening and
application assistance.
Medicare Health Plans (HMOs, PPOs, PFFSs) or Pt. C
If you are currently enrolled in a Medicare Health Plan that
provides your Pt A and Pt B benefits such as Kaiser or Secure
Horizons, the MHP will enroll you in their Medicare-approved Pt. D
prescription drug benefit plan and will inform you of the
co-payments, deductibles, and premiums. Pt. D plan enrollment
periods open in mid November of each year, so you should be hearing
from various plans in early October.
If you wish to enroll in an HMO or if you wish to switch HMO's,
you will need to choose the HMO that has the prescription drug plan
with the drug formulary, co-payments, deductibles, and premiums
that best meets your needs. Call the HMO for plan details and
coverages before November.
Medicare Supplemental Plans (Medigap) and Employer Group
Plans
If you have a Medicare Supplement (Medigap) policy (through
AARP, Mutual of Omaha, Bankers Life, etc.) without Pt. D
prescription drug coverage and if you are not part of an employer
group plan, you will need to enroll in a Pt. D prescription drug
Plan. Contact Seniors! Inc., and we will send you details on all
stand-alone Pt. D plans offered in Colorado.
If you currently have a Medicare Supplement (Medigap) plan that
includes Pt. D prescription drug coverage (such as Plan H, I or J)
you can keep this coverage; however, enrolling in a Pt. D
prescription drug plan could be less expensive.
If you have coverage from an employer group plan, contact that
benefits coordinator at the plan and ask if your plan includes a
Medicare approved Pt. D prescription drug plan. Some employer group
plans offer Pt. D Prescription Drug Plans that Medicare has not
approved.
Medicaid and Pt.D
If you are a full Medicaid beneficiary and in a long-term care
facility, you will be deemed eligible for Pt. D low income
prescription subsidy and should be automatically enrolled in a Pt.
D prescription drug plan if you are not already enrolled in a plan.
If you learn that you or a relative has yet to be automatically
enrolled, call Seniors! Inc. at 303-300-6978. Our application
assistance manager can help you submit an application for the
benefit.
Enrollment Period
Pt. D Initial Enrollment Period: 7 months surrounding your 65th
birthday. Begins 3 months prior to birth month, including the birth
month, and three months after birth month. Coverage begins 1st day
of month following month of enrollment (enrollment at some time in
June, coverage begins August 1st).
The Annual Election Period opens on November 15th and ends on
December 31st. Pt. D coverage begins January 1st.
Special Enrollment Periods exist for beneficiaries who are full
dual eligibles (Medicare & Medicaid), partial dual eligibles
(Medicare Savings Plan enrollees), and beneficiaries in long-term
care facilities. These beneficiaries can switch among Pt. D
prescription drug plans at any time. Call Seniors! Inc. to learn
about special enrollment periods (SEPs).
TRICARE for Life
If you receive TRICARE as a military retiree or Veterans
Administration benefits, you will not need to sign up for a Pt. D
Prescription Drug Plan. You should contact TRICARE for advice.
For more information, call us at Seniors! Inc. at (303) 300-6978
or contact Medicare at 1-800-MEDICARE or go to www.medicare.gov
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