September 28, 2005
On September 23, the Centers for Medicare and Medicaid Services (CMS) announced the names of the plans in each state that will be offering coverage under the upcoming Medicare prescription drug benefit. Beginning in mid-October, these plans will begin marketing coverage to all Medicare beneficiaries. Enrollment in drug plans will start on November 15 and coverage will begin on January 1, 2006.
Under the new Medicare Part D drug benefit, coverage will be offered through federally-approved private sector prescription drug plans (PDPs) and Medicare Advantage (MA) plans, rather than through a single federal bureaucracy. This will provide beneficiaries with a choice of as many as 20 plans in some states. There will be 8 plans that operate nationally. In 44 states, MA plans offering drug coverage at no cost will be available -- these managed care MA plans offer coverage of physician and hospital services in addition to medications.
According to CMS, in every state (except Alaska) there will be at least one plan with a monthly premium of less than $20 (far below the expected average monthly premium of $37). More importantly, in every state there will be multiple plan options available for dual eligible beneficiaries and individuals receiving low-income assistance, i.e. plans that are at, or below, the average cost (see below).
Individuals concurrently eligible for both Medicare and Medicaid (about 1.2 million of whom have a severe mental illness) will be required to enroll in the new Medicare Part D program -- at no cost. After November 15, CMS will begin enrolling these dual eligible beneficiaries into PDPs and MA plans that are at or below the regional average. Upon auto-enrollment, dual eligibles will be able to switch to any plan that is at or below the average regional plan -- even on a monthly basis after January 1. Dual eligibles will receive coverage with no monthly premium, no annual deductible and cost sharing limited to $1 for generic medications and $3 for brand name medications.
For low-income Medicare beneficiaries -- those at or below 150% of the federal poverty level -- (about $14,300 for an individual and $19,200 for couples) -- subsidies are available in order to make drug coverage affordable. Beneficiaries can apply for these subsidies now through the Social Security Administration (www.ssa.gov), senior centers and retail pharmacists.
By mid-October, CMS will be making available several internet-based decision and search tools that will allow beneficiaries to make decisions about enrollment and compare the coverage available under each drug plan for specific medications. These search tools will be available at www.medicare.gov
NAMI is a partner with other leading mental health organizations in sponsoring a new Web site for the latest information on Medicare's new prescrption drug benefit, especially for consumers without coverage or who currently receive prescriptions through Medicaid. Visit www.mentalhealthpartd.org. The new benefit starts January 1, 2006 and will mean changes for many people receiving treatment for mental illnesses.
A separate independent website will also be available to compare the available drug plans at www.maprx.info
To view a map of available prescription drug plans (PDPs) and Medicare Advantage (MA) plans, click here.