The following was adapted from an article that first appeared in the October 2005 issue of InsideMS (now known as Momentum). It provides a basic overview of Medicare prescription drug coverage, with an emphasis on issues most relevant to people with MS and their caregivers. Some key terms are defined in a glossary.
The Medicare Modernization Act, also known as Medicare Part D, went into effect on January 1, 2006 as an option for all Medicare beneficiaries. Medicare prescription drug plans are private insurance plans approved by the federal government that offer Medicare beneficiaries insurance coverage for their drug costs. There are many plans from which to choose, and the challenge is finding the plan that best meets your needs. All plans share the costs of drugs with beneficiaries, and financial assistance is available for those who qualify. Navigating through the many choices and decisions to be made can be complex, but there are many sources of help.
Who Needs a Medicare Prescription Drug Plan?
Anyone who is eligible for Medicare is eligible for a Medicare prescription drug plan, but not everyone needs one. If you have drug coverage now that is ‘just as good as' a Medicare prescription drug plan, your current plan is considered ‘creditable coverage' and you probably don't need to enroll in a Medicare drug plan. You can enroll in one later if your current drug coverage ends. Your current insurer is required to tell you if your current coverage qualifies as ‘creditable coverage', and you can always contact them and ask if you are unsure.
It is important to enroll on time to avoid the lifetime penalty. The lifetime penalty is a 1% addition to your Part D premium for every month you failed to enroll after you become eligible if you have no other creditable coverage. Medicare beneficiaries under age 65 who incur this penalty get one chance to have it forgiven when they turn 65 and take advantage of a second Initial Enrollment Period.