Medicare Prescription Drug Assistance Drug program

Medicare’s first and foremost goal was the creation of a system that would guarantee that the elderly population’s medical care needs would be met.  While Medicare originally limited its benefits to individuals aged 65 and older, in 1972 Medicare coverage was expanded to also include those individuals who are severely disabled and because of their disability entitled to at least 24 months of disability benefits, and also to include patients who suffer from the advanced stages of kidney disease that require dialysis or a kidney transplant.  It is important to note that Medicare does not cover custodial care for individuals in need of round the clock treatment or long-term nursing home stays.  Additionally, dentures, dental care, glasses, hearing aids and most prescription drugs are not covered.

The small number of prescription drugs that Medicare Part B will cover up to 80% is limited to an injectable drug for osteoporosis, erythropoietin by injection for end-stage kidney disease, immunosuppressive drug therapy for transplant patients, some oral cancer drugs, and a few other drugs.  Thus, if a Medicare recipient is not enrolled in the optional Pat B coverage, these benefits will not apply. Additionally, patients will be required to pay an annual $110 deductible for Part B services prior to Medicare’s paying its agreed upon 80%. 

The high cost of prescription drugs has long since been a major consideration for Medicare recipients, and many a patient is not taking prescribed drugs simply because they are too expensive.  Unfortunately, the inability to obtain such needed drugs quite often negates the benefits received under Medicare provisions, and the program is seeking to remedy this situation by offering Medicare-approved drug discount cards to plan participants.  In order to qualify for a drug discount card, an individual must participate in Medicare Part A and/or Part B, and not receive any prescription drug benefits through Medicaid.   Furthermore, benefits are sometimes curtailed if prescription drugs are covered (in whole or in part) through a current health insurance policy.  Enrollment in a Medicare-approved drug discount card program is not free.  As a matter of fact, costs may be $30 per year. It is of vital importance that interested individuals do their homework and compare the card programs, as each may not cover the exact same drugs, may not be accepted at a locally convenient pharmacy, and may not permit for easy mail-order refills.

Another way for Medicare recipients to receive prescription drug coverage is through the purchase of a, optional Medigap insurance policy, available from local insurance companies.  Those individuals, who already own a Medigap policy that includes prescription coverage, may choose to not sign up for the new Medicare insurance coverage.  However, new enrollees in Medigap policies who sign up after January 1, 2006 will no longer be able to purchase a policy that contains a prescription drug benefit.

The year 2006 will mark the beginning of a new Medicare insurance coverage for prescription drugs as well as the phase-out of the Medicare-approved drug discount card programs. The plan will not offer free prescriptions, but it will cover most often about half of the cost of prescriptions.  Additionally, this insurance coverage requires a fee-based subscription and enrollment must be completed by May 15, 2006.  While it is still costly, this plan does guarantee that an individual will not pay more than $3600 per year for prescriptions. Keeping in mind the growing numbers of Medicare recipients who are also borderline indigent, special plans are available for individuals who are unable to meet the deductibles, co-payments, or enrollments fees by substantially increasing the payment percentages and lowering the co-payment amounts.

Generally speaking, Medicare recipients who join the prescription drug plan will pay a monthly fee of about $37.  Also, they will pay the first $250 in a calendar year for qualifying prescriptions.  This sum is considered a deductible, and once it is met, participants will be liable for 25% of the costs of drugs per calendar year up to and including $2,250.  If a plan participant requires further prescriptions, any costs above $2,250 will be the sole responsibility of the patient, unless the out-of-pocket costs reach $3,600.  At that point the plan will pay 95% of the drug costs.