The Biggest Change to Medicare in 40 Years

You may have heard about a new section of Medicare called "Part D." It’s important to learn about Part D, because its introduction marks the first time Medicare will offer optional prescription drug coverage to all individuals who are entitled to or enrolled in Medicare benefits under Part A and Part B.

Medicare Part D is the name of the prescription drug benefit established by the Medicare Modernization Act of 2003 (MMA). "This is a big change to the Medicare program," says Richard Alter, R.Ph., manager of the Meridian Pharmacy. "In fact, it’s the biggest change to Medicare in 40 years."

Coverage will be available to everyone with Medicare, regardless of his or her income or whether he or she is enrolled in Medicare or a Medicare Advantage plan. It also provides help with brand name and generic drugs. Plus, seniors can get their medications, and the valuable savings that go with them, at their community pharmacy, where it’s convenient.

How Will Part D Work?
Based on the list of drugs — or a drug formulary — health plans will give their Medicare recipients a list of drugs that will be covered. This formulary will be approved by the Centers for Medicare and Medicaid Services, which is the federal agency responsible for administering Medicare. This formulary can then guide doctors as they choose prescriptions that will be effective, safe, and economical for their Medicare patients.

Pharmacists Play an Important Role
Pharmacists will be a big part of making the new program work. Pharmacists have always supported customer-focused health care. "Tens of millions of Medicare beneficiaries will enroll in Medicare drug plans in the first few months this benefit is offered," states Richard, "many of whom will likely turn to their local pharmacist for help in understanding the Medicare drug coverage. To get the most out of the new drug plan, pharmacists are being given the opportunity to counsel seniors on their medication usage. This will help ensure that prescription drugs are taken appropriately and that adverse drug interactions are reduced."

Pharmacists are vital in managing patient medications, helping patients deal with chronic illnesses, and improving medication use. Coverage plans are creating Medication Therapy Management (MTM) programs for certain high-risk Medicare beneficiaries, in particular, patients who take multiple drugs for multiple chronic diseases.

Everyone Needs to Know
Raising awareness of the new plan is big part of its success. Many seniors do not know about this drug coverage benefit, and many more mistakenly think they do not qualify. "We need to make sure that seniors are aware of this drug benefit," says Richard. "They should be confident about their decision to use it. It will likely lower their prescription costs!"

When coverage takes effect in 2006, the average Medicare subscriber will see his or her medication costs reduce by about half. Almost one third of the people enrolled will be eligible, and extra help is even able to those with higher assets and incomes.

Enrollment begins on November 15. The first enrollment period runs through May 15, 2006. Coverage begins January 1, 2006.

Currently, health plans can enroll their Medicare recipients. But Part D is voluntary, so recipients will be given the choice of whether or not they want to enroll, usually by means of a form that they can fill out and submit to their heath plan. Although enrollment is voluntary, seniors will pay less if they enroll on time.

Questions About Medicare?

You’ll find more information about Part D on the Web at www.medicare.gov. If you don’t have a computer, a library or senior center may help you find what you need. Or call toll free 1-800-MEDICARE (1-800-633-4227).

Medicare Basics

Part A: Part A is hospital insurance. It helps pay for inpatient care in hospitals and skilled nursing facilities and some home health care. It doesn’t cover longterm care.

Most people don’t pay for Part A and get it automatically when they turn 65.

Part B: Part B is medical insurance that helps pay for outpatient care and doctors’ services. This includes outpatient mental health care, cancer screenings, and flu shots. It also covers physical and occupational therapy, as well as some home health care. Part B only covers services and supplies when they are medically necessary. But it doesn’t cover everything, including most eyeglasses and hearing aids.

If you choose to receive Part B benefits, you must enroll. You can sign up near your 65th birthday or during specific periods each year. For most people, there is a monthly cost, or premium.