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Medicare Part D

On January 1, 2006 a new voluntary Medicare prescription drug program, referred to as Medicare Part D, went into effect for all Medicare eligible consumers.

Consumers who were eligible for both Medicare and Medicaid (dual eligibles) lost their Medicaid prescription coverage on December 31, 2005. The only way (i.e. not voluntarily) dual eligibles could continue to receive prescription drugs was through Medicare part D .

Some Medicare Part D eligible consumers were also eligible for a federal Low Income Subsidy (LIS) which eliminates premiums and deductibles. Dual eligibles were automatically enrolled in both the LIS and Medicare Part D programs.

In 2005 the Coalition created a Provider Guide to the Medicare D Part Prescription Drug benefit which was intended to educate community mental health providers about the many issues Medicare consumers may face when they enroll in a Medicare Prescription Drug Plan. This Guide was updated for the 2006/07 plan years. The Coalition's Provider Guide to the Medicare Prescription Drug Benefit (PDF) »

Resource Highlights

The frequently updated resource list below contains links to additional information. For a complete list of resources, visit the Medicare Part D Resources page.

Medicare's Annual Open Enrollment is from Oct. 15 - Dec. 7

Each year plans change what they cost and what they cover. The next general open enrollment starts on October 15, 2011. During this time, people with Medicare can add, drop or change their prescription drug coverage. They can also select a health plan for their 2012 coverage.

Spotlights

EPIC:



Selfhelp Community Services'  Evelyn Frank Legal Resources Program

Training materials written and updated by various staff at the Evelyn Frank Legal Resources program since 2005.

An outline, updated for the 2010 Part D enrollment period covers the basic design of the Medicare Part D prescription drug benefit, the Extra Help subsidy for low income beneficiaries, how Part D works with other types of drug coverage including EPIC and Medicaid , and how to get Extra Help by using the Medicare Savings Program. It describe the Part D program and how it works in New York -- how it works with New York Medicaid, EPIC, ADAP , and other programs.

This Appendix contains charts, forms, and plan lists referenced in the outline described above.

Extra Help From the Social Security Administration

Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $4,000 per year. To qualify for the Extra Help, a person must be on Medicare, have limited resources and income, and reside in one of the 50 states or the District of Columbia.

What help can I receive?

New York Health Access

This site is made possible in part by grants from the New York State Office for Aging and the New York Community Trust. We are also grateful to Western New York Law Center for hosting the site.

This site is the product of the work of a group of legal services attorneys and paralegals who work in the field of health and public benefits law in New York state.

  • Getting Started
    Click here if you have questions about Medicare Part D prescription drug coverage, but don't know where to start.
  • Overview
  • Selecting a drug plan
    Part D drug coverage is provided by hundreds of private health insurance plans. Find out how to choose a plan that covers your drugs.
  • What drugs are covered?
    Medicare Part D doesn't cover all prescription drugs. Find out which drugs might not be covered, who does cover them, and how to solve coverage problems.
  • Extra Help
    Also known as the Limited Income Subsidy (LIS), this government benefit program makes Medicare Part D drug coverage more affordable for people with limited income.
  • Exceptions and Appeals
    If a Part D drug plan denies coverage for a drug, the member can appeal.

 

Center for Medicare and Medicaid Services

Plan and Premium Information for Medicare Plans Offering Part D Coverage 

Plan and Premium Information for Medicare Plans Offering Part D Coverage - New York Only

Medicare Part D Stand-Alone Prescription Drug Plans - New York Only

Medicare Advantage Plans with drug coverage (MA-PDs) in New York State

Medicare Rights Center

Medicare Interactive, which explains when people may enroll in a Medicare private plan and/or the Medicare prescription drug benefit, as well as when they can change or drop coverage.:

Can I change my Medicare private drug plan (Part D) at any time?

New England Journal of Medicine - July 23, 2009
Medicare Part D Update — Lessons Learned and Unfinished Business - Health Policy Report, Patricia Neuman, Sc.D., and Juliette Cubanski, Ph.D.
View PDF »

Medicare & You Handbook

Eligibility, Enrollment and Disenrollment Guidance

CMS enrollment and disenrollment guidance for current and future contracting Part D plan sponsors and other parties interested in the operational and regulatory aspects of Part D plan enrollment and disenrollment. .

Medicare Prescription Plan finder

Register for a free copy of "Medicare Part D Appeals"

An Advocate's manual to navigating the Medicare private drug plan appeals process". This manual offers an comprehensive overview of the entire process in an easy-to-understand manner.

An essential resource for the Mental Health Community

This site has separate sections targeted specifically at Psychiatrics and Other Physicians, Providers at Community Behavioral Health and Integrated Health Centers and Consumers and Their Families.