Don’t be without prescription drug coverage

Don't be without prescription drug coverage
South Dakotans with Medicare who are to receive "extra help" in paying for prescription drug coverage should sign up for a drug plan that meets their individual needs, a South Dakota State University specialist said.

"Making application for the extra help was only the first step. All with confirmed extra help coverage now need to look at a best-fit plan for them," SDSU Extension Family Resource Management Specialist Liz Gorham said.

Those who are dual enrollees in Medicaid and Medicare will be automatically enrolled by Dec. 31, 2005, in any plan (it may or may not cover the drugs currently being used). They can, after Jan. 1, re-enroll in a different plan.

Other persons with Medicare receiving some extra help (SLMB, QIMB and QI) need to act soon. Unlike the dual enrollees, they will be without coverage if they fail to enroll in a plan by the last day of 2005. If they do not sign up on their own, they will be automatically enrolled but not until May with coverage beginning on June 1.

If they sign up in January 2006, prescription drug coverage can start for them in February or the month following the month they enroll.

All persons with Medicare who receive "extra help" may re-enroll in a new plan every month. This is not the case for other enrollees in Medicare Part D insurance.

Those who received notice that they did not qualify for extra help, are not disqualified from choosing a prescription drug plan to help pay for their drugs. They have until May 15 to apply for a Medicare prescription drug plan offered by some 17 companies operating in South Dakota.

Insurance will start the month after they choose a plan. If they do not select a plan by May 15, or do not currently have a prescription drug plan with "credible coverage," they will have to pay a 1 percent per month penalty of the average national premium ($32.86) to join a Medicare-approved drug prescription plan.

All persons with Medicare, who do not qualify for extra help, are allowed to make one change in their drug insurance plan during this initial enrollment period until May 15. Then every year, from Nov. 15 to Dec. 31, persons with Medicare Prescription Drug Insurance may change their coverage.

They may want to do this to reflect coverage of any new drugs prescribed by their doctor that are not on their current company's drug formulary or they may like the terms better than another plan offers.

To set up a meeting to get a plan tailored to your prescription drug needs contact a South Dakota Medicare Partner for assistance by calling your county Extension office, the SHIINE Office at 1-800-536-8197 or 1-800-MEDICARE (1-800-633-4227)/ TTY 1-877-486-2048.

"All South Dakotans can help us to identify this audience to assist in this effort." Gorham said.

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