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PRESCRIPTION DRUG COVERAGE |
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For the first time ever, everyone
with Medicare, regardless of income, health status or
prescription drug usage, will have access to prescription drug
coverage. This new coverage begins on January 1, 2006.
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To get Medicare coverage for your
prescription drugs, you must choose and join a Medicare drug
plan. |
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For more information on Medicare's
prescription drug plan, you can call 1-800-MEDICARE
(1-800-633-2273) or you can visit
www.medicare.gov.
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Prescription Drug Coverage: Basic Information |
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Prescription Drug
Coverage: Cost |
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Prescription
Drug Coverage: Coverage |
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Prescription Drug Coverage: Convenience |
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Prescription Drug Coverage: Peace of Mind |
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Prescription Drug Coverage: Additional Information |
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First Choice Community Health Centers Disclosure |
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PRESCRIPTION DRUG COVERAGE: BASIC INFORMATION |
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What is
Medicare prescription drug coverage? |
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Medicare
prescription drug coverage is insurance that covers both
brand-name and generic prescription drugs at participating
pharmacies in your area. Medicare prescription drug
coverage provides protection for people who have very high
drug costs or from unexpected prescription drug bills in the
future. |
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Who can get Medicare prescription drug coverage?
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Everyone with Medicare is eligible
for this coverage, regardless of income and resources, health
status, or current prescription expenses. |
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When can I get Medicare prescription drug coverage?
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You may sign up when you first
become eligible for Medicare (three months before the month
you turn age 65 until three months after you turn age 65).
If you get Medicare due to disability, you can join from three
months before to three months after your 25th month of cash
disability payments. |
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If you don't sign up when you are
first eligible, you may pay a penalty. If you didn't
join when you were first eligible, your next opportunity to
join will be from November 15, 2007 to December 31, 2007.
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How does Medicare prescription drug coverage work? |
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Your decision about Medicare
prescription drug coverage depends on the kind of health care
coverage you have now. There are two ways to get
Medicare prescription drug coverage. You can join a
Medicare prescription drug plan or you can join a Medicare
Advantage Plan or other Medicare Health Plan that offers drug
coverage. |
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Whatever plan you choose, Medicare
drug coverage will help you by covering brand-name and generic
drugs at pharmacies that are convenient for you. |
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Like other insurance, if you join,
generally you will pay a monthly premium, which varies by
plan, and a yearly deductible (between $0-$265 in 2007).
You will also pay a part of the cost of your prescriptions,
including a copayment or coinsurance. Costs will vary
depending on which drug plan you choose. Some plans may
offer more coverage and additional drugs for a higher monthly
premium. |
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If you have limited income and
resources, and you qualify for extra help, you may not have to
pay a premium or deductible. You can apply or get more
information about the extra help by calling Social Security at
1-800-772-1213 (TTY 1-800-325-0778) or by visiting
www.socialsecurity.gov
on the web. |
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Why should I get Medicare prescription drug coverage? |
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Medicare prescription drug coverage
provides greater peace of mind by protecting you from
unexpected drug expenses. Even if you don't use a lot of
prescription drugs now, you should still consider joining.
As we age, most people need prescription drugs to stay
healthy. For most people, joining now means protection
from unexpected drug bills in the future. |
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What
if I have a limited income and resources? |
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There is extra help for people with
limited income and resources. If you qualify for extra
help, Medicare will pay for almost all of your prescription
drug costs. You can apply or get more information about
the extra help by calling Social Security at
1-800-772-1213
(TTY 1-800-325-0778) or visiting
www.socialsecurity.gov
on the web. |
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PRESCRIPTION DRUG
COVERAGE: COST |
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Premium - this is the cost
you pay to join a Medicare drug plan. Premiums vary by
plan. |
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Deductible - this is the
amount you pay for your prescriptions before your plan starts
to share in the costs. Deductibles vary by plans.
No plan may have a deductible more than $265 in 2007.
Some plans may not have any deductible. |
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Copayment/Coinsurance - this
is the amount you pay for your prescriptions after you have
paid the deductible. In some plans, you pay the same
copayment (a set amount) or coinsurance (a percentage of the
cost) for any prescription. |
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In other plans, there might be
different levels or "tiers," with different costs. (For
example, you might have to pay less for generic drugs than
brand names. Or, some brand names might have a lower
copayment than other brand names.) Also, in some plans
your share of the cost can increase when your prescription
drug costs reach a certain limit. |
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PRESCRIPTION
DRUG COVERAGE: COVERAGE |
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Formulary - a list of drugs
that a Medicare plan covers is called a formulary.
Formularies include generic drugs and brand-name drugs.
Most prescription drugs used by people with Medicare will be
on a plan's formulary. The formulary must include at
least two (2) drugs in categories and classes of most commonly
prescribed drugs to people with Medicare. This makes
sure that people with different medical conditions can get the
treatment they need. |
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Prior Authorization - some
drugs are more expensive than others even though some less
expensive drugs work just as well. Other drugs may have
more side effects, or have restrictions on how long they can
be taken. To be sure certain drugs are used correctly
and only when truly necessary, plans may require a "prior
authorization." This means before the plan will cover
these prescriptions, your doctor must first contact the plan
and show there is a medically-necessary reason why you must
use that particular drug for it to be covered. Plans
might have other rules like this to ensure that your drug use
is effective. |
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Coverage Gap - if you have
high drug costs, you may consider which plans offer additional
coverage until you spend $3,850 (in 2007)
out-of-pocket. In some plans, if your costs reach an
initial coverage limit, then you pay 100%
of your prescription costs. This is called the coverage
gap. This "gap" in coverage is generally above $2,400
(in 2007) in total drug costs until you spend $3,850
out-of-pocket. Some plans might offer some coverage
during the gap. Even in plans where you pay 100%
of covered drug costs after a certain limit, you would still
pay less for your prescriptions than you would without this
drug coverage. |
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PRESCRIPTION
DRUG COVERAGE: CONVENIENCE |
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Drug plans must contract with
pharmacies in your area. Check with the plan to make
sure your pharmacy or a pharmacy in the plan is convenient to
you. Also, some plans may offer a mail-order program
that will allow you to have drugs sent directly to your home.
You should consider all of your options in determining what is
the most cost-effective and convenient way to have your
prescription filled. |
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PRESCRIPTION DRUG COVERAGE: PEACE OF MIND |
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Even if you don't take a lot of
prescription drugs now, you still should consider joining a
drug plan. As we age, most people need prescription
drugs to stay healthy. For most people, joining now
means you will pay a lower monthly premium in the future since
you may have to pay a penalty if you choose to join later.
You will have to pay this penalty as long as you have a
Medicare drug plan. If you reach the point where you
have spent $3,850 (in 2007) out-of-pocket for drug
costs during the year, the plan will pay most of your
remaining drug costs. This protection could start even
sooner in some plans. |
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PRESCRIPTION DRUG COVERAGE: ADDITIONAL INFORMATION |
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For more information regarding the
drug benefit plan, you can visit the Medicare website at
http://www.medicare.gov/pdphome.asp. There you
will find links to information that is covered in this page
and more. |
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You may also contact Medicare at the
toll free phone number at |
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1-800-MEDICARE or
1-800-633-4227. |
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FIRST CHOICE COMMUNITY HEALTH CENTERS DISCLOSURE |
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First Choice Community Health
Centers is providing you this information as a community
service and no representations or guarantees are made as to
eligibility or enrollment. |
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First Choice Community Health
Centers cannot advise you on which plan you should prescribe
to, if any. |
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The information above is subject to
change without notice. |
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