FACT Sheet: Medicare and HIV/AIDS. Henry J. Kaiser Family Foundation (October 2004)
Policy and Politics: Medicare Prescription Drug Coverage. Article from the Bulletin of Experimental Treatments for AIDS (BETA), Summer 2005
Medicare Part D Drug Benefit: What You Need to Know. American Academy of HIV Medicine
The New Medicare Prescription Drug Law: Issues for Dual Eligibles With Disabilities and Serious Conditions. Kaiser Commission on Medicaid and the Uninsured, June 2004
Medicare's official website allows you to learn more about Part D and the prescription plans available to you.
Medicare Rights Center (MRC) is the largest independent source of health care information and assistance in the United States for people with Medicare.
Social Security Administration is offering a low income subsidy to individuals on Medicare to help them pay for the additional costs of the prescription drug plans.
Who can get Medicare prescription drug coverage?
Everyone with Medicare is eligible for this coverage, regardless of income and resources, health status, or current prescription expenses. Medicare eligible individuals who do not have credible coverage, prescription drug coverage that is at least as good as a Medicare prescription drug plan, should enroll in a Medicare prescription drug plan.
When can I get Medicare prescription drug coverage?
The first enrollment period ends May 15, 2006. If you don't sign up by May 15, 2006, you may pay a penalty. After that, yearly enrollment is from November 15 to December 31.
How does Medicare prescription drug coverage work?
Like other insurance, if you join, you will pay a monthly premium, which varies by plan, and a yearly deductible (no more than $250 in 2006). You will also pay a part of the cost of your prescriptions, including a co-payment 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. If you have limited income and resources, and you qualify for extra help, you may not have to pay a premium or deductible.
The Medicare Part D drug plans have the flexibility to determine what drugs to cover and at what cost. A list of the plans covered drugs is called a formulary. Before choosing plan you will want to make a list of all the drugs you are currently taking and enter them in the formulary finder at www.medicare.gov. By doing this, you will know if your drugs are covered and a general idea of cost sharing. Plans using formularies are required to include at least two drugs in each class however, all Medicare Part D drug plans are required to cover all drugs included in the antiretroviral class so that individuals who are HIV-positive will have access to every FDA approved antiretroviral.
What if a drug is not included on the formulary?
If a specific drug is not included on your formulary or it is included but the cost-sharing is at a high cost co-pay tier, then the patient may submit an appeal to the insurance company if you and your doctor determine the drug is medically necessary. Insurance companies must make a decision on appeal requests within 72 hours.
What if I have a limited income and resources?
There is extra help for people with limited income and resources. Almost 1 in 3 people with Medicare will qualify for extra help and Medicare will pay for almost all of their prescription drug costs. To apply for this additional help please contact the Social Security Administration at www.ssa.gov or call 1-800-772-1213.