Starting January 1, 2006 Medicare will offer a new "Prescription Drug Coverage" under a designation called Part D. It will cover some limited brand and generic drugs. This new drug coverage requires all people with Medicare to make a decision about this new coverage. As a medical professional, your Medicare patients may ask you questions about this new coverage. Specifically, they may ask if this Part D coverage applies to any of the drugs or radiopharmaceuticals that you will administer during their nuclear medicine radiology or cardiology procedures. The simple answer is "no", the drugs and radiopharmaceuticals provided with these procedures are covered under Part A or Part B services for Medicare patients not under the new Part D coverage.
CMS issued a Medlearn Matters article number SE0557 which clarifies this issue, they state "There has been some confusion among Fee-For-Service (FFS) providers regarding their ability to bill drugs covered under Part D. In short, being an enrolled provider in the FFS does not impart Part D- related billing privileges. Medicare Part B covers a limited number of prescription drugs and biologicals. These drugs continue to be covered and paid for under the FFS Medicare program and FFS providers will continue to bill their Carriers, Fiscal Intermediaries, and Durable Medical Equipment Regional Carriers (DMERCs) for these drugs."
Read more if you wish to further assist your patients regarding details of Part D:
All people with Medicare will have a range of choices to enable them to get prescription drug coverage that reflects their preferences, including options with low premiums and options offering more coverage than Medicare's standard drug benefit, the Centers for Medicare & Medicaid Services (CMS) announced today.
Enrollment for Medicare's prescription drug coverage runs from November 15 through May 15, 2006. Coverage begins on January 1 if a beneficiary enrolls before then. After that, coverage begins on the first of the month after a beneficiary enrolls.
Medicare will provide comprehensive support to help beneficiaries make a confident decision about drug coverage. That support includes community-based resources offering personalized counseling, materials on www.medicare.gov and through 1-800-MEDICARE, and the Medicare & You handbook with information about coverage in the local area.
For more information on the new Medicare prescription drug coverage, visit www.medicare.gov on the web, call 1-800-MEDICARE (1-800-633-4227), or get free counseling from your State Health Insurance Assistance Program.
An Update on Medicare Part D
This new prescription drug benefit begins in January 2006. People with Medicare will have several choices for getting their Part D coverage. These include the following:
o Those who are in or want to be in the original, fee-for-service Medicare program can enroll in a Part D Prescription Drug plan (PDP) that contracts with Medicare. o Those who are in, or want to enroll in a Medicare Advantage managed care plane (HMO, PPO, etc) can enroll in that plan's Part D Medicare Advantage Prescription Drug plan (MAPD).
Initial enrollment period for Part D will start on November 15, 2005, ending on May 15, 2006. People with Medicare can enroll in a Part D plan at any time during this period without facing a penalty. Those who want their Part D coverage to start on January 1, 2006, must enroll in a Part D plan before the end of 2005.
FACT: Once a person has chosen a Part D plan, he or she must stay with that plan until the next enrollment period. (There are a few exceptions.)
People with Medicare who already have prescription drug benefits, at least as good as or better than Medicare's, may be able to keep it without the risk of paying a higher Part D premium. If they later decide to enroll in Part D, these people will get a letter of Creditable Coverage from their current plan.
PDPs will begin marketing enrollment for their plans in October 2005. These PDP marketing materials will be approved by CMS this summer. Companies that offer Part D plans will have the flexibility in designing the benefits that they provide, including the drugs they cover and the cost sharing they charge. People with Medicare will only be able to enroll or disenroll from the plan they choose at certain times of the year.
FACT: Effective 2006, people with Medicare will no longer be able to enroll or disenroll on a monthly basis from a Medicare HMO plans.
The Social Security Administration handles Medicare eligibility and enrollment for Part A and Part B. They will not however be enrolling People with Medicare, into Part D. Social Security's part is to enroll Low Income People with Medicare who are eligible to extra help to pay for some or all of the beneficiary's out of pocket expenses.
Applications are being accepted by Social Security for Extra help for the Medicare Prescription Drug Plan costs. If you haven't received an application or information regarding extra help paying for one of the new Medicare prescription drug plans and you think you may be eligible, you should apply.
You can contact the Social Security Administration at 1-800-772-1213 to ask questions about whether you are eligible for extra help. You can also visit their Web site at www.socialsecurity.gov.
BenefitsCheckUpRx also helps people with Medicare and other older adults to learn about and enroll in government benefits, including the new Medicare Prescription Drug Coverage and other valuable federal, state and private programs that can save you money on health care and prescription drugs. www.benefitscheckup.org
More details can be found on the CMS web site: Medicare Part D Coverage
