Medicare Part D Prescription Drug Benefit Frequently Asked Questions
Question: What
is the Medicare Prescription Drug Benefit, and when can Medicare beneficiaries
enroll?
Answer: The Medicare Prescription
Drug, Improvement, and Modernization Act of 2003 (MMA) provides elderly
and disabled people on Medicare access to prescription drug coverage
from private prescription drug plans. Medicare beneficiaries can choose
from two or more drug plans in their area. People who choose to enroll
in a drug plan pay a monthly premium to receive prescription drug benefits,
and deductible and copayment costs may also apply. Assistance with paying
premiums, deductibles and copayments is available to low-income beneficiaries.
For an overview of the Medicare Prescription Drug
Benefit, please see the Kaiser Family Foundation's fact sheet The
Medicare Prescription Drug Benefit.
The initial enrollment period ended May 15, 2006. The next opportunity
to enroll will occur between November 15 and December 31, for enrollment
beginning January 1st of the following year. You may also enroll within
63 days after you first become eligible for Medicare and do not have
coverage at least as generous as standard Medicare Part D prescription
drug coverage.
Question: What
is the difference between a prescription drug plan (PDP) and
Medicare Advantage Prescription Plan (MA-PD)?
Answer: Medicare prescription drug plans
(PDPs) provide only prescription drug coverage, as a supplement to traditional
fee-for-service Medicare. Medicare Advantage prescription drug (MA-PD)
plans cover both drugs and other Medicare benefits. For more information,
please see the Kaiser Family Foundation publications, The
Medicare Prescription Drug Benefit and Medicare
Advantage Fact Sheet.
Question: Do
pharmacies need to contract with Medicare Part D plans in
order to be reimbursed for services to Medicare enrollees?
Answer: Yes. As of January 1, 2006, pharmacies
will be able to receive
reimbursement only for those Medicare patients (including dual
eligibles, patients covered by both Medicaid and Medicare) enrolled in
Prescription Drug Plans (PDPs) that the pharmacy has contracts with.
Pharmacies will no longer be reimbursed by state Medicaid programs for
prescriptions provided to dual eligible patients. For information about
contracting with PDPs, please see the Health Resources and Services
Administration's
Medicare Part
D & Safety
Net Providers: Contracting with Prescription Drug Plans.
Question: How many rural Medicare beneficiaries have enrolled in Medicare Part D?
Answer: As of June 2006, over half of rural
Medicare beneficiaries had Medicare Part D coverage. Another 21% had
employer or federal sponsored prescription drug coverage. A higher percent
of rural Medicare beneficiaries enrolled in Part D are in a stand-alone
prescription drug plans, compared to urban Part D enrollees. A lower
percent of rural Part D enrollees than urban are in Medicare Advantage
prescription drug plans, which cover both drugs and other Medicare benefits.
Overall, 74% of rural Medicare beneficiaries have creditable prescription
drug coverage, compared to 76% of those living in urban areas. For
more details about rural versus urban enrollment in Medicare Part D,
please see the RUPRI Center for Rural Health Policy Analysis brief, Enrollment
in Medicare Part D for Rural Beneficiaries Is Encouraging.
Question: Do rural Medicare beneficiaries have access to the same range of Medicare prescription drug plans as urban beneficiaries?
Answer: Rural Medicare beneficiaries have
access to stand-alone prescription drug plans that are generally the
same as the plans available to urban beneficiaries. However, the Medicare
Advantage prescription drug plans available in rural areas tend to be
less generous than those offered in urban areas. For more information
about the characteristics of Medicare prescription drug plans available
in rural versus urban areas, please see the RUPRI Center for Rural Health
Policy Analysis brief, Medicare
Part D: Early Findings on Enrollment and Choices for Rural Beneficiaries.
Question: Do
rural Medicare beneficiaries have access to pharmacies that participate
in a Medicare Prescription Drug network?
Answer: Prescription drug plans (PDPs), which
provide only prescription drug coverage, and Medicare Advantage prescription
drug (MA-PD) plans, which cover both drugs and other Medicare benefits,
are required to have participating pharmacies in their networks to provide
adequate pharmacy access to participants. For rural areas, "at least
70 percent of Medicare beneficiaries in the plan's service area, on average,
live within 15 miles of a retail pharmacy participating in the prescription
drug plan's or MA-PD plan's network." Please see A
Rural Perspective Regarding Regulations Implementing Titles I and II
of the Medicare Prescription Drug, Improvement, and Modernization Act
Of 2003 (MMA) for more information.
Question: Are there special considerations when conducting outreach for Medicare Part D in rural communities?
Answer: Yes. When trying to educate rural communities about Part D and the low-income subsidy, some considerations include the following:
- Rural communities place value on preserving and respecting history and traditions.
- Enrollment plans need to be practical and useful to the local situation.
- Content of outreach materials need to be personalized to targeted groups.
- Outreach activities need to be sensitive to the cultural diversity of the rural area. Materials should be culturally competent and take into consideration special language needs.
- Rural communities may need information for short-term decision-making as well as long-term decision-making.
- Careful thought should be given before assuming that new technologies
are appropriate for use in educating rural communities. Will the community
members be receptive; do we know anything about past use of technology
in these communities; will many members of the community have access
to the technology?
- Methods of communication need to fit life patterns and resources.
- Consider educational levels when developing outreach materials.
- Work through well respected local organizations.
- Use community members to develop and test outreach materials. Community approved methods and materials will have better success. Meet with key informants from the community.
- Use various outreach approaches to better reach all
community members.
- Be prepared to change methods, materials, approaches depending upon community responses.
Credits
Maintained by: Holly Gabriel,
holly@raconline.org
Last revised 06/30/2008
