NEW DRUG COVERAGE IN VERMONT TO INCLUDE OPTIONS FOR ADDITIONAL BENEFITS AND SAVING MONEY
COST, COVERAGE, AND CONVENIENCE CAN BE FOCUS OF CHOICE
People with Medicare in Vermont will have a range of choices for prescription drug coverage to suit their individual needs, including plans that help save money or offer more coverage than Medicare’s standard drug benefit, the Centers for Medicare & Medicaid Services (CMS) announced today.
“Medicare drug coverage is coming with lower costs and better coverage options than many people expected, and there will be help available locally and nationally to assist people in making a decision,” HHS Secretary Mike Leavitt said.
“Everyone in Medicare who lives in Vermont , no matter what their income or how they get their health care, can choose coverage that reflects what they want, including lower cost, more complete coverage, and convenient access,” said CMS Administrator Mark B. McClellan, M.D., Ph.D.
For example, the lower cost choice could be a stand-alone plan with a low premium and low prices for a beneficiary’s drugs. The more complete coverage choice could be a drug plan that offers coverage for generic drugs and in some cases even brand-name drugs through the “coverage gap” in the standard Medicare benefit, a plan with no deductible, and a plan that covers almost all of the commonly used drugs. And for convenient access, a beneficiary can choose a plan that provides coverage through their own preferred pharmacies.
Medicare beneficiaries in Vermont who choose a stand-alone plan can get coverage for as little as $7.32 a month. Many plans in Vermont will also offer coverage with reduced or no deductible. Other plans will offer coverage that goes beyond Medicare’s coverage limits. That coverage could include flat copays or “tiers” of drug payments. In that, a plan might offer generic drugs for one rate, preferred brand-name drugs for slightly more, and most other brand-name drugs for a slightly higher charge.
The stand-alone prescription drug coverage includes many plans with very broad formularies. Next month, Medicare will provide specific information on the formularies and the costs of drugs in the formularies.
All approved prescription drug plans meet Medicare’s requirements for providing access to medically necessary drugs, including formulary standards as well as standards for access to convenient retail pharmacies and to drugs in nursing homes. The plans are required to provide coverage at least as good as Medicare’s standard coverage, which pays on average 75 percent of drug costs after a $250 deductible up to $2,250 in total drug spending. The coverage also pays approximately 95 percent after $3,600 in out-of-pocket costs to protect against very high drug expenses. This means that for a monthly premium that is lower than expected, Medicare would pay more than half of a typical beneficiary’s drug costs, or more than $1,100. Medicare beneficiaries will have access to plans that cover much more than the standard benefit, as noted above.
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 day 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.