Pakistani American Pharmaceutical Association

qualifies for extra help paying Medicare prescription

drug costs (and doesn’t need to apply for extra help) for

the rest of the 2006 calendar year, even if she doesn’t

qualify for Medicaid in some later months because she

has lower medical expenses.

Once she starts receiving the extra help, she pays no

premium, has no deductible, and pays only small

co-payments. Her co-payments will be $1 for each of her

10 generic prescriptions, for a total of $10. Added to

her doctor visits, that totals $85 in medical expenses.

Her medical bills are no longer high enough to cause a

need for Medicaid (she doesn’t exceed the $200 limit

under spend down). But, the extra help she receives

increases the income available to her. She now has

$615 available for other expenses, $115 more than she

had before receiving the extra help.

During a month in 2006 where Rebecca’s medical

expenses for items other than prescription drugs are

Month with High Month with Low Month with High Med.

Med. Expenses Med. Expenses

Monthly Income $700 $700 $700

Medicaid Spend down Requirement—$200 in Medical Bills to Reach $500 in Monthly Income

Rebecca’s Drug Spending $150 $10 $10

Other Medical Bills $75 $75 $210

Rebecca’s Total Medical Bills $225 $85 $220

Meets spend down requirement

and qualifies for Medicaid? Yes No Yes

Rebecca’ s Out-of-Pocket Spending $200 $85 $200

for Medical Care (Medicaid pays $25) (Medicaid pays $20)

Rebecca’s cash available for other expenses $500 $615 $500

high, Medicaid will again be available to her once she

has medical bills of at least $200. For example, if, in

addition to the $10 in total prescription drug copays,

she has another $210 in medical expenses, including

doctor visits and dental care, she will more than meet

her spend down amount and will qualify for Medicaid.

She has not lost her ability to rely on the Medicaid

program in months when she has higher medical bills.

4. If you don’t qualify for extra help

Even if you’re not eligible to receive extra help, you can

still join a Medicare prescription drug plan that meets

your needs. Enrolling in a Medicare prescription drug

plan will save the average person more than half on

their annual prescription drug costs. You will have to

pay a monthly premium (generally around $32 per

month in 2006), a deductible, and co-payments. You

can enroll in a plan beginning November 15, 2005.

If you don’t currently have prescription drug coverage

that is at least as good as a Medicare prescription drug

plan, you should enroll in a Medicare prescription drug

plan by May 15, 2006, to pay a lower premium. If you

don’t enroll by May 15, 2006, you may have to wait

until November 15 of the next year to enroll. You will

also have to pay at least 1% more per month for your

premium for every extra month you waited to enroll.

You will have to pay this higher premium for as long as

you have Medicare prescription drug coverage.

For more information about Medicare prescription drug coverage…

Read the “Medicare & You 2006” handbook you get in the mail in October 2005. It will include more detailed

information about Medicare prescription drug plans, including which plans will be available in your area. After that

time, if you need help choosing a Medicare prescription drug plan that meets your needs, you can

■ Visit www.medicare.gov on the web and select “search tools” to get personalized information.

■ Call your State Health Insurance Assistance Program (SHIP). (See your copy of the “Medicare & You 2006”

handbook for their telephone number) You can also call 1-800-MEDICARE (1-800-633-4227), or look at

www.medicare.gov on the web to get their telephone number. TTY users should call 1-877-486-2048.

■ Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

There are programs for people with limited income and resources who live in Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and

American Samoa. Programs vary in these areas. To find out more about their rules, call your State Medical Assistance Office, visit www.medicare.gov  on the web or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048

Pages: