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        Volume CCXXXIV, Number 45              May, 2004

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1. Simple information about eligibility and benefits

Section 1: Discount card basics 7 Words in blue are defined on page 32. You can enroll in a Medicare-approved drug discount card as early as May 2004. These cards may help lower your outpatient prescription drug costs by offering a discount off the price of your prescriptions and some drugs you can get without a prescription if ° you don't have health insurance that covers outpatient prescriptions, ° you have health insurance that limits how much it will pay for your outpatient prescriptions, ° you don't get any type of discount off the price of your outpatient prescriptions, or ° you currently get a discount that is less than the Medicare-approved drug discount card offers. Note: The discounts from the discount card don't apply to drugs that Medicare currently covers (like some cancer drugs). How the Program Works In this program, private companies (like a large group of pharmacies or an insurance company) offer a discount card to people with Medicare. To be a part of this program, companies must apply to Medicare and meet certain Medicare standards like ° providing quality customer service, ° being a stable, reputable business, ° setting up a process for handling complaints, and ° having experience offering prescription drug discounts. 9. 9 Page 10 11 Section 1: Discount card basics 8 Words in blue are defined on page 32. How the Program Works (continued) If a company offers a Medicare-approved drug discount card, the company must make it available to every person with Medicare in the state (unless the company is a Medicare Managed Care plan, see page 14). The companies will decide ° which prescription drugs will be discounted, and ° the amount of the price discount for those drugs. This means you need to compare each card carefully to choose the one that offers your prescriptions at the best discounted price. You can compare drug discount cards and drug prices at www. medicare. gov on the web. Select "Prescription Drug and Other Assistance Programs." You can also call 1-800-MEDICARE (1-800-633-4227) to get this information. TTY users should call 1-877-486-2048. Many of the companies that offer a discount card will have a list of drugs they will discount called a discount drug list. When you choose a discount card, you may get a lower price only on the prescription drugs on this list. A company can change its discount drug list and the discounted prices anytime. The company will give you information about, and changes to, its discount drug list if you ask for them. It will also put these changes on its website (if it has one). Each company will have a toll-free telephone number for you to call with questions. Caution: If you take a prescription that Medicare covers, you must go to a pharmacy that accepts Medicare. If you go to a pharmacy that doesn't accept Medicare, Medicare won't pay for the prescription. Section 1: Discount card basics Who can get a Medicare-approved drug discount card? You can get a Medicare-approved drug discount card if ° you have Medicare Part A and/ or Part B, and ° you don't have outpatient prescription drug benefits through Medicaid (your state may call this Medical Assistance). If you're enrolled in a state pharmacy assistance program (not Medicaid), you can still get a card. Visit www. medicare. gov on the web to see if your state has a pharmacy assistance program. Note: If you already have prescription drug coverage through your current health insurance, or you already get discounts on your prescriptions, review your coverage closely to see if this discount card will save you more money on your prescriptions. When can I get a Medicare-approved drug discount card? You can enroll in a Medicare-approved drug discount card as early as May 2004. The discount cards are good until December 31, 2005. When you choose a discount card, you can't switch to another card for the rest of the calendar year, unless ° you move to a state in which your discount card isn't offered, ° you join or leave a Medicare Managed Care plan, ° you enter or leave a long-term care facility (like a nursing home), or ° the private company stops offering your discount card. How do I choose a Medicare-approved drug discount card? When comparing your Medicare-approved drug discount card choices, you may want to review the discount drug list, drug prices, and choice of pharmacies. This may help you choose the Medicare-approved drug discount card that's best for you. How do I enroll in a Medicare-approved drug discount card? You can enroll in a Medicare-approved drug discount card as early as May 2004. If a company offers a Medicare-approved drug discount card, the company must make it available to every person with Medicare in the state (unless the company is a Medicare Managed Care plan, see page 14). When you choose a discount card, you will need to provide information like that on the sample enrollment form on pages 15-16. For a copy of an enrollment form, call the company that offers the drug discount card you want. Ask for the Medicare-approved drug discount card enrollment form. Depending on the company, you can apply by mailing or faxing the completed form to the company or by providing your information over the telephone or on the web. To get a card, you must apply by December 31, 2005. You may be able to choose from several Medicare-approved drug discount cards. To find out which discount cards are available in your area, for help choosing a discount card, or for help filling out the enrollment form ° look at www. medicare. gov on the web. Select "Prescription Drug and Other Assistance Programs," ° call 1-800-MEDICARE (1-800-633-4227), ° call your State Health Insurance Assistance Program (SHIP). To find the telephone number for your SHIP, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Or, visit www. medicare. gov on the web. Select "Helpful Contacts," or ° call the company offering the drug discount card you want. Once your enrollment form has been approved, the company will send you a Medicare-approved drug discount card. The company will also send specific materials you will need like a member handbook, discount drug list, pharmacy provider directory, and complaint procedures. Can I enroll in more than one Medicare-approved drug discount card? No. You can enroll in only one Medicare-approved drug discount card at a time. If you have non-Medicare-approved discount cards, you may use these and your Medicare-approved drug discount card. You should compare the different costs of your prescriptions among all of the drug discount cards that are available, to make sure you are making the best choice. If you move to another state where your current discount card isn't offered, you can enroll in another discount card. Note: If you live part-time in more than one state during the year, you can still enroll in only one Medicare-approved drug discount card. If you want to use the discount card in more than one state, make sure you choose a discount card that is offered in all of the states where you live. Are there any costs to join a Medicare-approved drug discount card? Private companies that offer these cards are allowed to charge you an annual enrollment fee of no more than $30. You will have to pay a new enrollment fee every calendar year. You may have to pay it more often if ° you voluntarily decide to switch to a different discount card because you move to another state where your discount card isn't offered, ° you switch to a different discount card after you join or leave a Medicare Managed Care plan, ° you choose a new discount card because the company stopped offering your discount card, or ° you switch to a different discount card after you enter or leave a long-term care facility (like a nursing home). If you don't pay the annual enrollment fee, the company can cancel your discount card. No matter when you join a Medicare-approved drug discount card, you still have to pay the entire annual enrollment fee. Are there any costs to join a Medicare-approved drug discount card? (continued) Except for the annual enrollment fee and the costs for your prescriptions, private companies offering Medicare-approved drug discount cards can't charge any extra fees. There is no monthly fee for any of these discount cards. What happens if my enrollment form for a Medicare-approved drug discount card is denied? If you apply for a Medicare-approved drug discount card and your enrollment form is denied, the company will send you a letter explaining how to get Medicare to review your enrollment form again. You should follow the instructions in that letter. If Medicare decides that you do qualify for the card, they will send you a letter explaining what to do. What drug discounts are available? The discount amount is a lower retail price on your prescriptions. The private companies will decide which prescriptions will be offered at a discount and your cost for those prescriptions. If there is a generic drug available, the pharmacy should tell you the difference in price between generic and brand name covered discount drugs. Only drugs included on the private company's discount drug list will be discounted. Different drugs on this list may be discounted at different rates, and the discounted prices may change over the course of the year. Where can I get my prescriptions if I have a Medicare-approved drug discount card? The company will send you a pharmacy provider directory after you are enrolled in the discount card. To get the discount on your prescriptions, you must go to one of the pharmacies listed in this directory. If you don't go to a pharmacy listed in this directory, you may not get the discount on your prescriptions. You can also find the pharmacy closest to you that accepts your Medicare-approved drug discount card by looking at www. medicare. gov on the web. Select "Prescription Drug and Other Assistance Programs." What happens if I choose a discount card and then my doctor changes my prescription? If your doctor changes your prescription or prescribes a new drug, give your doctor a copy of the discount drug list for your discount card. This list should be in the materials you get from the company offering your discount card. This list and the prices for drugs can change. You can call the company, or look on the company's website to find out if the discount drug list has changed. If your doctor needs to prescribe a drug that isn't on the discount drug list for your card and you don't have any other health insurance that covers outpatient prescription drugs, you will have to pay full price for the prescription. You can also look at www. medicare. gov on the web to find other programs that may help you pay for your prescriptions. Select "Prescription Drug and Other Assistance Programs." Or, call 1-800-MEDICARE (1-800-633-4227) for this information. TTY users should call 1-877-486-2048. What should I do if a company that offers a Medicare-approved drug discount card contacts me directly? If a company contacts you about joining its Medicare-approved drug discount card, you should compare the card it offers to your other discount card choices before you make a decision. To compare your choices, you can ° look at www. medicare. gov on the web. Select "Prescription Drug and Other Assistance Programs," or ° call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Can I get a Medicare-approved drug discount card if I am in a Medicare Managed Care plan? Yes. Your Medicare Managed Care plan may offer a Medicare-approved drug discount card only to its plan members. If it does, you can choose to join only this discount card. If you choose not to join the discount card offered by your Medicare Managed Care plan, you can't choose another Medicare-approved drug discount card. If your Medicare Managed Care plan doesn't offer a Medicare-approved drug discount card, or offers a discount card that is open to non-members, you can choose any discount card offered in your state. Call your Medicare Managed Care plan for more information. Can I leave a Medicare-approved drug discount card? Yes. You can leave a discount card anytime by notifying the company to tell them why you are leaving. If you must leave for any of the following reasons, you can choose a new discount card anytime: ° You move to a state in which your discount card isn't offered ° You join or leave a Medicare Managed Care plan ° You enter or leave a long-term care facility (like a nursing home) ° The private company stops offering your discount card If you choose to leave the program in 2004 for any reason other than those listed above, you can apply for a new discount card beginning on November 15, 2004. You will be able to use your new discount card beginning in 2005. If you choose to leave the program in 2005 for any reason other than those listed above, you can't apply for a new discount card. What if the company stops offering my discount card? If the company stops offering your discount card, the company will notify you, in writing, within a reasonable amount of time. If you choose to join another discount card, you will have to pay the annual enrollment fee again. 16.

2. Important additional information about the $600 credit

Help with your prescription drug costs If your annual income is below a certain level, Medicare may pay your annual enrollment fee for the Medicare-approved drug discount card and provide up to a $600 credit each calendar year (2004 and 2005) toward your prescription drugs. You can use the $600 credit toward most prescriptions, even those not on the discount drug list. If you get the $600 credit to help you pay for your prescriptions, you will still have to pay a percentage of the cost for each prescription. Who can get the $600 credit from Medicare to help pay for prescriptions? You may be able to get the $600 credit to help pay for your prescriptions if ° you have Medicare Part A and/ or Part B, ° you don't have other health insurance with any outpatient prescription drug coverage (except a Medicare + Choice plan or a Medigap policy), and ° your annual income in 2004 is no more than $12,569 if you are single, or no more than $16,862 if you are married (this includes your income and your spouse's income).* * Income includes money that you receive through retirement benefits from Social Security, Railroad Retirement, the Federal government, or other sources. Income also includes benefits you receive for a disability or as a Veteran, plus any other sources of the type that you would report for tax purposes. These income limits change each year. If you live in Alaska or Hawaii, income limits are different. You can't get the $600 credit from Medicare for prescription drugs if you have outpatient prescription drug coverage from any of the following: ° Medicaid ° TRICARE for Life (military health insurance) ° Employer group health plan or other health insurance coverage including some Medicare Managed Care plans (other than a Medicare + Choice plan or Medigap policy) ° FEHBP (health insurance for Federal employees or retirees) You also can't get the $600 credit if you are in a Medicare Managed Care plan that is a "cost" plan that offers a drug discount card to its members. If you have questions about whether this applies to you, call your plan. How do I get the $600 credit from Medicare to help pay for prescriptions? To find out if you can get the $600 credit from Medicare, complete and return an enrollment form like the sample enrollment form on pages 22-24. To get a copy of this form, call the company offering the discount card you want, and ask for an enrollment form for the $600 credit. You can apply by mailing or faxing the completed form to the company. If you don't already have a Medicare-approved drug discount card when you apply for the $600 credit, you must apply for the $600 credit to help pay for your prescriptions and the discount card you want at the same time. After you provide this information, the company will send your completed form to Medicare. Medicare will see if you meet the requirements for the $600 credit. If you qualify for the $600 credit from Medicare, you won't have to pay the annual enrollment fee for the discount card you choose. If you are already enrolled in a Medicare-approved drug discount card and you become eligible for the $600 credit, you can apply through the company that offers your card at anytime. If you qualify, Medicare will pay the annual enrollment fee, and the company will refund any enrollment fee you already paid for that year. When can I apply for the $600 credit from Medicare to help pay for prescriptions? In 2004, you can apply anytime for the $600 credit through a Medicare-approved drug discount card. If you are eligible, you will get the full $600 credit no matter when you apply in 2004. You don't have to reapply for the $600 credit to help pay for your prescriptions in 2005. As long as you have a Medicare-approved drug discount card, you will get another $600 credit on your discount card at the beginning of 2005. When can I apply for the $600 credit from Medicare to help pay for prescriptions? (continued) In 2005, if you are applying for the first time, the amount of your credit will depend on when you apply for a Medicare-approved drug discount card. The chart below shows how much you will get depending on when you apply in 2005: What happens to the rest of the $600 credit if I have money left on December 31, 2004? You may be able to carry over any of the $600 credit you have left at the end of 2004. The three situations below and on page 20 describe when you can carry over any of the credit you have left. 1. If you keep the same discount card for all of 2004 and some of your $600 credit is left at the end of the year, you can use that money in 2005. 2. If you leave a Medicare-approved drug discount card and join a new Medicare-approved drug discount card in 2004 for any of the following reasons and you have some of your $600 credit left, you may be able to use that money when you join the new Medicare-approved drug discount card: ° You move to a state in which your discount card isn't offered ° You join or leave a Medicare Managed Care plan ° You enter or leave a long-term care facility (like a nursing home) ° The private company stops offering your discount card If you apply between You will get January 1 -March 31, 2005 April 1 -June 30, 2005 July 1 -September 30, 2005 October 1 -December 31, 2005 $600 credit $450 credit $300 credit $150 credit What happens to the rest of the $600 credit if I have money left on December 31, 2004? (continued) 3. If you change Medicare-approved drug discount cards, you can use any of the $600 credit you have left at the end of 2004 under your new card in 2005 if ° you changed cards for one of the reasons listed on page 19, or ° you elected to change cards between November 15, 2004 and December 31, 2004. If you switch discount cards for any reason not listed above, you will lose any of the $600 credit left from 2004. What happens if I don't get the $600 credit from Medicare to help pay for prescriptions? If you apply for the $600 credit from Medicare and your enrollment form is denied, the company will send you a letter explaining how to get Medicare to review your enrollment form again. You should follow the instructions in that letter. If you ask for a review and Medicare decides that you do qualify for the $600 credit to help pay for your prescriptions and you have already paid your annual enrollment fee, you will get a refund. How do I use the $600 credit from Medicare to help pay for prescriptions? If you are approved for the $600 credit from Medicare to help pay for your prescriptions, the amount you are approved for will be applied to your discount card. Each time you use your discount card, you will pay a 5% or 10% coinsurance on the discounted cost of your prescription. The pharmacy will then deduct the amount you spend on your prescriptions from your discount card. Whether you pay a 5% or 10% coinsurance depends on your annual income when you applied for the $600 credit and the Medicare-approved drug discount card. How do I know how much of my $600 credit I have left? When you use your discount card, the pharmacist or the statement you get with your prescription will tell you how much of the $600 you have left. You can also call the company's toll-free telephone number to get this information. What happens to my $600 credit if I leave the discount card? You can leave the discount card anytime by writing the company to tell them why you are leaving. If you are leaving for reasons other than the four listed on page 19, you will lose the remainder of the $600 credit for that year. You may be able to choose another discount card any time from November 15, 2004 through December 31, 2004. You will be able to use your new discount card in 2005. You will also be able to get a $600 credit in 2005 if you qualify. What happens when my $600 credit runs out? When you have used all of your $600 credit, you still will be able to use your Medicare-approved drug discount card to save money on your prescriptions. If you don't have other prescription drug coverage, you will have to pay the full discounted price. (Source: CMA official government booklet)