Information for beneficiaries who have current coverage

CAUTION:  Beneficiaries should talk to their insurer, benefits administrator, or other plan provider before they make any changes to their prescription drug coverage.  If they decide to enroll in a Medicare prescription drug plan and drop their current prescription drug coverage, they may not be able to get this coverage back.  And if their prescription drug coverage is provide together with their medical coverage, they might not be able to drop just the prescription drug benefit.

If a beneficiary is dually enrolled in Medicare and Medicaid and receives pharmaceuticals through Medicaid, they will now get most of their drugs through Medicare rather than Medicaid.  CMS will automatically enroll those beneficiaries on or before January 1, 2006) in a prescription drug plan that serves their region.  Dual eligible beneficiaries who were already enrolled in a Medicare Advantage plan will be automatically enrolled in that plan for their prescription drug coverage.

If a beneficiary has "creditable coverage" under an existing prescription drug plan, they can elect to continue to utilize their current prescription drug coverage or switch to a new Medicare prescription drug plan.  "Creditable coverage" means the beneficiary's current prescription drug coverage is, on average, at least as good as Medicare's standard prescription drug coverage.  "Creditable coverage" may be drug coverage from a beneficiary or spouse's employer or union-sponsored plan, a Medigap plan, a health insurance policy, the VA, TRICARE, the  Federal Employees Health Benefits Program, a PACE program, the Indian Health Service, tribe, or Urban Indian Organization, or a state's high risk pool.

A beneficiary's insurer or plan provider should notify the beneficiary by November 14, 2005, to inform them if their current drug coverage is creditable.   Beneficiaries should contact their insurer, benefits administrator, or other plan provider if they don't get information about creditable coverage from them by November 14, 2005.

If a beneficiary's coverage is creditable, they may remain with their current coverage or switch to a new plan.  If coverage is creditable and a beneficiary does not have a break in coverage (more than 63 days without creditable coverage) the beneficiary will not have to pay a penalty if they decide to enroll in Medicare prescription drug coverage after May 15, 2006.

If a beneficiary's current drug coverage is not creditable, beneficiaries will pay a premium penalty for waiting to enroll in Medicare prescription drug coverage after May 15, 2006.  Premium costs will go up at least 1% pre month for every month that the beneficiary waits to join.

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