Here are some answers to questions commonly asked about Medicare prescription drug coverage.
- Q. Who is eligible for Medicare prescription drug coverage (Part D) benefits?
A. To be eligible for Blue MedicareRx Medicare-approved prescription drug coverage, you must be entitled to Medicare benefits under Part A or enrolled in Part B and you must reside in New Mexico. You must also not be enrolled in any other Part D plan. You must continue to pay your Part B Medicare Premium.
- Q. When can I enroll?
A.There are three types of enrollment periods during which you can enroll.
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Annual Enrollment Period (AEP) - Between November 15 and December 31 of each year, anyone eligible for Medicare prescription drug coverage may enroll in Blue MedicareRx.
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Initial Enrollment Period (IEP) - For the 3 months before and 3 months after an applicant becomes eligible (by either turning 65 or becoming disabled), they may enroll in Blue MedicareRx.
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Special Enrollment Period (SEP) - There are several very special circumstances that would allow a Medicare eligible recipient to enroll in Blue MedicareRx outside of the annual or initial enrollment period. Some examples include, but are not limited to:
*Moving into the service region
*Involuntarily losing creditable coverage
*Receiving dual eligibility
Because of the specific timeframes and documentation required for enrolling during the Special Enrollment Period, please contact our Customer Service Department at (888) 285-2254 (TTY: (888) 844-3757) between 6 a.m. to 6 p.m. MT, Monday-Friday, for further details.
- Q. How do I enroll?
A.Enroll in Blue MedicareRx. It should take you 10 minutes to
complete the enrollment form on our secure site.
If you would prefer not to use the online enrollment form, we offer two other enrollment options.
You can download (print) an enrollment form. Once you complete it, mail it
to:
HISC - Blue MedicareRx
PO Box 7020
Lawrence, KS 66044
Or, you can call 1-888-285-2254 (TTY: 1-888-844-3757), 6 a.m. to 6 p.m. MT, Monday through Friday.
- Q. What are my options if I have a Medicare Supplement plan with prescription drug benefits?
A. If you have a Medicare Supplement plan with drug coverage, you may do one of three things. You may choose to keep your existing coverage. Or, you can sign up for a Medicare-approved prescription drug plan and then have the prescription drug benefit portion of your existing plan removed. Your Medicare Supplement premium would then be adjusted. You can also enroll in a Medicare-approved prescription drug plan and change to another Medicare Supplement plan offered by your carrier.
If you decide to enroll in a Medicare-approved prescription drug plan after the enrollment period ends, you may face a late enrollment penalty.
If your current Medicare Supplement Plan does not cover Prescription drugs, all you need to do is Enroll Now.
- Q. What are my options if I have a plan with prescription drug benefits through my employer?
A. If you currently have drug coverage through a retirement plan and it is “creditable” (coverage with equal or greater value than Medicare standard prescription drug coverage), you may keep that coverage and wait to enroll in Part D. The organization offering your current coverage, such as your former employer or union or the insurance company they hired, will tell you whether your current coverage is “creditable.”
If you have and keep “creditable” coverage for a few years but later decide to join Medicare Part D, you will not be subject to the late enrollment penalty.
- Q. Who qualifies for special assistance in paying premiums?
A. Assistance is available for those with limited income and resources. Your eligibility is determined by your annual income AND your resources including savings and stock—but not your home or car. If your income and resources are under the levels listed in the chart below, you may qualify for extra help.
| Premium $37/month |
Income at or below 100% of poverty level. $0 |
Income above 100% of FPL, QMB, SLMB, QI, SSI - only, or incomes below 135% FPL and limited resources ($6,000 individual and $9,000 married couple) $0 |
Income below150% of FPL and limited resources ($10,000 individual and $20,000 married couple) Sliding scale based on income |
| Deductible $250/year |
$0 |
$0 |
$50 |
| Coinsurance to $3,600 out of pocket |
$1/$3 copay |
$2/$5 copay |
15% coinsurance |
| Catastrophic 5% or $2/$5 copay |
$0 |
$0 |
$2/$5 copay |
Source: Medicare & You-National Medicare & You Training Program: Outreach Toolkit Medicare Prescription Drug Coverage, April 2005 and http://www.cms.hhs.gov/partnerships*.
- Q. What happens if I qualify for a special assistance in paying premiums for Medicare Prescription Drug Plan costs?
A. If you have qualified for additional assistance for your Medicare Prescription Drug Plan costs, the amount of your premium and cost at the pharmacy will be less. Once you have enrolled in Blue MedicareRx, Medicare will tell us how much assistance you are receiving, and we will send you information on the amount you will pay. If you are not receiving this additional assistance, you should call Medicare 24 hours a day, 7 days a week at 1-800-MEDICARE (1-800-633-4227, TTY users call 1-877-486-2048), your State Medicaid Office, or the Social Security Administration at 1-800-772-1213 (TTY/TDD users call 1-800-325-0778), between 7 a.m. and 7 p.m., Monday through Friday, to see if you might qualify.
Please Note: For more information contact your State Medicaid Office or the Social Security Administration at 1-800-772-1213 or visit www.socialsecurity.gov*.
- Q. Do I have to enroll in a Medicare prescription drug plan?
A. No. However, if you do not enroll during the initial enrollment period in a Medicare prescription drug plan, and then choose to enroll later, you may face a government-imposed late enrollment penalty of 1 percent for every month you delay. However, you will not be penalized if you have prescription drug coverage that’s considered “creditable,” meaning equal to or better than Medicare prescription drug coverage.
Example:
Your current drug costs are $775 a year and you have no prescription drug coverage. You choose not to join a Part D plan in 2006. Three years later your drug expenses increase and you decide to join a Part D plan. You will have to pay a penalty of 1 percent a month for every month you delayed enrollment. This means you will pay a 36 percent higher premium each month for as long as you get Medicare prescription drug benefits.
- Q. What are my protections in this plan?
A. All Medicare Prescription Drug Plans agree to stay in the program for a full year at a time. Each year, the plans decide whether to continue for another year. Even if a Medicare Prescription Drug Plan leaves the program, you will not lose Medicare coverage. If a plan decides not to continue, it must send you a letter at least 90 days before your coverage will end. The letter will explain your options for Medicare prescription drug coverage in your area.
If Blue MedicareRx ever denies coverage for your prescription drugs, we will explain our decision to you. You always have the right to appeal and ask us to review the claim that was denied. In addition, if your physician prescribes a drug that is not on our formulary, is not a preferred drug or is subject to additional utilization rules, you may ask us to make a coverage exception.
- Q. Can I enroll if I do not have Medicare Parts A and B?
A.You must have Medicare Part A or Part B (or both) to be eligible for a Medicare prescription drug plan. To discuss how to get Part A or Part B, you should call Medicare 24 hours a day, 7 days a week at 1-800-MEDICARE (1-800-633-4227, TTY users call 1-877-486-2048), your State Medicaid Office, or the Social Security Administration at 1-800-772-1213 (TTY/TDD users call 1-800-325-0778), between 7 a.m. and 7 p.m., Monday through Friday.
- Q. Can I enroll if I already have a Medicare Advantage Plan?
A. If you are enrolled in a Medicare Advantage plan you may not enroll in a prescription drug plan, unless you are a member of a Private Fee-for-Service (PFFS) MA Plan, a Medical Savings Account (MSA) MA Plan, or an 1876 Cost Plan. Medicare is working with Medicare Advantage and other Medicare Health Plans to help them provide even more coverage and/or lower costs. Your Medicare Advantage Plan will let you know about the prescription drug options they will offer. You can also choose to switch to another Medicare Advantage Plan or Medicare Health Plan. Or you could choose a Medicare Supplement Plan and join a Medicare Prescription Drug Plan.
This information may be available in other formats.
* By clicking this link, you will be leaving the Part-D Plan-specific Web pages.
