A guide to Medicare's new drug coverage
If one of your loved ones receives Medicare benefits, you've no doubt heard about the high cost of prescription drugs. Later this year, millions of seniors and people with disabilities will have the opportunity to save money by signing up for Medicare Part D, the new prescription drug coverage. But the options can be confusing, even for the savviest health care consumer.

As a Medicare insurer for more than 20 years, Humana knows consumers are looking for the best health care value at every stage of life. Here's a brief guide to the changes in Medicare — to help you guide those you care about.

What is Medicare?
Medicare terminology
What's changing in 2006?
Where do you get the new Medicare prescription drug coverage?
What are the important dates to know?
When does PDP coverage start?
Do Medicare beneficiaries have to enroll in a prescription drug plan?
How does a person decide whether to enroll in a PDP?
What happens to the much-talked-about Medicare drug discount card?
How much does a PDP cost?
Is the government helping with some of the cost?
Where can I get more information about PDPs?

Q. What is Medicare?

A. Medicare (also called Original Medicare) is the nation's largest health insurance program and covers nearly 40 million Americans. Administered and paid for by the federal government, Medicare is for people 65 years of age and older, some disabled people under 65 years of age, and people with end-stage renal disease (permanent kidney failure treated with dialysis or a transplant).

Medicare has four parts:

• Part A covers inpatient hospital care. It also covers medical care at skilled nursing facilities (but not long-term or custodial care), some hospice care, and some home health care. For hospital and nursing home care, there are deductibles and/or co-payments, and limits on the number of days of care covered.
• Part B helps cover doctors' services, wherever they are provided, and outpatient hospital care. It also helps cover other medically necessary care like physical and occupational therapy, lab tests, medical equipment and some home health care. Here again there is an annual deductible and coinsurance.
• Part C includes all Medicare Advantage plans. Original Medicare doesn't cover all services or all costs. However, more comprehensive coverage is available from private insurers who contract with Medicare to offer Medicare Advantage plans. You must have Medicare Parts A and B to be eligible to join a Medicare Advantage plan.
• Part D is the new Prescription Drug Plan. Anyone enrolled in Medicare can sign up for a Medicare prescription drug plan (PDP). The new PDPs will be offered by companies that contract with Medicare, including Humana.

Q. What's changing in 2006?

A. In addition to introducing the new prescription drug coverage, Medicare has set new guidelines for changing Medicare plans mid-year. In the past, seniors could change Medicare plans at different times during the year. Beginning in 2006, the new law allows them to make only one change during the year — and the kind of change they can make is limited.

Q. Where do you get the new Medicare prescription drug coverage?

A. The new Prescription Drug Plans (PDPs) are available only from private insurers like Humana who are approved by Medicare to offer this new coverage. People who are eligible for a PDP can get coverage in one of two ways:

• Those with an Original Medicare plan or Medicare supplement (Medigap) plan can join a PDP to use with their current plan, or
• Those already in a Medicare Advantage (MA) Plan, or who decide to join one, can get a PDP automatically as part of their MA plan. This combination is called an MA-PD plan.

Q. What are the important dates to know?

A. Here's a quick look at key dates and deadlines:

• October - November 2005 — Medicare mails "Medicare & You" handbook with information about the Medicare Advantage and Prescription Drug Plans available in your area.
• November 15, 2005 — First date to enroll in a PDP or Medicare Advantage plan for 2006.
• January 1 - June 30, 2006 — During this period, members can switch from one Medicare Advantage Plan to another.
• May 15, 2006 — Last date in 2006 to enroll in a Medicare prescription drug plan. For those who wait until later, the premium increases one percent for every month they delay, although some exceptions apply.
• July 1 - December 31, 2006 — People with Medicare cannot switch plans during this time; they must keep the same coverage until the end of 2006.

Q. When does PDP coverage start?

A. The coverage date depends on the date of PDP enrollment:

• People who join by December 31, 2005 will have Medicare PDP coverage beginning on January 1, 2006.
• Those who join later will be covered starting on the first day of the month after they enroll.

Q. Do Medicare beneficiaries have to enroll in a prescription drug plan?

A. Although people can save money on prescription drugs through a PDP, enrolling in a PDP is an option, not a requirement.

Q. How does a person decide whether to enroll in a PDP?

A. Anyone eligible for Medicare CAN join a PDP. But whether they SHOULD join depends on their situation:

• Those who now have prescription drug coverage with an MA plan will be placed into an MA-PD plan automatically as of January 1, 2006. They don't need to enroll in a separate PDP — in fact, doing so may cause them to lose their MA coverage.
• Those who don't have prescription drug coverage should consider joining a PDP. Since different PDPs cover different drugs, a list of current prescriptions may help with the decision. Even people who don't take many prescriptions should consider a PDP now, since the premium is likely to be higher after May 15, 2006.
• Those who have prescription drug coverage through a former employer or union should check with their benefits administrator to see if their retiree plan is at least as good as the standard Part D benefit

Q. What happens to the much-talked-about Medicare drug discount card?

A. The new PDPs replace the Medicare drug discount cards. People who purchased a card can use it until May 15, 2006, or until they join a Medicare prescription drug plan — whichever is first.

Q. How much does a PDP cost?

A. According to Medicare, premiums for a standard PDP will be around $32 a month in 2006. However, some PDPs offer lower out-of-pocket costs and cover more drugs, so premiums may be higher. Humana will have three prescription drug plans with monthly premiums as low as $1.87, so it pays to shop and compare. The RX Calculator at www.humana-medicare.com helps members manage and monitor their prescription drug costs.

Q. Is the government helping with some of the cost?

A. A member with limited income and resources can apply for help with paying for Medicare prescription drug coverage. If a member has not received an application from the Social Security Administration (SSA) but thinks he or she may qualify for help, that member can apply online at www.ssa.gov, or call the local SSA office.

Q. Where can I get more information about PDPs and MAs?

A. Medicare will provide general information about PDPs and MAs throughout the year. You can also get details through any of these sources:

• Humana — For more information about prescription drug plans, call 1-800-851-1768 seven days a week, 8 a.m. to 11 p.m. EST. People with speech or hearing impairment can call our TDD number, 1-877-833-4486 (Monday - Friday 7 a.m. to 7 p.m. EST, Saturday 7 a.m. to 3:30 p.m. EST). Or visit www.humana.com on the Web.
• Medicare — For help deciding which PDP plan to choose, call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. The TTY number is 1-877-486-2048. Medicare is also mailing a handbook to beneficiaries, called "Medicare & You 2006." Free, personalized information is also available online at www.medicare.gov on the Web.
• Social Security Administration — For information about financial assistance, call 1-800-772-1213 weekdays 7:00 a.m. to 7:00 p.m. EST. The TTY is 1-800-325-0778.

Bottom line:
It's worth your time to understand Medicare's newest options. As an informed health care consumer, you're in a position to help your loved ones make important choices. And the knowledge you gain may come in handy as you prepare for your own retirement years.

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