Medicare Part D
On December 8, 2003 the Medicare Prescription Drug, Improvement and Modernization Act of 2003 was enacted. It created a new “Part D”, which established a prescription drug benefit for Medicare beneficiaries. This program went into effect for all Medicare eligible consumers on January 1, 2006.
In 2014, New York State will have 31 stand-alone prescription drug plans (PDP) and 8 of these will be benchmark plans ($0 premium for those who qualify for a full low income subsidy). It’s important to review your plan every year, since many changes may have occurred. Your current plan may have raised their premiums, they may have changed the medications they cover, or they may not be participating as a provider. Your needs may have also changed and you may be on different medications or have a different financial situation. Compare 2013 NYS Medicare PDP plan to 2014 plans will provide you with a comparison of the 2013 plans to the current 2014 plans. To make other comparisons based upon your needs use the Medicare Prescription Drug Finder.
This site is designed to be a quick reference guide for all stakeholders looking for information on the Prescription Drug Plans, benefits, eligibility, enrollment, how to obtain “Extra Help” through a low income subsidy, and additional resources for general information on Medicare Part D. The materials presented on this site are intended to be informational and not authoritative. For authoritative information, individuals should consult the federal Centers for Medicare and Medicaid Services.
Quick Reference Guide Sections
Plans, Benefits, and Premiums
- New York State's Medicare Prescription Drug Plans for 2014 – Lists all plans for 2014 with update premium and deductible information.
- New York's Benchmark PDPs with LIS for 2014 – Lists the 2014 plans that include Low Income Subsidy (LIS).
- Medicare Prescription Drug Plan Finder – Compares other Prescription Drug Plans (PDP)s to your current plan to find out what works best for you.
- Formulary Finder for Prescription Drug Plans – Formulary information provided by selecting State and Plan name.
Eligibility and Enrollment
- Medicaid coverage for people with Both Medicare and Medicaid (Dual Eligibles) – Provides overview about coverage for dual eligible beneficiaries.
- Medicare Prescription Drug Coverage Personal Information Worksheet for People with Medicare & Medicaid – Worksheet to help you gather all the information you need to find the Medicare plan that meets your needs.
- Medicare Eligibility Tool – Eligibility and premium calculator for Medicare.
Extra Help/ Low-Income Subsidy
- 2014 Resource and Cost-Sharing Limits for Low-Income Subsidy (LIS) – Information regarding income limits and available financial resources used in determining if you qualify for extra help.
- What you need to know about Extra Help with Medicare Prescription Drug Plan Costs: – Describes the Extra Help program. Provides links to forms, publications and also information links available in other languages.
- Extra Help With Medicare Prescription Drug Plan Costs Application Website – Application site for Extra Help through the Social Security Administration.
- Who is Automatically Eligible for Extra Help to pay for Prescription Drug Coverage in 2014 – Includes information on who automatically qualifies for Extra Help, If you have been paying too much and who to contact, and other ways to save on prescription drug costs.
- Medicare Savings Programs – In some cases, if you qualify, Medicare Savings programs may also pay for Medicare Part A, Medicare Part B, deductibles, coinsurance and/or copayments.
- Changes in Qualifying for Extra Help in 2014 – CMS information sheet.
Tip Sheets and Consumer Alerts
- Medicare Prescription Drug Coverage: How to file a grievance, appeal denied prescription drug coverage – If you disagree with a decision made by your PDP, here is what you can do about it.
- Understanding True Out-of Pocket (TrOOP) Costs – Information on what types of payments count towards Troop costs.
- Medicare Part D Enrollment Assistance – Tips on how to complete a Medicare Part D prescription drug plan application.
- CMS Tip sheet for understanding Medicare Parts C&D Enrollment periods – Enrollment periods and when you can sign up. Special enrollment periods (SEP) are also defined.
- Bridging the Coverage Gap ( Donut Hole) – Ways to delay or avoid the coverage gap and continue to save money on the drug costs while in the gap.
- Search Prescription Drug coverage across all Medicare Part D plans – Search for the coverage and costs associated with your medication(s) across all Medicare Part D plans.
- Medicare Part D 2014 Antidepressant and Anti-Psychotic Medication Crosswalk (127Kb) – 2014 Benchmark plans spreadsheet indicating antidepressant and antipsychotic medication coverage information such as tier level, prior authorization, step therapy and quantity limit information.
General Information and Resources
- Center for Medicare and Medicaid Services- General information and overview of prescription coverage – See the left hand side menu on this web page.
- Medicare information regarding Medicare Part D – The official U.S. government site for Medicare Drug coverage.
- Medicare – The official U.S. government site for people with Medicare.
- Medicare and You Handbook 2014 – The official U.S. government Medicare Handbook for 2014.
- Social Security Administration – Official website of the U.S. Social Security Administration.
- NYS Office for the Aging: Health Insurance Information, Counseling & Assistance (HIICAP) – Information, education and counseling on Medicare and other health insurances. Free advocacy for those with health issues.
- NYS Department of Health: Medicaid and the Medicare Part D Prescription Drug Benefit – Information for NYS residents who have Medicaid and Medicare.
- NYS Department of Health: Medicare Part D frequently asked questions.
- Kaiser Family Foundation: Medicare Prescription Drug Benefit Fact Sheet.