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The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA)

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), went into effect on January 1, 2006 making all 43 million Medicare beneficiaries eligible to participate in Medicare’s prescription drug coverage through Medicare Part D. The standard benefit requires that enrollees pay a monthly premium, an annual deductible, and coinsurance or a copay for their prescription drugs.

There is not a limit on the number of drugs a plan will cover in a given calendar year, though Medicare drug plans, like most other prescription plans, do use a formulary, or list of preferred medications. However, if your physician wants you to have a drug that is not on the formulary, you can ask for an ‘exception’ to the formulary list.

If you do not join a Medicare drug plan by May 15, 2006 you can still join, though you may have to wait until November 15, 2006 to join and then you may be assessed a higher premium (at least 1% per month for each month you wait to join).

The U.S. Department of Health and Human Services (HSS) has predicted that over 39 million Medicare beneficiaries will have prescription coverage this year. Everyone with Medicare has access to prescription drug coverage, regardless of income or health status.

There is ‘extra help’, also called a ‘low-income subsidy’ to help those with Medicare who have limited resources to help them pay for the prescription drug plan. You can call Social Security at 1-800-772-1213 or visit www.socialsecurity.gov for more information.

Companies that provide a pharmacy benefit to Medicare beneficiaries are advertising heavily these days. By now, most people have seen various advertisements from companies which offer the plan, but how does one choose which plan is right for her? The Medicare Drug Plan (Part D) is very complicated for many patients. Even some doctors find it overwhelming at times.

To help answer the many questions this bill poses, the Centers for Medicare & Medicaid Services (CMS) has set up over 140 networks for community-based education. CMS is also working with close to 10,000 local partners and Area Offices on Aging around America to facilitate this massive effort. CMS has even developed on-line tools to assist.

Medicare assistance is available 24 hrs each day at 1-800-MEDICARE. For more information, visit www.medicare.gov or www.eldercare.gov to learn about opportunities for counseling and assistance in your local area.

Other helpful resources:
http://www.aarp.org/bulletin/prescription/Articles/a2003-11-26-foryou.html
http://www.npr.org/templates/story/story.php?storyId=5174771

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