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You have probably heard about Medicare Part D that is going to be implemented beginning on January 1, 2006. People’s experience with Part D will differ in significant ways depending on what benefits they currently receive. If you are one of the 40+ million Americans eligible for Part D, it is important to get informed now in order to avoid potential consequences such as penalties or breaks in your prescription drug coverage.

For most people who are eligible for Medicare (those 65 or older and those with certain disabilities), Part D is a voluntary program. Those wishing to participate will have to select one of the many Part D plans that will be offered and enroll in it. For people who are eligible for both Medicare and Medicaid (called “dual eligibles”) participation is required and dual eligibles will be automatically enrolled in Part D. This represents a significant change for many dual eligibles, many of whom are individuals living with mental health needs:

1) Medicaid will no longer cover the cost of most prescription drugs;

2) The new Part D benefit will require a monthly premium and co-payments;

3) There will be certain requirements and restrictions in the Part D plan you choose, and;

4) Your Part D plan may not cover some drugs at all and may not cover drugs purchased at certain pharmacies.

If you are a dual eligible you should already have received a letter or two from the Center for Medicare & Medicaid Services (CMS) notifying you of this transition. If you are unsure about whether you are a dual eligible, you should discuss it with your case manager, benefits counselor, or call 1-800-MEDICARE (TTY 1-877-486-2048).

Information on the approximately three dozen Part D plans should be available to the public. Beginning November 15th, Part D participants will be able to enroll in one of the available plans. Most dual eligible people will be enrolled into a plan at random by CMS, but they will have the option to switch their enrollment to a plan they feel better meets their needs before December 31, 2005. To assist people in finding the plan that best fits their medication needs, CMS is creating an online tool that will help individuals choose a suitable plan, which is available at www.medicare.gov/

People with very low incomes may qualify for Extra Help, a low-income subsidy that will pay for most costs associated with participating in Part D. Dual eligibles will be automatically enrolled in Extra Help. Depending on income, this subsidy will cover the monthly premium cost of some plans, help reduce the cost of others, and reduce co-payments to between zero and five dollars. Additional information on the low-income subsidy is available by calling the Social Security Administration (SSA), which will administer Extra Help, at 1-800-772-1213 (TTY 1-800-325-0778) or by going to http://www.socialsecurity.gov/prescriptionhelp/.

Understanding that this new prescription drug benefit is complex and will be difficult for many to navigate, there are numerous resources available to help make this transition easier. MHANYS has established a website dedicated specifically to Medicare Part D www.MedicarePartDNYS.org. It is our hope that this website will act as a clearinghouse of information on this new drug benefit, providing links to useful websites and information and provide Part D beneficiaries with updates. On this website will be a workbook to help consumers navigate the new benefit.

We urge you to get as much information as possible and educate yourself on this new benefit, as it will surely have a large impact on the ability of those affected to access prescription drugs.