MEDICARE PRESCRIPTION DRUG COVERAGE
(PART D)

Medicare prescription drug coverage (Part D) is available to everyone with Medicare. To get Medicare drug coverage, you must join a Medicare drug plan. Plans vary in cost and drugs covered.

Individuals can choose and join the Medicare drug plan that works best for them.

Each plan has a monthly premium. All drug plans must provide coverage that is at least as good as standard Medicare prescription drug coverage.

Two types of plans offer Medicare prescription drug coverage:

• Medicare Prescription Drug Plans. These plans (sometimes called "PDPs") add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
• Medicare Advantage Plans (like an HMO or PPO) or other Medicare health plans that offer Medicare prescription drug coverage. You get all of your Part A and Part B coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called "MA-PDs."
  

Who Can Get Medicare Drug Coverage?
To join a Medicare Prescription Drug Plan, you must have Medicare Part A and/or Part B. To get prescription drug coverage through a Medicare Advantage Plan, you must have Part A and Part B.

When Can You Enroll

• October 15th - December 7th is open enrollment.
• During this period you can enroll in or switch plans, which will become effective January 1st.
• Individuals newly entitled to Medicare can enroll three months before month of eligibility, month of eligibility, or three months after month of eligibility. If you enroll three months before your eligibility, your prescription coverage would be effective the month your Medicare begins. If you enroll the month Medicare begins or three months after, your prescription coverage would be effective the following month.
• If you have creditable prescription drug coverage and your coverage ends, you have 63 days to enroll in a Medicare Prescription without incurring a penalty
  
  

How to Get Help Extra Help with Medicare Prescription Drug Plan Costs

The Social Security Administration and the Centers for Medicare & Medicaid Services are working together to get you Extra Help with your Medicare prescription drug plan costs. If you have limited resources and income, you may qualify for Extra Help with the costs—monthly premiums, annual deductibles, and prescription co-payments—related to a Medicare prescription drug plan. To find out if you qualify, Social Security will need to know the value of your savings, investments, and real estate (other than your home), and your income.

In 2010 under a new law, more Medicare beneficiaries could qualify for Extra Help with their Medicare prescription drug plan costs because some things no longer count as income and resources. The Extra Help is estimated to be worth an average of $3,900 per year.

Who Can Get Extra Help?

Anyone who has Medicare can get Medicare Part D prescription drug coverage. Some people with limited resources and income are eligible for Extra Help to pay for the costs—monthly premiums, annual deductibles, and prescription co–payments—related to a Medicare prescription drug plan. To qualify for Extra Help:

• You must reside in one of the 50 states or the District of Columbia.
• Your resources must be limited to $12,510 for an individual or $25,010 for a married couple living together. Resources include such things as bank accounts, stocks, and bonds. Your house and care do not count as resources; and
• Your annual income must be limited to $16,245 for an individual or $21,855 for a married couple living together. Even if your annual income is higher, you still may be able to get some help. Some examples where your income may be higher are if you or your spouse:
• Support other family members who live with you;
• Have earnings from work; or
• Live in Alaska or Hawaii.
  

How Can I Get More Information?

For more information about getting Extra Help with your Medicare Prescription drug plan costs, visit www.socialsecurity.gov/extrahelp or call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).

You can apply for Extra Help online at www.socialsecurity.gov/extrahelp;
call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to apply over the phone or request that an application be mailed to you; or apply at your local Social Security office. Social Security representatives are available to help you complete your application.

State Pharmaceutical Assistance Program (SPAP)
Illinois Cares Rx

If you have Medicare, Illinois Cares Rx will provide additional coordinating benefits.

If you do not have Medicare, Illinois Cares Rx provides two benefits: Illinois Cares Rx BASIC and Illinois Cares Rx PLUS.

Who May Get Illinois Cares Rx Prescription Drug Benefits?

A claimant or claimant’s spouse who meets the requirements and applies each year may get Illinois Cares Rx prescription drug benefits. The information on your Form IL-1363 application will determine your prescription drug benefits.

Each person approved for Illinois Cares Rx prescription drug benefits will get a card under his or her own name. Persons eligible for Medicare who want to receive coordinating benefits MUST enroll themselves in a coordinating Medicare prescription drug plan. In addition to the Illinois Cares Rx card, you will receive an identification card from your Medicare Part D prescription drug plan to use at the pharmacy.

Illinois Cares Rx Plus

All persons with Medicare who are:

• Single with an annual income less than $27,610; or Married with an annual income less than $36,635.
  

Or

Adults age 65 or older who do not have Medicare and:

• Single with an annual income less than $26,917; or
• Married with an annual income less than $36,212; and
• A citizen or qualified non-citizen.

Illinois Cares Rx Plus covers almost all prescription drugs.

Illinois Cares Rx Basic

Adults age 65 or older who do not have Medicare and have a total annual income of:

• More than $26,917 but less than $27,610 if you are filing an application for yourself; or
• More than $36,212 but less than $36,635 if you filing an application for you and your spouse or one qualified additional resident; or
• Less than $45,657 if you are filing an application for you, your spouse and one other qualified additional resident or for you and at least two qualified additional residents.

Or

People who are disabled who do not have Medicare and have a total annual income of:

• Less than $27,610 if you are filing an application for yourself;
• Less than $36,635 if you filing an application for you and your spouse or one qualified additional resident; or
• Less than $45,657 if you are filing an application for you, your spouse and one other qualified additional resident or for you and at least two qualified additional residents.

Illinois Cares Rx Basic covers prescription drugs for the treatment of Alzheimer’s disease, arthritis, cancer, diabetes, glaucoma, heart disease and its related conditions, lung disease and smoking-related illnesses, multiple sclerosis, osteoporosis and Parkinson’s disease.

Medicare Savings Programs

Medicare Savings Programs can help pay all or part of your Part A and/or Part B premiums if you meet certain income and resource limits. There are four types Medicare Savings Programs:

1. Qualified Medicare Beneficiary (QMB) Program
   You must be eligible for Part A to qualify, even if you’re not enrolled.
2. Specified Low-Income Medicare Beneficiary (SLMB) Program
   You must be eligible for Part A to qualify, even if you’re not enrolled. If you have income from working, you may qualify for SLMB benefits even if your income is higher than the limits in the chart below.
3. Qualified Individual (QI) Program
   You must be eligible for Part A to qualify, and you must apply every year for QI benefits. QI applications are granted on a first-come, first-served basis, with priority given to people who got QI benefits the previous year. QI benefits aren't available to people who qualify for Medicaid.
4. Qualified Disabled and Working Individuals (QDWI) Program
   The QDWI program helps pay the Part A premium. You may qualify if you:
   • Are a working disabled person under age 65
   • Lost your premium-free Medicare Part A when you went back to work
   • Aren't getting medical assistance from your state
   • Meet the income and resource limits required by your state

Income and resource limits for Medicare Savings Programs can be located at:
http://www.hfs.illinois.gov/medicalbrochures/hfs3757.html

Resources

• Medicare & You Handbook 2010 (fall 2011)
• Medicare Rx plans - Information & Enrollment
  1-800-MEDICARE (or 1-800-633-4227)
  www.medicare.gov
• Illinois Benefits – information to help with decision-making
  www.illinoisbenefits.org
• Area Agency on Aging for Lincolnland
  217-787-9234 or 1-800-252-2918
  www.aginglinc.org
• Illinois Department on Aging
  1-800-252-8966
  www.state.il.us/aging
• Senior Health Insurance Program (SHIP) 1-800-548-9034
  www.idfpr.com/doi/default2.asp
  

Local Senior Health Assistance Program Sites

Cass County

• Cass County Council on Aging
  800-854-6472
• Cass County Health Department
  877-452-3057
• Prairie Council on Aging
  800-862-4464

Christian County

• CEFS Economic Opportunity Corporation
  217-562-5611
• Senior Citizens of Christian County
  217-824-4263
  

Greene County

• Illinois Valley Economic Development Corporation
  618-498-3483
• Prairie Council on Aging
  800-862-4464
  

Jersey County

• Illinois Valley Economic Development Corporation
  618-498-3483
• Prairie Council on Aging
  800-862-4464

Logan County

• OASIS Senior Center
  217-732-6132
• Senior Services of Central Illinois
  800-252-2516

Macoupin County

• Illinois Valley Economic Development Corporation
  618-498-3483
• Montgomery County Health Department
  217-532-2001 or 800-721-7734

Mason County

• Senior Services of Central Illinois
  800-252-2516
  

Menard County

• Menard County Board
  217-632-4412
• Senior Services of Central Illinois
  800-252-2516

Montgomery County

• CEFS Economic Opportunity Corporation
  217-532-3662
• Montgomery County Health Department
  217-532-2001 or 800-721-7734

Morgan County

• Prairie Council on Aging
  800-862-4464
  

Sangamon County

• Senior Services of Central Illinois
  217-528-4035

Scott County

• Prairie Council on Aging
  800-862-4464