Cheat Sheet

Medicare Prescription Drug Coverage For Dummies

Medicare Part D is the prescription drug coverage portion of Medicare. And Part D can be confusing — a pity, because those who need to understand it most are often elderly. You can start to unravel the Medicare mystery by first understanding who qualifies for Medicare. If you still have questions about benefits, several consumer advocacy groups can help you. Also consider a few resources that may help you save money on your necessary prescriptions.

Who Qualifies for Medicare

Medicare helps tens of millions of seniors and people with disabilities nationwide pay for healthcare. Medicare doesn't pay all of your medical bills, by any means. Nonetheless, it still gives a lot of protection against today's high healthcare costs if you don't have other health insurance. To qualify for Medicare, you must meet certain rules, depending on the following circumstances:

  • If you're age 65 or older: You qualify for Medicare as soon as you reach age 65 if you or your spouse has worked long enough to entitle you to Social Security or Railroad Retirement benefits, even if you're not yet receiving them. You usually need at least 40 credits (amounting to about ten years of work) to become eligible for these retirement benefits, which are paid through monthly checks.

    Anyone with enough work credits can claim these benefits from the age of 62 onward, though doing so means accepting lower payments than when starting at or after full retirement age. (For people born between 1943 and 1954, full retirement age is now 66.) But remember — even if you claim these benefits early, you still have to wait until age 65 to qualify for Medicare.

    The annual statement you receive from Social Security says whether you qualify for Medicare or, if you're not eligible yet, when you will be. If you lose your statement, call Social Security at 800-772-1213 to ask for a replacement.

  • If you're younger than 65 and have disabilities: You're entitled to Medicare at any age if you have a severe illness, injury, or disability that prevents you from earning more than a certain amount of money each month and you've received Social Security disability benefits for at least 24 months. These months need not be consecutive.

    Anyone diagnosed with Lou Gehrig's disease (Amyotrophic Lateral Sclerosis, or ALS) doesn't have to wait 24 months to join Medicare. If you think you may qualify and want to find out the earnings limits that apply to your circumstances, call Social Security at 800-772-1213 or visit the website.

  • If you have permanent kidney failure: You're entitled to Medicare at any age if you have end-stage renal disease (ESRD) — usually defined as needing a kidney transplant or regular dialysis — and if you or your spouse has paid into Social Security through work for a certain length of time. This period depends on how old you are. For specific eligibility information, visit the Social Security website or call them at the number listed above.

  • If you don't qualify for Medicare: If you're 65 or older but don't have enough work credits, you may be able to buy into the system by paying premiums. You can buy in only if you're an American citizen or a legal resident (green card holder) who has lived in this country continuously for at least five years.

  • The premiums for Medicare Part A (hospital insurance) are pretty hefty for people who don't qualify for Medicare — the amount varies depending on how many work credits you have — but they're probably less expensive than insurance you can buy yourself. Purchasing Medicare Part A makes you eligible for other Medicare benefits, like prescription drug coverage. If you work long enough to earn enough credits to qualify for Medicare in the future, you no longer have to pay Part A premiums.

4 Consumer Information and Advocacy Organizations for Medicare

The nonprofit organizations listed below are leading sources of information on Medicare and act as advocates on behalf of Medicare beneficiaries within Congress and state legislatures. They want to hear about people's first-hand experiences with Medicare (including Part D), and they welcome volunteers to help their efforts.

  • AARP uses the power of its membership (nearly 40 million members in 2008) to promote the interests of people age 50 and over. These interests include improving Medicare and Part D, preserving Social Security, and promoting legislation to achieve health insurance access for all Americans.

    A nonpartisan organization with headquarters in Washington, D.C., AARP has offices in every state (plus the District of Columbia, Puerto Rico, and the U.S. Virgin Islands) and advocates in Congress and all state legislatures. Through the AARP Foundation, attorneys litigate court cases of special importance to older Americans. Among other publications, its news magazine Segunda Juventud is for Spanish-speaking members.

  • The Center for Medicare Advocacy promotes the interests of people on Medicare nationally and is staffed by policy experts, attorneys, researchers, and information specialists. Based in Connecticut, with an office in Washington, D.C., the nonpartisan center advocates to improve Medicare services and other healthcare rights, litigates court cases, and publishes policy documents and consumer information.

    It invites consumers to send in questions to its website (above) and responds to about 7,000 telephone and e-mail inquiries each year. Phone 860-456-7790 (Connecticut) or 202-293-5760 (Washington).

  • California Healthcare Advocates is the leading consumer watchdog organization for Californians on Medicare. Based in Sacramento, with offices in Los Angeles, Oakland, and Santa Ana, CHA conducts public policy research and community outreach; promotes recommendations for improving Medicare services and rights at the federal and state level; and provides up-to-date consumer information on its website, including the publication California Medicare News.

  • Families USA is a grassroots, nonpartisan organization that promotes quality healthcare for all Americans from the consumer perspective. Based in Washington, D.C., it serves as a consumer watchdog on government actions related to health coverage, including Medicare and Part D. It also provides updates on developments in the pharmaceutical industry and regularly publishes surveys of drug prices.

4 Resources for Saving Money on Prescription Drugs

Whether you're on Medicare or not, prescription drugs can get expensive. The following resources can help people with limited incomes save money on prescription drugs through various public and private programs:

  • BenefitsCheckUp: This website, a service of the National Council on Aging, allows you to find national, regional, state, or local programs that provide benefits you may qualify for without realizing it — or perhaps never knew existed. It has helped more than 2 million users find more than $6 billion in benefits.

    Online, you're asked about your zip code, age, health status, family circumstances, and income. You do not give your name, address, or any other identifying information. You can search for benefits that will help pay for prescriptions and/or other benefits to reduce your living expenses. You can also search the Senior Housing Locator to find housing options, including assisted living, residential and nursing home care, and independent-living retirement communities.

  • The Health Resources and Services Administration: The website of this federal agency, a division of the U.S. Department of Health and Social Services, allows you to locate clinics in your area for free or low-cost healthcare and medications.

  • The National Council on Aging: This nonprofit organization sponsors many programs designed to help older Americans stay healthy and independent, find jobs and community service opportunities, and link them to benefits and resources. You can also call its Washington headquarters or four regional offices to ask for the phone numbers of resources in your community:

    Washington, D.C., 202-479-1200 (TDD 202-479-6674)

    San Francisco, California, 415-982-7007

    Lakewood, New Jersey, 732-367-7111

    Steubenville, Ohio, 740-283-2182; Nashville, Tennessee, 615-834-4900.

  • The Partnership for Prescription Assistance: This organization gives a single access point for getting information on more than 475 public and private assistance programs — including 180 offered by pharmaceutical manufacturers — that provide free or low-cost prescription drugs to people with limited incomes.

    To see if you qualify for any programs, go to the website or call toll-free 888-477-2669. You'll be asked to list your prescription drugs and give some information about yourself, including approximate income and savings — but not your name or any other identifying information. Any program you qualify for is identified, with instructions on how to apply. In many cases, you can download application forms from the website, fill them out, and take them to your doctor to send in.

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