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Medicare Rx

In an effort to reduce health care costs for millions of senior citizens, Congress approved and implemented a major improvement to Medicare. Since January 1, 2006, Medicare-eligible individuals have been able to join a Medicare Prescription Drug Plan. This section is intended to assist you in answering the following questions:
What is Medicare Prescription Drug Coverage?
Medicare prescription drug coverage became available in 2006 to everyone with Medicare through Medicare Prescription Drug Plans and Medicare Advantage Plans (like HMOs or PPOs) that offer prescription drug coverage. Medicare Prescription drug coverage is insurance offered through private insurance providers that have established Medicare-approved drug plans, which became available January 1, 2006. Anyone eligible for Medicare can join an approved Medicare Prescription Drug Plan. If you elect to join a Medicare Prescription Drug Plan, you will pay a monthly premium, as well as part of your prescription drug expenses. Medicare will then pay the remaining expense. Your expense will vary depending on the plan you choose. Each approved Medicare Prescription Drug Plan will provide a standard level of coverage for both generic and brand name drugs, and each plan will have a formulary, which is a list of drugs covered by the plan. Medicare Prescription Drug Plans will include: at least two drugs in every therapeutic category; convenient access to pharmacy networks; and a process for getting drugs not listed on the formulary.

For many individuals, one of the most important benefits of a Medicare Prescription Drug Plan is its cost. The average premium for drug coverage among all Medicare Prescription Drug plans will be approximately $30 per month for 2010, with the potential for some plans having a premium of $20 per month or even less. In future years, the amount you pay for your premium may increase.

Medicare provides "extra help" to pay prescription drug costs for people who meet specific income and resources limits. Resources include your savings and stocks, but not your home or car. If you qualify, you may get help paying for your Medicare drug plan’s monthly premium, yearly deductible, and prescription co-payments. In most cases, if you get extra help, you won’t pay a premium. Check with your plan. If you qualify for extra help, you also might not have a coverage gap.

You may have received the Help With Medicare Prescription Drug Plan Costs application in the mail from the Social Security Administration for extra help paying for a Medicare Prescription Drug Plan. It is very important that you fill out this application and return it to the Social Security Administration as soon as possible. If you didn’t receive the application in the mail and think you may qualify for this help, call the Social Security Administration or visit their Web site on the Internet. You can also go to your State Medical Assistance office to apply. Income and resource limits to qualify for extra help are changed yearly. You can find out what these limits are by contacting Social Security:
  • Call SSA at 1-800-772-1213 or visit www.socialsecurity.gov on the Internet.
  • TTY users should call 1-800-325-0778.
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How Does Medicare Prescription Drug Coverage Work?
Standard Medicare Prescription Drug Plans approved by Medicare are designed to share the drug expenses with you, using what are known as co-insurance percentages or dollar amounts that vary, based on the levels of drug expenses incurred for the year. Separate co-insurance amounts apply to the four levels of drug expenses.

Premium
You pay a premium for the Medicare Prescription Drug Plan. The average premium for drug coverage among all Medicare Prescription Drug plans will be approximately $30 per month for 2010, with the potential for some plans having a premium of $20 per month or even less. In future years, the amount you pay for your premium may increase.

Level 1 Expenses: $0 - $310
In addition to your premium, you will be responsible for paying a $310 deductible before the plan begins to pay any expenses. This means that you will pay 100% of the first $310 of your prescription drug expenses each year, before the plan begins to contribute to your expenses.

Level 2 Expenses: $310 - $2,830
After you pay your deductible, you will be responsible for paying 25% of your next $2,520 of prescription drug expenses in 2010, while the Medicare Prescription Drug Plan will pay the remaining 75%. Some plans may use flat dollar co-pays for each prescription instead of a percentage.

Level 3 Expenses: $2,830 - $6,440
If you incur at least $2,830 of prescription drug expenses in 2010, you will be responsible for paying 100% of your next $3,610 of drug expenses in 2010. This group of expenses is referred to as the "coverage gap" since the Medicare Prescription Drug Plan makes no contributions to these expenses. Note, you will still have access to discounts on the price of your drugs during this time.

Level 4 Expenses: $6,440 +
If you incur at least $6,440 of prescription drug expenses in 2010, the Medicare Prescription Drug Plan will be responsible for paying most of your remaining drug expenses for the year. There is no upper limit. You will still pay a small portion, such as five percent or a small flat dollar amount for each prescription, such as $2.50 for each generic drug and $6.30 for each brand name drug.

 

The savings you receive from joining a Medicare Prescription Drug Plan will depend on the amount of drug expenses you incur for the year. Your total expense for the year, including both your expenses and the Medicare Prescription Drug Plan’s expenses, are used for determining your co-insurance amounts.

Not All Plans Provide the Same Features
Although many approved Medicare Prescription Drug Plans will follow this standard coverage, individual plans may vary. Not all plans will provide the same features. As your total expenses on prescription drugs grow during the year, you may or may not move through all of the levels described above.

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How Do I Determine if a Medicare Prescription Drug Plan is Right for Me?
During open enrollment, you will have the choice to elect drug coverage under a Medicare Prescription Drug Plan or under the U. S. Steel Insurance Program, while continuing to receive other health care coverage under the U. S. Steel Insurance Program.

In determining which prescription drug plan to choose, the objective generally is to choose the plan that saves you the most with respect to the cost of your prescription drugs, while meeting your drug needs. If there are several plans that will save you the same amount of money, compare the formularies next and then the pharmacy networks. The result from these comparisons will provide you with a prescription drug plan that meets your needs!

You may also use the Annual Prescription Drug Utilization and Expense Worksheet to help you determine the best plan for your needs.

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What if I'm Enrolled in a Company Sponsored Health Maintenance Organization (HMO)?
If you are currently enrolled in a Medicare Advantage HMO plan through U. S. Steel, you will be notified by your HMO plan about your drug coverage. Your Medicare Advantage HMO plan will include Medicare Prescription Drug Coverage. You should not join a stand-alone Medicare Prescription Drug plan in addition to this coverage. You will receive all of your health care benefits and Medicare Prescription Drug Coverage through your Medicare Advantage HMO plan.

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Where Can I Get More Information?
You may automatically receive or request a Medicare & You Handbook from Medicare, which will identify the Medicare Prescription Drug Plans available in your area. You also will receive information from private insurance providers detailing their plans' costs, formularies, and pharmacy networks. If you have questions about the new Medicare Prescription Drug Coverage, call Medicare at 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov on the Internet. TTY users should call 1-877-486-2048.

Your commitment to U. S. Steel throughout the years has played an important role in helping to make the company what it is today. We are committed to providing you with information and resources regarding Medicare Prescription Drug Plans to assist you in making an informed decision.

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