Medicare Part D

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On December 8, 2003 the Medicare Prescription Drug, Improvement and Modernization Act of 2003 was enacted. It created a new “Part D”, which established a prescription drug benefit for Medicare beneficiaries. This program went into effect for all Medicare eligible consumers on January 1, 2006.

In 2011, New York State will have 30 stand-alone prescription drug plans and 11 of these will be benchmark plans ($0 premium for those who qualify for a full low income subsidy). It's important to review your plan every year, since many changes may have occurred. Your current plan may have raised their premiums, they may have changed the medications that they cover, or they may no longer be participating as a provider. Your needs may have also changed and you may be on different medications or have a different financial situation. New York's Benchmark PDPs and Actions that Need to be Taken for 2011 will give you a quick overview of the premium changes and steps that you may need to take, if you qualify for a benchmark plan. In addition to that, be sure to review the Annual Notice of Change sent out by your current plan (mailed by October 31, 2010) outlining changes to their plan for 2011 and use the Medicare Prescription Drug Plan Finder to make other comparisons based on your needs.

This site is designed to be a quick reference guide for all stakeholders looking for information on the Prescription Drug Plans, benefits, eligibility, enrollment, how to obtain “Extra Help” through a low income subsidy, and additional resources for general information on Medicare Part D. The materials presented on this site are intended to be informational and not authoritative. For authoritative information, individuals should consult the federal Centers for Medicare and Medicaid Services (CMS) .

Quick Reference Guide Sections

Plans, Benefits, and Premiums – Updated for 2011

• New York State's Medicare Prescription Drug Plans for 2011 – Lists all plans for 2011 with update premium and deductible information.
• New York's Benchmark PDPs and Actions that Need to be Taken for 2011 – Indicates changes to 2010 benchmarks and actions that may need to be taken for 2011.
• Medicare Prescription Drug Plan Finder – Compares other Prescription Drug Plans (PDP)s to your current plan to find out what works best for you.
• Formulary Finder for Prescription Drug Plans – Medicare site that, based upon your current medications, will indicate what plans would best meet your needs.
• 2010 NYS Medicare Prescription Drug Plan Contact Information – NYS Department of Health offers Customer Service information for the 2010 benchmark PDPs.

Eligibility and Enrollment

• Q & A Sheet on Plan Enrollment for People with Both Medicare & Medicaid (Dual Eligibles) (PDF) - from Medicare Access for Patients Rx.
• Medicare Prescription Drug Coverage Personal Information Worksheet for People with Medicare & Medicaid (PDF) – Helps dual eligibles gather all of the information they need to find a Medicare drug plan that meets their needs.
• Medicare Eligibility Tool – Determine if you are eligible for Medicare.

Extra Help/ Low-Income Subsidy

• 2010 Resource and Cost-Sharing Limits for Low-Income Subsidy (LIS) (PDF) – Centers for Medicare and Medicaid Services (CMS) releases guidance on the new resource limits for applying for a financial assistance to pay for Medicare Part D premiums.
• What You Need to Know About Extra Help with Medicare Prescription Drug Plan Costs (PDF) – Social Security Administration's guide that provides a basic understanding of the low income subsidy program for 2010.
• Changes in the Law Could Make More People Eligible for Extra Help in 2010 - Fact Sheet from Social Security on changes in resources counted towards eligibility.
• Changes in Qualifying for Extra Help in 2011 (PDF) – CMS Tip Sheet.

Tip Sheets and Consumer Alerts

• Medicare Prescription Drug Coverage: How to File a Grievance, Request a Coverage Determination or File an Appeal (PDF) – If you disagree with a decision made by your PDP, here's what you can do about it.
• Repayment of Premiums and Co-Payments Paid Out of Pocket (PDF) – Fact sheet on how to get reimbursed by a Medicare Drug Plan for expenses that should have been covered.
• Using Your New Medicare Drug Coverage (PDF) – Tips on how to make your first trip to the pharmacy go smoothly.

General Information and Resources

• Center for Medicare and Medicaid Services – General information and overview of prescription drug coverage.
• CMS's Frequently Asked Questions about Medicare Prescription Drug Coverage
• CMS Legislative Summary: Medicare Modernization Act of 2003 – Provides information on the changes in the law and the resulting provisions.
• Medicare – The official U.S. Government site for people with Medicare.
• Medicare and You 2011 (PDF) – The official government handbook on how to get the most out of Medicare. Summary of Medicare benefits, rights and protections, and answers to the most frequently asked questions about Medicare.
• Social Security Administration – Official website of the U.S. Social Security Administration.
• NYS Office for the Aging: Health Insurance Information, Counseling & Assistance (HIICAP) – Information, education and counseling on Medicare and other health insurances. Free advocacy for those with health insurance issues.
• NYS Department of Health: Medicaid and the Medicare Part D Prescription Drug Benefit – Information for NYS residents who have Medicaid and Medicare.
• Kaiser Family Foundation's: Resources on the Medicare Prescription Drug Benefit