This information is intended for patients who are Medicare beneficiaries and their families. If you are not eligible for Medicare, please speak with your nursing home staff to see if this information applies to you.

On January 1, 2006, Medicare will begin covering prescription drugs that may be filled by a local pharmacy or provided through your nursing home, assisted living provider or other organization providing care. Nursing homes usually contract with a single pharmacy that has special knowledge of the needs of older persons and persons with disabilities. KPS Pharmacy has created a brochure to explain the Part D Drug benefit to residents and their families. Please click here to open a PDF of the brochure.

Many beneficiaries will have access to drugs through prescription drug insurance for the first time. The government agency responsible for providing the benefit, the Centers for Medicare and Medicaid Services (CMS), is working very hard to implement this program, and over the course of the next several months, you will receive more information about this new benefit. To learn more about CMS offerings for beneficiaries and their families go to http://www.medicare.gov/medicarereform/default.asp.

This insurance will be offered through private entities, such as health insurers and managed care organizations. These plans will provide insurance coverage for prescription drugs. Similar to your Medicare Part B benefit, if you join you will pay a monthly premium (around $32 in 2006 for a basic plan), an annual deductible, and a share of the cost of your prescriptions. Costs will vary depending on the drug plan you choose, and whether you qualify for reduced or no cost-sharing. You may qualify for free or low-cost drugs if you meet certain income and asset requirements. Each drug plan will offer coverage of different drugs, at different costs to you. When you enroll in a drug plan, it is important for you to choose one that meets your prescription drug needs.

You may have been receiving information about the new prescription drug benefit through the mail from government agencies, such as CMS and the Social Security Administration (SSA). Health plans and managed care organizations that will be offering the benefit on behalf of Medicare may begin sending out information about their plan offerings. Please speak with your nurses and other nursing home staff if you have any questions about the information you have received.

Q: What if I already have drug coverage through Medicaid?

If you have coverage through Medicaid and you are eligible for Medicare, you still must enroll in a new Medicare drug plan in order to get prescription medications after January 1, 2006. Medicaid will no longer cover your drug costs. While you are in the nursing home, your Medicare drug plan will not charge copays for your prescriptions.

Beginning this fall, you can choose to enroll in a drug plan. If you do not choose a plan, one will be selected for you, in a process called auto-enrollment. If you are auto-enrolled in a plan, you do have the option to choose another plan at any time during your stay in a nursing home.

Q: How does the benefit work in the nursing home?

If you are living in a nursing home, you will need to choose a Medicare drug plan in order to receive your prescription medications. The Nursing staff can help you select a plan that is best for you. Once you enroll, some or all of your drug costs will be paid for through your drug plan. Your drugs will continue to be delivered by KPS Pharmacy. There is no need to change pharmacies.