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Health Care Reform:

Health Insurance & Affordable Care Act

Medicare Rx Benefit: Sorting Out the Options

WebMD looks at the choices facing Americans who enroll in Medicare's prescription drug benefit.

Concerns for Mentally Ill Patients

The American Psychiatric Association is especially concerned about dual-eligible patients with mental illnesses requiring medication. Many of these patients use multiple medications but may not be able to make decisions about plan choices.

In addition, Medicare is not covering some psychoactive drugs, including benzodiazepines, used by some patients.

State health insurance programs (SHIPs) are taking the lead in providing advice directly to low-income patients on how to sign up for a drug plan. For mentally ill patients and their loved ones or caregivers, the National Alliance for the Mentally Ill and the National Mental Health Association are both offering resources to help.

Employer-Based or Retiree Plans

Millions of seniors already have drug coverage through a retiree health plan or a current employer. If that includes you, you'll have to decide whether to keep your private coverage or join Part D.

First, your employer will have to let you know if they are keeping coverage. One possible effect of the new government coverage is that it may cause private insurers to drop their drug plans. Medicare is trying to avoid this by paying subsidies to private plans as an incentive for them to keep prescription insurance.

"It appears that many if not most of them will continue, at least for the time being," says Cheryl Matheis, director of health strategies for AARP.

Employers are required by law to inform beneficiaries about their existing drug coverage and whether they're keeping it. If so, they are also required to tell you whether that coverage is as good or better than what Part D is offering.

They key word to look for is "creditable." A private plan that is creditable is one that is functionally equivalent or better than Part D. If yours is, you can stay with it or choose to go with a Medicare plan. And if you choose private coverage and go with Medicare later, you won't have to pay a penalty for late enrollment.

Participation in Part D is purely voluntary. But if your private coverage is not creditable, you'll pay a premium penalty if you decide to switch to Medicare after May 15, 2006.

Again, you'll want to use Medicare's web site to compare formularies and out-of-pocket costs like co-payments, deductibles, and co-insurance to see which kind of coverage is best for you.

The key is that letter from your employer. If you don't get one by the end of October, get in touch with your employer's human resource department to find out when it's coming and whether your coverage is creditable.

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