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MI You’re reading this book, chances are you’re baffled. That’s okay — you’re not alone. Since Medicare prescription drug coverage began in 2006, I’ve heard from multitudes of people trying to get their minds around Medicare Part D — the program’s official name — and most often they call it "confusing." In fact, the crispest verdict came from an exceptionally on-the-ball 93-year-old who’d spent the afternoon swing dancing at a Wisconsin senior center. He asked, simply: "Why did they come up with a program I couldn’t figure out myself?"

That’s why I’ve written this book. There’s no doubt about it — the Medicare drug program is complicated, largely because it comes with a lot of choices. Sure, choice is a good thing, but having many options also forces you to make more decisions. And to make good decisions — instead of just guessing and hoping for the best — you have to know the angles. That’s where Medicare Prescription Drug Coverage For Dummies Comes in. It takes you step by step through the choices you face and gives you the practical knowledge you need to make informed decisions. Consider it a road map for navigating the twists and turns in the system so you Can Figure it out for yourself — and with confidence.

Part D is a real benefit. Yes, it could be simpler and better, but it has still saved money for millions of people and allowed many to get the meds they need for the first time. For 40 years, Medicare didn’t pay for outpatient prescription drugs at all, and during that time, these meds became increasingly expensive and more necessary as a medical treatment. But now there’s Part D, and the problems are different. Typical questions I hear include:

"There are 52 Medicare drug plans in my area, so how the heck am I supposed to choose one?"

"I’ll be getting my meds through my retiree health plan. How will Part D affect it?"

"I was tricked into a plan I didn’t want. How do I get out of it?"

I "This benefit has saved me a lot of money, but now my plan has stopped paying for my drugs entirely. Why?"

This book answers those questions and many more. Yes, taking a whole book to explain Part D says a lot about the program’s complexities. But in these pages, I try to consider everybody’s circumstances by covering the widest possible spectrum of issues. In doing so, I draw on the frontline experiences of people like you who’ve grappled with Medicare drug coverage, my own

Experience in helping them, and the knowledge of many experts I’ve badgered for answers to the trickiest questions.

So whatever your situation, Medicare Prescription Drug Coverage For Dummies Offers strategies to cut through the confusions of Part D, either for yourself or for someone you’re helping. It explains the program’s ins and outs in plain words. It shows you how to avoid or cope with pitfalls and suggests how you can lower your costs or find a better deal. Best of all, it convinces you that you can — yes, you can — handle Medicare Part D!

About This Book

Medicare Prescription Drug Coverage For Dummies Gives you a lot to chew on, but don’t worry — you can take small bites. What you personally want to read depends on your situation — and on whether you’re using this book to help yourself or someone else. But one matter’s certain: If you recognize yourself in any of the following scenarios, you can find help in these pages:

You have no insurance for prescription drugs right now (or it’s coming to an end), but you’ll soon be going into Medicare and know zip about Part D coverage or how to get it.

I You do have drug insurance now (from an employer or elsewhere) but will soon be eligible for Medicare and need to know whether Part D will affect you and whether you should sign up for it.

I You’re already in Medicare but haven’t signed up for Part D and are wondering whether you should.

I You’re already enrolled in a Medicare Part D plan but can use some help troubleshooting problems, finding a better deal, or cutting your expenses.

I You need to know about Part D because you’re helping parents, relatives, or friends find the best Medicare drug plan for them.

I In your job (or as a volunteer) working with seniors or people with disabilities, you can use a plain-language reference to Part D.

Conventions Used in This Book

As you may expect from a program run by a federal bureaucracy, you’re going to meet certain unavoidable jargon in this book. This Part D-speak is worth getting to know, because notices you receive from Medicare or your drug plan — or any to-and-fros you have with either — will be easier to understand. So I use the following conventions:

New terms in Part D-speak are explained the first time they appear.

I When you see the word "Medicare" used on its own, it usually means the whole Medicare program. (As in: "When you join Medicare. . .") Sometimes it means the federal agency that runs Medicare. (As in: "Medicare may send you a notice. . .") The agency’s official name, the Centers for Medicare & Medicaid Services (CMS), is used as the source of information in some tables.

I The Medicare prescription drug program is referred to interchangeably as Part D or Medicare drug coverage. The private plans that provide this coverage are referred to as Part D plans or Medicare drug plans.

I also include a few standard conventions to help you navigate this book:

Italics Indicate definitions and emphasize certain words.

Boldface Text highlights key words in bulleted lists and actions to take in numbered steps.

Monofont points out Web and e-mail addresses.

"Quotation marks" generally indicate specific buttons or links you are to click on a given Web site.

What You’re Not to Read

Guess what? You can skip the sidebars — chunks of text that appear in nifty gray-shaded boxes. They’re not necessary to understanding how to find your way through Part D. Still, you may find them interesting. Ever wonder how on earth Congress dreamed up some of the more oddball bits of this program? You’ll find answers in the sidebars scattered throughout this book.

Foolish Assumptions

This book assumes that you don’t have any working knowledge of the Medicare prescription drug program — none, zip, nada. But even if you do, you can still find practical insights and useful tips to help you navigate the system more quickly, easily, and confidently.

Another point: This book assumes no political standpoints. Part D has always been controversial, coming under fire from conservatives and liberals alike. If you hold strong opinions, fine — that’s your privilege. But in these pages, the only "us versus them" undertone is a bias toward consumers (us) rather than government bureaucracies and insurance companies (them). The aim of this book is to help you understand and deal with the system as it is now. If you want it changed, please tell your members of Congress, not me!

How This Book Is Organized

Medicare Prescription Drug Coverage For Dummies Has six main parts with 21 chapters and three appendixes. Just dive into whatever you need to know — whether you’re thinking about Medicare drug coverage for the first time, you’re already in a Part D plan, or you’re in a special situation, such as having a limited income or living in long-term care. You don’t need to read stuff you already know, and you don’t have to wade through stuff you don’t need to know right now. The following summaries of each part include guidance on what you may want to read, according to your own situation.

Part I: The Nuts and Bolts of Medicare Prescription Drug Coverage

This first part begins with a quick run through the essentials of Medicare as a whole. This spot’s your first port of call if you’ll soon be going into Medicare and need to know if you qualify and how to sign up. Next, I get into the nitty-gritty of Part D itself by first looking broadly at the main rules of the prescription drug program and how it works. Then I take a closer look at the big questions that matter most to your pocketbook and health — costs and coverage. These chapters are essential reading if you’re considering Part D for the first time.

In this part, too, I provide detailed information about the program-within-a-program known as Extra Help, which offers much more generous drug benefits to people with limited incomes. Head to this chapter if you think you can’t afford the premiums and co-payments required in the regular Part D program, or if you currently get your meds from Medicaid.

Part II: Deciding Whether to Sign Up for Part D

For many people, this crucial question — "Do I really need Part D?" — can cause everything from head-scratching to panic attacks. Read this part if you already have prescription drug insurance, rely on free or low-cost drugs from some other source, or take no or very few meds right now. Here you discover how to find out if your current drug coverage is considered better or worse than Part D coverage and why this distinction matters. You also find help in weighing the consequences of continuing to have no drug coverage when you’re eligible for Part D — including hard facts about the late penalty if you don’t sign up for Part D at the right time.

Part III: Choosing and Enrolling in

The Right Part D Plan for You

Having to pick just one Medicare drug plan — out of more than 50 that are available to you, wherever you live — can bring on an acute form of paralysis, especially because each plan has different charges and covers a different range of drugs than the next one. So this part shows you the best ways to pick the plum — meaning the best plan for you — out of a whole lot of apples, oranges, and pears. It explains how to compare plans properly in the quickest way and why doing so is worth the effort. It also suggests ways to avoid scams and hard-sell marketing tactics. Finally, I show you how to enroll in the plan of your choice. Check out this part if you’re joining Part D for the first time And If you’re already in a Part D plan in November or December and want to know if it’ll still be the best one for you next year.

Part IV: You’re In! Navigating Part D from the Inside

This part covers a ton of ground — from first receiving your plan’s card right through to the end of the year when you’re deciding whether to stay with this plan or switch to another. Want to know how to navigate the dreaded doughnut hole (formally known as the coverage gap)? Need a drug that your plan won’t pay for? Want to cut down your out-of-pocket expenses? Wondering how going into a nursing home affects your Part D coverage? Need help in challenging a decision your plan has made that you don’t agree with? You can find the answers to these questions and many more right here. Consider reading much of this part if you’re joining a Medicare drug plan for the first time. But if you’ve been in a plan for a while, you may just want to jump into the chapter that directly speaks to your particular concern.

Part V: The Part of Tens

From the Ten Commandments to David Letterman’s Top Ten Lists, ten has long been the magic number for snappy lists. This part has two ten-point lists. Check them out for information you can take in at a glance on two key areas — ten ways for boomers to ride to the rescue of loved ones grappling with Part D and ten proposed changes to Part D that you should know about.

Part VI: Appendixes

Appendix A offers sample worksheets you can use when comparing Part D plans — whether stand-alone drug plans or Medicare Advantage plans. Appendix B is your go-to resource for when you need personal help with Part D. Look here for the names and contact info of organizations and agencies mentioned in this book. Appendix C is your guide to safely buying prescription drugs by mail order from abroad. It explains steps you can take to ensure you receive genuine products from reputable pharmacies instead of falling prey to counterfeit medicines and dubious sellers.

Icons Used in This Book

Icons are those cute drawings you see in the page margins now and again. Here’s what they mean:

^jjfcDuQfy This icon indicates a situation in which you need your doctor’s help — for

Example, when asking your Part D plan to pay for a medicine it doesn’t usually «f _ Lw I Cover, or when finding out whether a lower-cost drug would work just as well as the expensive one you’re taking now.

BED

This icon signals important info. If you take anything away from this book, it should be information highlighted with this icon.

This icon draws your attention to on-target advice and practical insights that will save you time, effort, and maybe even money.

This icon raises a red flag to alert you to a Part D rule or potential pitfall that may trip you up if you remain blithely unaware of it.

Where to Go from Here

Nobody expects you to read this book cover to cover. Harry Potter It’s not! But you can jump in anywhere to the bit you need, at whatever point you happen to be in when grappling with Medicare prescription drug coverage. I’m going to whip off the cloak of invisibility to reveal. . . not the Sorcerer’s Stone, not the Chamber of Secrets. . . but the practicalities of a system that isn’t very mysterious at all — after you know how to navigate it.

Part I

The Nuts and Bolts of Medicare Prescription Drug Coverage

The 5th Wave By Rich Tennant

""Exactly – vihat kind O£ Prescription medication Are you – taking?"

In this part. . .

Efore you can choose a prescription drug plan, you should understand the basics of Medicare Part D prescription drug coverage — how it fits into the wider Medicare program and, broadly, how it works.

First, for those of you who are just about to join Medicare, I give a quick primer on the different parts of the Medicare program — Part A (hospital coverage), Part B (doctors and outpatient services), Part C (private health plans), and Part D (drug coverage) — as well as how to be sure you’re eligible for Medicare and how to enroll. Then I give an overview of the main rules of Part D so you can get a general idea of how Medicare drug coverage works if you’re not yet enrolled in the program.

In the remaining chapters of this part, I explain in more detail the two topics that probably most concern you at this stage — how much you’re likely to spend and save in Part D (whether you’re in the regular program or you qualify for extra financial help in paying for meds) and how your prescription drugs will be covered.

Chapter 1