A: The $2,250 amount referred to by your pharmacist is NOT the sum total of your out-of-pocket costs in 2006 under Medicare Part D. That total in 2006 is $3,600. The amount you spend on what the government calls "True Out of Pocket Costs" is important, because once you have spent the out-of-pocket maximum of $3,600, then you receive catastrophic coverage which covers 95% of your drug costs from then on. According to the 2006 Medicare & You guide book, here’s a break- down of costs:

* You pay a monthly premium (this varies on where you live and the plan you select). Your premiums do not count toward your total out-of-pocket.

Then the following costs are counted toward your total out-of-pocket:

* If your drug plan has a deductible, you pay the first $250 for your prescriptions. This will be the full retail cost of your drugs and not the co-payment amount.

* After you pay the deductible you pay co-payments or co-insurance worth approximately 25% of your drug costs from $250 to $2,250 and the drug plan pays the other 75% of these costs, then

* You pay 100% of your next $2,850, the "doughnut hole", then

* After you have spent $3,600 ($250 deductible + $500 co-insurance (I don’t see where this co-insurance amount comes from) + $2,850 doughnut hole) you pay 5% of your drug costs or co-pays of $2 to $5 for the rest of the calendar year. Your drug plan pays the rest.

While $3,600 is steep enough, not all of your out-of-pocket costs may count towards the $3,600 out-of-pocket maximum. Drugs that are not on your drug plan’s formulary normally do not count, unless you received an exception to the plan’s formulary. In addition, you won’t be able to purchase "reimported" drugs from outside the U.S. and have them count toward the deductible or the out-of-pocket maximum of your drug plan.

It’s important to carefully review your drug plan formulary and if a prescription is not covered find out whether your doctor can prescribe a different drug to treat your condition that is covered by your plan.

Have you signed TSCL's Medicare Prescription Drug Plan Protest Petition?

For more information call Medicare toll free at (800) 633-4227.

May 2006