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You know that Medicare prescription drug coverage (known as Medicare Part D) became available on January 1, 2006 to anyone who has Medicare Part A and/or Part B. Medicare Part D is offered through private plans approved by Medicare.

But if you already enjoy the benefits of a prescription drug assistance program offered by the State of New Jersey through the Senior Gold Prescription Discount program (Senior Gold), how will Medicare Part D affect you?

Here are the facts you need to know:

  • If you are a Senior Gold beneficiary who receives Medicare benefits, you must participate in Medicare Part D in order to use Senior Gold benefits.
  • As a Senior Gold beneficiary enrolled in Medicare Part D, you MUST pay the premiums to join a Medicare prescription drug plan. Utilizing your Senior Gold benefits, however, will help reduce any other out-of-pocket costs associated with Medicare Part D, such as deductibles and co-insurance. The Senior Gold program will NOT pay premiums for Medicare prescription drug plans.
  • When used with your Senior Gold benefits, the Medicare prescription drug coverage may save you more money on your prescriptions.
  • If you were eligible to enroll in Medicare Part D before May 15, 2006 but chose not to enroll, Medicare will charge you a late enrollment fee at a 1% monthly premium increase if you now choose to enroll in a Medicare prescription drug plan.
  • Senior Gold beneficiaries are members of a qualified state pharmaceutical assistance program. That means they are entitled to one Special Enrollment Period for Medicare Part D during each calendar year beyond the annual enrollment period. They do NOT have to wait to enroll in Medicare Part D until the annual enrollment period begins each year on October 15th.

Medicare Advantage (MA) Participants

If you participate in a Medicare Advantage plan for your health benefits, you must contact your MA plan directly and ask how to add a prescription drug benefit to your existing Medicare health insurance coverage. It is important to remember that with your Medicare Advantage plan, you will be responsible for paying the premiums for both your medical coverage (Medicare Part B) and your prescription coverage (Medicare Part D). As a Senior Gold beneficiary with a Medicare Advantage plan, if you do not add prescription coverage to your Medicare Advantage plan, you risk losing your Senior Gold benefits.

Creditable Coverage

  • Senior Gold participants who have "creditable coverage" for prescription drugs through a former employer or union and have been notified to not enroll in Medicare Part D do not have to enroll in order to use Senior Gold benefits. Creditable coverage means that the prescription drug coverage provided by an employer or union is, on average, at least as good as that which is provided by a basic Medicare prescription drug plan. Employers or unions are responsible for sending out notification regarding creditable coverage and whether or not to enroll in Medicare Part D to their employees/retirees.
  • Senior Gold participants with creditable coverage from a former employer or union are asked to send a copy of the notice to the Senior Gold program.

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