Medicare Prescription Drug Coverage
Frequently Asked Questions for Senior Gold Beneficiaries

What is Medicare Part D?

Part D refers to the federal outpatient prescription drug benefit offered by Medicare that began January 2006. This benefit was established by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003.

As a Senior Gold beneficiary in New Jersey , how will Medicare Part D affect me?

All Senior Gold beneficiaries enrolled in Medicare Part A and/or Part B must enroll in Medicare Part D to use Senior Gold benefits. You will have to pay a monthly premium directly to the Medicare prescription drug plan of your choice. Your Senior Gold benefit can be used during any Medicare Part D deductible phase, active benefit phase, and coverage gap, thereby reducing out-of-pocket costs associated with participation in Medicare Part D.

NOTE: If you were eligible to enroll in Medicare Part D before May 15, 2006 but chose not to enroll, the federal Medicare program 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 November 15th.

Will I have to pay a premium for my Medicare Part D benefits?

Senior Gold participants who are eligible to use Medicare Part D must pay the premiums to join a Medicare prescription drug plan of their choice. However, they may use their Senior Gold benefits to help pay for any other out-of-pocket costs, such as deductibles and co-insurance, up to the current Senior Gold benefit.

NOTE : If you were eligible to enroll in Medicare Part D before May 15, 2006 but chose not to enroll, the federal Medicare program 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. As a Senior Gold beneficiary, you are a member of a qualified state pharmaceutical assistance program. That means you are entitled to one Special Enrollment Period during each calendar year beyond the annual enrollment period for Medicare Part D.

If I am newly eligible for Medicare, when can I enroll in a Medicare prescription drug plan?

When you first become eligible for Medicare, you have a seven-month period to enroll in a Medicare prescription drug plan to use Medicare Part D. This period begins three months prior to the month you turn 65 and ends three months after your birthday month. If you sign up for Medicare Part D after that seven-month period, you will be subject to Medicare’s late enrollment fee at a 1% monthly premium increase.

If I enroll in Medicare Part D, when will my federal prescription benefits begin?

If you are a Senior Gold participant and currently enrolled in Medicare Part D, you may change your Medicare prescription drug plan during the annual enrollment period from November 15 to December 31. Medicare Part D benefits under your new Medicare prescription drug plan will begin January 1^st of the following year. As a Senior Gold beneficiary you are allowed one Special Enrollment Period (SEP) so that you can change your Medicare prescription drug plan once a year, beyond the annual Medicare Part D enrollment period, if necessary.

NOTE : If you were eligible to enroll in Medicare Part D before May 15, 2006 but chose not to enroll, the federal Medicare program 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 during an annual open enrollment period.

How will things work at the pharmacy?

As a Senior Gold participant, you will present your Medicare prescription drug plan membership card and your Senior Gold card at the pharmacy so the combined savings can be applied. Senior Gold benefits help to make Medicare prescription drug coverage more affordable by reducing any other out-of-pocket costs associated with that coverage, such as deductibles, co-insurance, and the coverage gap known as the "donut hole."

Your co-payment will be $15 plus 50% of the remaining cost of the drug for Senior Gold covered prescriptions until you reach the Senior Gold program’s annual out-of-pocket threshold of $2,000 for individuals or $3,000 for married couples. Then you pay a flat $15 co-payment for the remainder of that eligibility period.

How many pills am I allowed per covered prescription?

As a Senior Gold participant enrolled in a Medicare prescription drug plan or other private insurance plan with prescription coverage, that Medicare or private insurance plan will specify the day supply of medication per covered prescription.

As a Senior Gold participant enrolled in Medicare Part D, can I use my Medicare prescription drug plan benefits outside of New Jersey?

Some Medicare prescription drug plans are national plans, meaning the benefits can be used anywhere in the United States. You would need to check with your specific Medicare prescription drug plan to determine if you can use its benefits outside New Jersey and what your co-payment responsibility would be outside New Jersey. Senior Gold benefits are not valid outside New Jersey!

I am a Senior Gold beneficiary, and my former employer or union has told me not to enroll in a Medicare prescription drug plan. If I do, I will lose the prescription coverage and perhaps even the entire medical coverage I have through my former employer/union. Can I still keep my Senior Gold benefits or still join the Senior Gold program if I’m eligible?

Yes. While it’s true Senior Gold participants must enroll in Medicare Part D if they are eligible in order to use Senior Gold benefits, Senior Gold will not require you to enroll in a Medicare prescription drug plan if your former employer or union has sent you a creditable coverage notice and told you not to enroll in Medicare Part D. You will still be able to use Senior Gold benefits if you qualify for them. You must submit the creditable coverage documentation to Senior Gold from your former employer or union that states you should not enroll in Medicare Part D. Senior Gold will verify this information and will not require you to enroll in Medicare Part D as a condition to using Senior Gold benefits.

Who is eligible for Senior Gold benefits?

Senior Gold benefits are available if you are a New Jersey resident; you are at least 65 years of age OR at least 18 years of age and receiving Social Security Disability benefits; and your annual income for 2009 is between $24,432 and $34,432 if single or between $29,956 and $39,956 if married. If you are eligible for Medicare Part D benefits, you must also enroll in a Medicare Part D prescription drug plan in order to use Senior Gold benefits.

Click here for further information about the Senior Gold program specifically.

Where can I turn if I have more questions about Senior Gold and Medicare Part D?