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SAMHSA News - July/August 2005, Volume 13, Number 4

Medicare Modernization Brings Big Changes: Easing the Transition (Part 1)

Medicare—the national health care program for Americans age 65 and older and younger people who qualify because of a physical or mental disability—is about to undergo the most dramatic change in its 40-year history.

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 makes many improvements to Medicare. Of note, all 42 million Medicare beneficiaries will have prescription drug coverage for the very first time. That new coverage has important implications, especially for those people eligible for both Medicare and Medicaid.

These 6.3 million dually eligible people—almost 40 percent of whom have serious mental illnesses or cognitive impairments—will receive their prescription medication through Medicare rather than Medicaid starting January 1, 2006.

"The prescription drug coverage coming next year is for everyone in Medicare, regardless of their income or how they get their Medicare," said Mark B. McClellan, M.D., Ph.D., Administrator of the Centers for Medicare & Medicaid Services (CMS). "At CMS, we are paying particular attention to making sure that those with Medicaid and Medicare have effective, smooth transitions to what will be very comprehensive coverage for all medically necessary treatments."

Whether you're a state mental health program director, substance abuse program director, treatment provider, advocate, or consumer, you need to know about these changes. And SAMHSA is determined to help.

"Although this is a CMS program, it's a very high priority for us here at SAMHSA as well," said SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W. "We've made a commitment to the Secretary of Health and Human Services that we'll do whatever we can to ensure this program is a success for the vulnerable populations we jointly serve."

Timeline: Medicare Prescription Drug Coverage

Note: People eligible for both Medicare and Medicaid should have already received information about Medicare prescription drug coverage. Call 1 (800) MEDICARE for more information. TTY users should call 1 (877) 486-2048.

October 2005
Detailed information available about Medicare prescription drug plans in the Medicare & You 2006 handbook and on www.medicare.gov. People with both Medicare and Medicaid will be notified which plan they'll be assigned if they don't choose a plan within the next 2 months.

November 15
First day to join a Medicare prescription drug plan.

November 15 to December 31
If people with Medicare and Medicaid don't join a plan by December 31, Medicare will enroll them in a plan effective January 1, 2006.

January 1, 2006
Medicare prescription drug coverage begins.

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