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Illinois Attorney General Lisa Madigan
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Advocating for Older Citizens

The New Federal Drug Benefit: Medicare Part D



What Are Medicare Prescription Drug Plans? Back to top


Beginning January 1, 2006, under the Medicare Prescription Drug Improvement and Modernization Act of 2003, prescription drug plans will be available to all seniors and people with certain disabilities who are on Medicare. You will be able to choose from more than 80 different plans, offered by 16 different companies, in Illinois. All plans have to provide coverage that at least meet the minimum standard set by Medicare, but plans will vary according to:

  • what drugs are covered;

  • which pharmacies you can use; and

  • what you pay for the plan’s premiums, deductibles, and prescription co-payments.

For a complete list of the companies and plans approved for Illinois, go to and click on Illinois on the map.

Who Is Covered? Back to top

If you are eligible for Medicare, you are entitled to Part D prescription drug coverage and can sign up for a plan.


How Much Will it Cost? Back to top


That will depend on the plan you choose. Unless you qualify for a limited income subsidy (see below), you will pay:

1) Monthly premiums ranging from about $20 - $35.
2) Annual deductibles ranging from $0 to $250.
3) Co-payments for each prescription.

Also, if your drugs cost more than $2,250 in one year, you will pay their full cost between $2,250 and $5,100. After you have spent $3,600 out-of-pocket, Medicare and your prescription drug plan will pay 95% percent of your remaining drug costs for the year.

What if I Have a Limited Income? Back to top

If your income level meets certain guidelines, you may be able to get extra help paying the costs of your prescription drug plan. For more information about whether you qualify and how to get such assistance, call 1-800-MEDICARE or your local Social Security office.

Where Will I Get My Medications? Back to top

You will still be able to get your drugs from a pharmacy. Different plans will use different pharmacies, though, so when choosing a plan, be careful to check which pharmacies the plan uses. Some plans may also offer mail-order prescription services.


What Drugs Will Be Covered? Back to top


Not all drugs will be covered by every plan. It is VERY important to compare plans to see which ones offer the drugs you use. Keep in mind:

  • All plans must offer drugs in six major categories specified by Medicare, but they do not have to offer every drug within each category.

  • A plan’s drug list (formulary) may not include your specific drug, but may offer a generic or another drug that would work just as well for you. Consult your doctor for possible substitutes.

Plans can change the drugs they offer frequently, although you will only be able to switch plans once a year. Pay attention to changes in plans so you can make the best choice for yourself every year.


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