ACHP: Quality and Experience Matter When Choosing Medicare Prescription Drug Coverage

People with Medicare shouldn’t wait to sign up for the new drug benefit; extra help is available for those with limited incomes and resources 

WASHINGTON, D.C. – For the first time ever, Medicare will offer prescription drug coverage to anyone who is eligible for the program.  But it doesn’t happen automatically — people with Medicare must sign up between November 15, 2005 and May 15, 2006.  If they don’t, the benefit will cost more later.

“It’s important for people with Medicare to sign up for prescription drugs,” said Jack Ebeler, President and CEO of the Alliance of Community Health Plans, which includes six of the ten highest-quality Medicare Advantage plans in the country.  “The best coverage options offer comprehensive benefits, high-quality, well-coordinated care and lots of experience in Medicare.”

Health plans and prescription drug only (PDP) plans can begin marketing on October 1.  How do people with Medicare determine which one to choose?  First, they should identify the plans in their area and compare the offerings by consulting or 1-800-MEDICARE.  Then, they should look at the monthly premium of each plan, and consider prescription drug and other health care needs.  Which option provides the right level of coverage at the best cost?  If the price looks too good to be true it probably is.

How a plan approaches care also matters.  When the plan, doctors, hospitals and patients work well together, the quality of care is usually better.  People with Medicare should check or to compare quality information about their plan options.  They should also remember to find out about plans’ experience.  Some have participated in Medicare for years and maintain a long-term commitment to people with Medicare.  Others may be new this year and lack a proven track record.

Seniors with limited incomes and resources should also sign up for the new prescription drug benefit, because of the extra help that Medicare will provide.  Seniors will pay low or zero-dollar premiums and deductibles, and low co-pays for prescriptions.  To determine eligibility and apply, check

There are two basic approaches to getting the new drug benefit.  One is to sign up for a PDP plan under Medicare Part D.  This option lets people with Medicare add a private drug coverage plan to supplement existing Medicare benefits.

Another way is to sign up for the Medicare Advantage program.  Medicare Advantage allows people with Medicare to choose one health plan in their area that will cover all aspects of care, including traditional benefits, such as hospital and doctors’ office visits, as well as the new drug benefit and others.

Six of the ten highest-quality Medicare health plans are members of ACHP, according to the National Committee for Quality Assurance (NCQA).

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ACHP is a leadership organization that brings together innovative health plans and provider organizations that are among America’s best at delivering affordable, high-quality coverage and care to their communities. Drawing on years of experience, members collaborate to identify problems, share information and work toward solutions to some of health care’s biggest challenges. Their work is the foundation for ACHP’s advocacy on behalf of better health care nationally.  More information is available at

Capital Health Plan; CareOregon; Fallon Community Health Plan; Group Health Cooperative; Group Health Cooperative of South Central Wisconsin; Health Alliance Plan; HealthPartners; HIP Health Plan of New York; Kaiser Foundation Health Plans and the Permanente Federation; M•Plan; OSF HealthPlans; UCare Minnesota; UPMC Health Plan