Prescription Drug Coverage Handouts for HCS clients
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Prescription Drug Coverage Handouts for HCS clients


Revised December 6, 2013



Purpose: This section has the text of the Prescription Drug Coverage handouts used by HCS staff.

If you receive Medicaid and Become Eligible for Medicare-Recipient

Once you become eligible for Medicare, you no longer use your Med ID card to pay for most of your prescription drugs. You will now get most of your prescription drugs through Medicare Part D and the Prescription Drug Plan (PDP) you enroll in. 

 

It is important that you enroll in a PDP so that the plan will be effective the month you become eligible for Medicare. 

 

Getting enrolled in a Prescription Drug Plan (PDP)

The Centers for Medicare and Medicaid Services (CMS) sends you an enrollment packet “Welcome to Medicare” before you become eligible for Medicare.  The explanation for how to enroll in a PDP is in this packet.  

 

A PDP is insurance that covers both brand name and generic prescription drugs at participating pharmacies in your area. There are many different types of plans to choose from that vary in cost, coverage, and yearly deductibles.

 

Be sure to ask about the premium and co-pays when comparing plans. Not all PDP premiums are fully paid for by Medicare.  If you choose a PDP that is not fully paid for by Medicare, you may have to pay a portion of your plan’s premium and higher co-pays. 

 

If you do not enroll in a PDP, CMS automatically enrolls you in a premium free plan.  You may have a period of time that you can’t get prescriptions unless you enroll in a plan through the emergency system, WellPoint.

 

Emergency prescription drug coverage

If you are not enrolled in a PDP and need prescriptions right away, most major pharmacies can enroll you through a national emergency system called WellPoint.  Bring your Medicare card and Medicaid coupon to the pharmacy to get your prescriptions.   You will be enrolled into the WellCare plan.  WellCare will be your PDP.  If WellCare doesn’t work for you, you can change plans.

 

Changing Plans

You can change plans at any time.  If you change plans, the new plan takes effect the next month after the month you enroll.  If you do change plans, you need to let Medicare staff know.  Call 1-800-Medicare (1-800-633-4227) or (TTY) 1-877-486-2048 and let them know.  You also need to tell a representative from your new plan that you are changing plans and which plan CMS had selected for you.

 

Resources that can help you pick a plan

  • Below are resources that can help you decide which plan is best for you.
     The Washington State Office of the Insurance Commissioner’s Statewide Health Insurance Benefits Advisors (SHIBA) HelpLine can help you understand your options. Call them at 1-800-562-6900.
  • Visit the federal Medicare website at www.medicare.gov.  The site has several tools to help you understand, compare, and choose a plan.  You can also talk with Medicare staff by calling 1-800-Medicare (1-800-633-4227) or (TTY) 1-877-486-2048.
  • Your local Senior Information and Assistance Office (I&A).  To find your local I&A office, visit the AAA website at www.agingwashington.org and click on “local AAAs” or look for the Area Agency on Aging office in the yellow pages of your telephone book under “Senior Services”.

Frequently Asked Questions

 

Can I Keep My Medicaid Drug Coverage?

No. Once you are eligible for Medicare, Medicaid will not continue the drug coverage it currently provides.

 

What if I have prescription drug coverage from another type of insurance (employer, union or retirement plan)?

If your other insurance plan is not as good as the Medicare prescription drug coverage, talk to your insurance carrier about your options. You may not be able to join a Medicare PDP without dropping your current health coverage (doctor and hospital).  If you drop your current insurance, you may not be able to get it back.

 

You do not need to enroll in a Medicare PDP if your other insurance plan provides benefits equal to or better than the Medicare PDP.  Your insurance provider should tell you if your current insurance plan is equal to or better than the Medicare PDP.  To keep your current insurance plan, you need to decline or dis-enroll in any Medicare PDP.  You need to talk with Medicare staff to do this.  Call 1-800-Medicare (1-800-633-4227) or (TTY) 1-877-486-2048 to decline or dis-enroll in the Medicare PDP.

 

What if I move to or live in a nursing home?

If you move to a nursing home, you still have a choice of what PDP you want to use. You can also switch plans at any time.  If you want help deciding which plan is best for you, use the resources listed above. You might also want to talk with staff at the nursing home and ask them for their suggestions. 

 

What if I pay part of my income for the cost of my long-term care (participation)?

If you are enrolled in a PDP where you have to pay part or all of your co-pays and premium, it is considered a medical expense and may be used to reduce your participation.

 

Report the amount you pay for co-pays and premiums to your local Home and Community Services (HCS) financial worker.  If you don’t remember who your financial worker is, call your local HCS Office.  The financial worker will need to see receipts for the amount you report.

 

If you get food assistance, co-pays and other medical expenses that exceed $35.00 per month may be used to give you more food benefits.  Report the amount you pay to your financial worker and provide receipts for the amount you report.

12/1/06

 


Prescription Drug Coverage If you are new to receiving Medicaid and are eligible for Medicare-Applicants

If you already receive Medicare or are eligible for it, you will get most of your prescription drugs through Medicare Part D and the Prescription Drug Plan (PDP) you enroll in.  You need to enroll in a PDP if you haven’t done so (see below).  Medicaid does not pay for most of your prescription drugs.

 

If you need to enroll in Medicare, contact your local Social Security Office. To find the nearest office, look in the “Federal Government” pages of your phone book or on the web at www.socialsecurity.gov.

 

Getting enrolled in a Prescription Drug Plan (PDP)

A PDP is insurance that covers both brand name and generic prescription drugs at participating pharmacies in your area. There are many different types of plans to choose from that vary in cost, coverage, and yearly deductibles.

 

Be sure to ask about the premium and co-pays when comparing plans. Not all PDP premiums are fully paid for by Medicare.  If you choose a PDP that is not fully paid for by Medicare, you may have to pay a portion of your plan’s premium and higher co-pays. 

 

If you are not enrolled in a PDP, the Centers for Medicare and Medicaid Services (CMS) automatically enrolls you in a premium free plan shortly after you are authorized for Medicaid.  You have 20 days to change PDPs if the plan CMS enrolls you in does not work for you.  You may have a period of time that you can’t get prescriptions unless you enroll in a plan through the emergency system, WellPoint.

 

If you are already enrolled in a PDP and are paying some or all of the premium, it may be time to find and switch to a premium-free plan since you are now receiving Medicaid.  This is your choice. 

 

If you do not enroll in a premium-free plan, CMS will enroll you in a premium-free plan shortly after you are authorized to receive Medicaid.  You will have 20 days to change plans if the plan CMS enrolls you in does not work for you or if you want to keep the plan you have.

 

Emergency prescription drug coverage

If you are not enrolled in a PDP and need prescriptions right away, most major pharmacies can enroll you through a national emergency system called WellPoint.  Bring your Medicare card and Medicaid coupon to the pharmacy to get your prescriptions.   You will be enrolled into the WellCare plan.  WellCare will be your PDP.  If WellCare doesn’t work for you, you can change plans.

 

Changing Plans

You can change plans at any time.  If you change plans, the new plan takes effect the next month after the month you enroll.  If you do change plans, you need to let Medicare staff know.  Call 1-800-Medicare (1-800-633-4227) or (TTY) 1-877-486-2048 and let them know.  You also need to tell a representative from your new plan that you are changing plans and which plan CMS had selected for you.

 

Resources that can help you pick a plan

Below are resources that can help you decide which plan is best for you.
 

  • The Washington State Office of the Insurance Commissioner’s Statewide Health Insurance Benefits Advisors (SHIBA) HelpLine can help you understand your options. Call them at 1-800-562-6900.
  • Visit the federal Medicare website at www.medicare.gov.  The site has several tools to help you understand, compare, and choose a plan.  You can also talk with Medicare staff by calling 1-800-Medicare (1-800-633-4227) or (TTY) 1-877-486-2048.
  • Your local Senior Information and Assistance Office (I&A).  To find your local I&A office, visit the AAA website at www.agingwashington.org and click on “local AAAs” or look for the Area Agency on Aging office in the yellow pages of your telephone book under “Senior Services”.

 

Frequently  Asked Questions

 

 

What if I have prescription drug coverage from another type of insurance (employer, union or retirement plan)?

If your other insurance plan is not as good as the Medicare prescription drug coverage, talk to your insurance carrier about your options. You may not be able to join a Medicare PDP without dropping your current health coverage (doctor and hospital).  If you drop your current insurance, you may not be able to get it back.

 

You do not need to enroll in a Medicare PDP if your other insurance plan provides benefits equal to or better than the Medicare PDP.  Your insurance provider should tell you if your current insurance plan is equal to or better than the Medicare PDP.  To keep your current insurance plan, decline or dis-enroll in any Medicare PDP.  Call and talk with Medicare staff by calling 1-800-Medicare (1-800-633-4227) or (TTY) 1-877-486-2048 to decline or disenroll in the Medicare PDP.

 

What if I pay part of my income for the cost of my long-term care (participation)?

If you are enrolled in a PDP where you have to pay part or all of your co-pays and premium, it is considered a medical expense and may be used to reduce your participation.

 

Report the amount you pay for co-pays and premiums to your local Home and Community Services (HCS) financial worker.  If you don’t remember who your financial worker is, call your local HCS Office.  The financial worker will need to see receipts for the amount you report.

 

If you get food assistance, co-pays and other medical expenses that exceed $35.00 per month may be used to give you more food benefits.  Report the amount you pay to your financial worker and provide receipts for the amount you report.

 

 

 

 

12/1/06

 

Modification Date: December 6, 2013