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Medicare Part D Prescription Drug Coverage - Interaction With Other Programs

Medicare will offer prescription drug coverage beginning January 1, 2006. This topic provides information about the Medicare Prescription Drug Coverage (Medicare Part D) program and its benefit interactions with other programs.

Your current coverage or benefits may change when Medicare prescription drug coverage starts.

Click on the statement below that applies to you to learn more from specialized sections of this topic:

·          You have limited resources and live on limited income

·          You get prescription drug coverage from the Department of Veterans Affairs (VA)

·          You get prescription drug coverage from TRICARE

·          You have Medicaid

·          You are in a nursing home

·          You get housing assistance from HUD

·          You get Food Stamps

·          You have health insurance through a current or former employer or union

·          Your state pharmacy program pays for your prescriptions

·          You are in a Medicare Advantage Plan or other Medicare Health Plan (like an HMO, PPO, or PFFS plan)

·          You have Medigap (Medicare Supplement Insurance)

·          You have Supplemental Security Income (SSI) benefits or get help from your state Medicaid program paying your Medicare premiums

·          You get prescription drug coverage from FEHBP

·          You get drugs from a Manufacturer’s Patient Assistance Program

·          You now buy low cost drugs from Canada or other foreign countries

You have limited resources and live on limited income

In 2009, if your resources are less than $12,510 (single) or $25,010 (married) and your 2008 annual income is below $15,600 for an individual ($21,000 for a married couple living together), you may qualify for extra help paying for Medicare Prescription Drug Coverage. You may not have to pay monthly premiums or deductibles, and you could pay $2.40 or less for your co-payments. See the Medicare Part D Prescription Drug Coverage - Extra Help With Costs topic for comprehensive information.

If you haven't received an application or information about the extra help, and you think you may be eligible, you should apply.

Get an application or apply over the phone by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You can also apply Online by visiting the Help With Medicare Prescription Drug Plan Costs section on the Social Security Administration website at:
http://www.ssa.gov/prescriptionhelp/

You get prescription drug coverage from the Department of Veterans Affairs (VA)

It will almost always be to your advantage to keep your current Veterans Affairs Pharmacy coverage without any changes. However, if you have limited income and resources, you may qualify for extra help from Medicare. Contact your benefits administrator for information about your Veterans Affairs coverage before making any changes. You may decide to keep your current coverage.

If you lose your Veterans Affairs coverage and join a Medicare drug plan, in most cases, you won't have to pay a penalty, as long as you join within 63 days of losing your VA coverage.

You get prescription drug coverage from TRICARE

It will almost always be to your advantage to keep your current coverage without any changes. However, if you have limited income and resources, you may qualify for extra help from Medicare. Contact your benefits administrator for information about your TRICARE coverage before making any changes. You may decide to keep your current coverage.

If you lose your TRICARE coverage and join a Medicare drug plan, in most cases, you won't have to pay a penalty, as long as you join within 63 days of losing your coverage.

You have Medicaid

Starting January 1, 2006, your drug costs will be covered by your Medicare prescription drug plan instead of Medicaid. You will need to join a Medicare prescription drug plan for Medicare to pay for your drugs. In most cases, you will pay a small amount out of your own pocket.

If you don't join a plan, Medicare will sign you up for one effective January 1, 2006 to make sure you don't miss a day of coverage. If you decide you want another plan, you can switch to another plan at any time without a penalty.

You are in a nursing home

If you have full coverage from Medicaid and live in a nursing home, you will pay nothing out of your own pocket for covered prescription drugs.

If you have full coverage from Medicaid and live in an Assisted Living or Adult Living Facility, or a Residential Home, you will pay a small copayment for each.

Long Term Care pharmacies will contract with Medicare prescription drug plans to provide prescription drug coverage to their residents. If you are entering, living in, or leaving a nursing home, you will have the opportunity to choose or change your Medicare prescription drug plan. This allows you to choose or change to a plan that contracts with the nursing home's pharmacy and meets your prescription drug needs.

For more information about Medicare prescription drug coverage and nursing homes, see:
Quick Facts about Medicare's New Coverage for Prescription Drugs for people who are Nursing Home residents or live in certain types of Long-term Care Facilities, available online at:
http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Language=English&Type=Pub&PubID=11121

You get housing assistance from HUD

If you have Medicare and get housing assistance from the Department of Housing and Urban Development (HUD), you may want to join a Medicare drug plan.

If you qualify for the extra help with paying for your drug plan's monthly premium and for the cost of your prescriptions, you won't lose your housing assistance. However, your housing assistance may be reduced as your prescription drug spending decreases. But please keep in mind that any decrease in your housing assistance will be more than made up for by the value of the extra help paying Medicare prescription drug plan costs.

You get Food Stamps

If you have Medicare and get Food Stamps, you may want to join a Medicare drug plan.

If you do join a plan, you may qualify for extra help paying Medicare prescription drug costs. If you qualify for extra help, your Food Stamps benefits may decline, but that decline will be more than offset by Medicare's extra help.

If you qualify, compare how much your costs are with your current drug coverage to what your costs would be with Medicare prescription drug coverage and the extra help.

If you are near the Food Stamps eligibility cutoff, you may lose your minimum food stamp benefits because you will be paying less for your prescription drugs. But please keep in mind that any decrease in food stamp benefits will be more than made up for by the value of the extra help with paying for your prescription drug costs.

You have health insurance through a current or former employer or union

Medicare will help employers or unions continue to provide retiree drug coverage that meets Medicare's standards. Your (or your spouse's) former or current employer or union will send you information about how your current coverage compares to the Medicare standard prescription drug coverage. This information is important because it can affect the decision you will need to make this fall about if and when you sign up for Medicare prescription drug coverage. Contact your employer or union's benefits administrator before you make any changes to your prescription drug coverage.

If you have prescription drug coverage through your current employer/union health insurance, you may find that you do not need Medicare prescription drug coverage. Look over your retiree health insurance coverage and see what prescription drugs aren't covered or what part of the costs you pay yourself. This coverage may be designed to supplement the new Medicare drug benefit (that is, you are intended to be enrolled in both), or it may be designed to take the place of the new Medicare drug benefit (that is, you are intended to be enrolled in one, but not both).

For more information about Medicare prescription drug coverage and Employer/Union Coverage, see:
Quick Facts about Medicare's New Coverage for Prescription Drugs for People With Employer/Union Coverage, available online at:
http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Language=English&Type=Pub&PubID=11107

Your state pharmacy program pays for your prescriptions

Each state decideS how its State Pharmacy Assistance Program (SPAP) works with Medicare prescription drug coverage. Some states give extra coverage when you join a Medicare prescription drug plan. Some states have a separate state program that helps with prescriptions. You should contact your State Pharmacy Assistance Program to get more information.

For more information about Medicare prescription drug coverage and State Pharmacy Assistance Programs, including phone numbers for each State Pharmacy Assistance Program, see:
Quick Facts about Medicare's New Coverage for Prescription Drugs for people who get help from their state pharmacy program to pay for their prescriptions, available online at:
http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Language=English&Type=Pub&PubID=11108

You are in a Medicare Advantage Plan or other Medicare Health Plan (like an HMO, PPO, or PFFS plan)

If you already have prescription drug coverage through your Medicare Advantage Plan or other Medicare Health Plan, check with your current plan to see if this coverage is changing. You will usually be required to get your drug coverage from your current health plan if you decide to stay in the plan. Contact your current health plan if you have any questions about your coverage.

You can also switch to another Medicare Advantage Plan or other Medicare Health Plan in your area that offers prescription drug coverage or switch to the Original Medicare Plan and join a Medicare Prescription Drug Plan.

You have Medigap (Medicare Supplement Insurance)

If you have a Medigap (Medicare Supplement Insurance) policy that does not cover prescription drugs, you may want to get Medicare prescription drug coverage. To have Medicare help pay for your drugs, you must join a plan that provides Medicare prescription drug coverage.

If you have a Medigap policy with prescription drug coverage, you may want to look at your coverage and see what prescription drugs aren't covered or what part of the costs you pay yourself. Most prescription drug coverage offered by Medigap policies, on average, is not at least as good as Medicare prescription coverage. You will generally save money and get better coverage with the new Medicare prescription drug coverage.

For more information about Medicare prescription drug coverage and Medigap plans that cover prescription drugs, see:
Do You Have a Medigap Policy with Prescription Drug Coverage?, available online at:
http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Language=English&Type=Pub&PubID=11120

You have Supplemental Security Income (SSI) benefits or get help from your state Medicaid program paying you Medicare premiums

You need to join a Medicare prescription drug plan for Medicare to pay for your drugs. You will automatically qualify for extra help for your prescription drug costs. If you don't join a plan, Medicare will sign you up for one to make sure you don't miss a day of coverage.

For more information about Medicare prescription drug coverage and Supplemental Security Income (SSI) benefits, see:
Quick Facts about Medicare's New Coverage for Prescription Drugs for people who get Supplemental Security Income benefits or help from their state Medicaid program paying their Medicare premiums, available online at:
http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Language=English&Type=Pub&PubID=11116

You get prescription drug coverage from FEHBP

It will almost always be to your advantage to keep your current coverage without any changes. However, if you have limited income and resources, you may qualify for extra help from Medicare. Contact your benefits administrator for information about your FEHBP coverage before making any changes. You may decide to keep your current coverage.

If you lose your FEHBP coverage and join a Medicare drug plan, in most cases, you won't have to pay a penalty, as long as you join within 63 days of losing your FEHBP coverage.

You get drugs from a Manufacturer’s Patient Assistance Program

If you now get one or more of your drugs free or at low cost from one of the assistance programs run by prescription drug manufacturers, you may be able to continue to do so as well as have Medicare drug coverage--as long as you still qualify for the drug company’s program. You'll need to check. Some companies may continue providing drugs to people in Medicare drug plans and some may not.

If you qualify for Medicare's Extra Help for people on limited incomes, you may not need to get drugs from a manufacturer any more. If you don’t qualify for extra help, but you sign up for Medicare's standard drug coverage, you may be able to continue to get drugs from a manufacturer.

You now buy low cost drugs from Canada or other foreign countries

Although the practice is still illegal, many Americans have found relief from high U.S. prices by buying drugs from abroad, mainly Canada, where they usually cost less. Many now wonder if continuing to do so would be less costly than signing up for Medicare drug coverage. Here are things to consider:

·          What if Canada does not allow drugs to be exported? They haven’t so far, but Canadian pharmacists have come under heavy commercial and political pressure to stop selling to Americans.

·          If you suddenly need very expensive drugs in the future or your total costs become very high, Medicare's catastrophic coverage would give far greater protection than low foreign prices.

If you sign up for standard Medicare drug coverage, your plan will not cover drugs purchased from abroad. You may pay less for drugs in the coverage gap by buying from abroad, but they would not count toward your out-of-pocket maximum that qualifies you for catastrophic coverage if your drug costs become high.

See Also

Medicare - Overview

Medicare Part D Prescription Drug Coverage - Overview

Medicare Part D Prescription Drug Coverage - Frequently Asked Questions

Medicare Part D Prescription Drug Coverage - Extra Help With Costs

Medicare Part D Prescription Drug Coverage - Glossary

Source

http://www.medicare.gov/MPDPF/Shared/Static/KeyInfo.asp

http://www.medicare.gov/pdp-common-situations.asp

http://www.medicare.gov/publications/pubs/pdf/10050.pdf

http://www.pueblo.gsa.gov/cic_text/health/newmedicaredrug/coverage.htm

http://www.cms.hhs.gov/limitedincomeandresources/

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