Medicare Part D Prescription Drug Coverage

Hynes & Chu, LLP ~ Attorneys at Law

**Click** Here to be taken to MEDICARE.GOV for detail on how Part D Medicare works.

Effective January 1, 2006 a new component was added to the Federal Medicare Program. This new component is called Part D Medicare and it covers prescription drugs. Part D is available to anyone with Medicare Part A or B. To receive prescription drug coverage under Part D you must first enroll in either a prescription drug plan (PDP) or a Medicare Advantage Plan (MA-PD). All of these plans are privately run.
Medigap insurance policies that include drug coverage (plans H, I, and J) are NOT considered PDPs.
Premiums will average about $33.37 per month (subject to where you live and which plan you choose)
Medicare Part D is an optional program, you do not have to enroll. However, if you do not enroll and later decide to enroll, your monthly premium will increase by 1% for each month you are not enrolled. No penalty increase will be imposed for late enrollment if you have "credible coverage" (existing drug coverage that is as good or better than Part D).
Medicare "Open Enrollment" period begins November 15th and continues through December 31st. During this period, you may enroll in a Medicare Part D plan, or if your currently have a plan, you may change plans. If you are in a "Medicare Advantage Plan" you may return to traditional Medicare, change your existing Advantage plan or enroll in an Advantage Plan for the first time.

***Starting in mid-November 2010 you will be able to switch to one of many New Medicare Part D plans. To help you make the switch U.S. News and World Report has published a useful article entitled : "7 Tips for Picking a Medicare Part D Plan". To read this articled click on the link below:

*<<>>* Click Here to Read about the 7 Tips*<<>>*

How does Medicare Part D work with Medicaid?

Your drug costs are covered by Medicare. You'll need to join a Medicare Prescription Drug Plan for Medicare to pay for your drugs.

In most cases, you'll pay a small amount for your covered drugs. If you have full coverage from Medicaid and live in a nursing home, you pay nothing 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'll pay a small copayment for each drug.

If you don't join a drug plan, Medicare will enroll you in one 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.

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EPIC, Part D Medicare and Medicaid Spenddown

The following are some basic questions and answers about how Medicaid benefits will work with Part D Medicare if you have a "spenddown":

Will seniors on a Medicaid spenddown and EPIC be automatically enrolled into a Medicare Part D drug plan? Answer = YES.
After being automatically enrolled in a Medicare Part D drug pllan, can seniors continue to use their EPIC coverage? Answer = YES.
Prior to meeting their spenddown, can seniors choose to use EPIC as a primary plan rather than their Medicare Part D coverage? Answer = NO.
For Seniors with a Medicaid spenddown, along with Medicare Part D coverage and EPIC, what drug costs will be applied to their Medicaid spenddown? Answer = When the drug is covered by their Part D plan, their out of pocket co-payment for drugs is applied to their Medicaid spenddown. When EPIC pays for a drug not covered by Part D, both the amount paid by EPIC and the EPIC co-payment can be applied to the Medicaid spenddown.
After seniors meet their spenddown, do they use EPIC or Medicaid for the drugs that are covered by their Medicare drug plan? Answer = They may use either Medicaid or EPIC (not both) for drugs not covered by Part D.