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Medicare Prescription Drug Coverage for People Who Get Medicaid

Authored By: Iowa Legal Aid LSC Funded
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Medicare provides prescription drug coverage for people who are eligible for Medicare alone, and for those who are eligible for both Medicare and Medicaid. "Dual eligibles" are the group of Medicare eligibles who also qualify for Medicaid. The following information is from Centers for Medicare & Medicaid Services (CMS), and is current as of December 20, 2012.

Prescription Drug Coverage: Basic Information

What is Medicare prescription drug coverage?

Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area. Medicare prescription drug coverage provides protection for people who have very high drug costs or from unexpected prescription drug bills in the future.


Who can get Medicare prescription drug coverage?

Everyone with Medicare is eligible for this coverage, regardless of income and resources, health status, or current prescription expenses.

To join a Medicare Prescription Drug Plan, you must have Medicare Part A or Part B. To join a Medicare Advantage Plan, you must have Part A and Part B. You must also live in the service area of the Medicare drug plan you want to join.


When can I get Medicare prescription drug coverage?

You may sign up when you first become eligible for Medicare (three months before the month you turn age 65 until three months after you turn age 65). If you get Medicare due to a disability, you can join from three months before to three months after your 25th month of cash disability payments. Anytime, if you qualify for Extra Help (see below).  If you don't sign up when you are first eligible, you may pay a penalty, unless you qualify for Extra Help (then, there is no penalty).

The annual Medicare open enrollment period is October 15 through December 7.  . If you make a change during this period, your new coverage will begin on January 1.

If you are eligible for both Medicare and Medicaid or if you qualify for Extra Help, then you may join, switch, or drop Medicare Advantage or Medicare prescription drug coverage at anytime. 


How does Medicare prescription drug coverage work?

Your decision about Medicare prescription drug coverage depends on the kind of health care coverage you have now. There are two ways to get Medicare prescription drug coverage. You can join a Medicare prescription drug plan or you can join a Medicare Advantage Plan or other Medicare Health Plan that offers drug coverage.

Whatever plan you choose, Medicare drug coverage will help you by covering brand-name and generic drugs at pharmacies that are convenient for you.

Like other insurance, if you join, generally you will pay a monthly premium, which varies by plan, and a yearly deductible. You will also pay a part of the cost of your prescriptions, including a copayment or coinsurance. Costs will vary depending on which drug plan you choose. Some plans may offer more coverage and additional drugs for a higher monthly premium. If you have limited income and resources, and you qualify for extra help, you may not have to pay a premium or deductible. You can apply or get more information about the extra help by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or by visiting www.socialsecurity.gov on the web.


Why should I get Medicare prescription drug coverage?

Medicare prescription drug coverage provides greater peace of mind by protecting you from unexpected drug expenses. Even if you don't use a lot of prescription drugs now, you should still consider joining. As we age, most people need prescription drugs to stay healthy. For most people, joining now means protection from unexpected prescription drug bills in the future.


What if I have a limited income and resources?

There is extra help for people with limited income and resources. If you qualify for extra help, Medicare will pay for almost all of your prescription drug costs. You can apply or get more information about the extra help by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or visiting www.socialsecurity.gov on the web.

If your resources are less than $ 13,070 (single) or $ 26,120 (married) and your income is limited (less than $16,755 for a single person and less than $22,695 for a married person living with a spouse and no dependants), you may qualify for extra help paying for Medicare Prescription Drug Coverage. These resource limits are for 2012  and may increase each year. The resource limits include things like your savings and stock.

  • Resources do not include your home or car, life insurance policies, burial plot, and up to $1500 per person for burial expenses.

If you qualify for Extra Help and join a Medicare drug plan, you will get the following:

  • Help paying your Medicare drug plan’s monthly premium, any yearly deductible, coinsurance, and copayments
  • No coverage gap
  • No late enrollment penalty
  • You automatically qualify for Extra Help if you have Medicare and meet one of these conditions:
  • You have full Medicaid coverage.
  • You get help from your state Medicaid program paying your Part B premiums (in a Medicare Savings Program).
  • You get Supplemental Security Income (SSI) benefits.

If you haven't received an application or information about the extra help, and you think you may qualify, you should apply. You can apply online by visiting the  Apply for Help with Medicare Prescription Drug Plan Costs section on the Social Security Administration website (www.ssa.gov).

How Do I Apply for Extra Help?

It is easy to apply for Extra Help. Just complete Social Security's Application for Extra Help with Medicare Prescription Drug Plan Costs (SSA-1020). Here's how:

·         You can apply online at www.socialsecurity.gov/extrahelp;

·         Call Social Security at 1-800-772-1213(TTY1-800-325-0778) to apply over the phone or to request an application; or

·         Apply at your local Social Security office.

After you apply, Social Security will review your application and send you a letter to let you know if you qualify for the Extra Help. Once you qualify, you can choose a Medicare prescription drug plan. If you do not select a plan, the Centers for Medicare & Medicaid Services(CMS) will do it for you. The sooner you join a plan the sooner you begin receiving benefits.

 

Last Review and Update: Dec 20, 2012
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