July 18, 2005
Medicare Soon to Pay Prescription Costs
for Some Medicaid
Beneficiaries
By Dr. Robert Wynia
(Third in a series)
Beginning next year, Montanans who qualify for both Medicaid and Medicare will no longer get prescription drug coverage through the Medicaid program. Instead, they will start getting their medications through Medicare.
The change is part of the new Medicare prescription drug benefit that Congress approved in 2003 as part of the Medicare Modernization Act. The drug benefit will take effect Jan. 1, 2006.
About 16,000 Montanans are eligible for both Medicare, which provides health-care coverage primarily for people age 65 or older, and Medicaid, which provides health-care coverage for low-income individuals. These "dual eligibles" should already have received a letter from the federal Medicare program informing them of this change.
If you are a dual eligible, you will need to join a Medicare prescription drug plan. You will have an opportunity to review available plans and choose the one that best suits your individual needs. You will have to pay a small amount out of your own pocket: $1 for a generic prescription drug or $3 for a name-brand prescription drug. But you will automatically be eligible for extra drug coverage offered through the Social Security Administration (see part 2 of this series).
You will be able to join a Medicare prescription drug plan starting Nov. 15, 2005. If you don't join by Dec. 31, Medicare will enroll you in a plan to make sure you don't miss a single day of prescription drug coverage. In October 2005, Medicare will let you know which plan it has picked for you; you'll be able to switch to a different plan any time.
Even though Medicaid will no longer pay for your prescription drugs, it will continue to pay for your other health-care costs, just as it does now.
While Medicare is run by the federal government, Medicaid is administered by the Montana Department of Public Health and Human Services. Research indicates that there are many Montanans with Medicare who may also be eligible for Medicaid but are not enrolled. To find out if you are eligible for Medicaid, visit your county Office of Public Assistance.
If you are one of the nearly 5,000 people in Montana who is enrolled in a Medicare Savings Program, Medicare will automatically enroll you in a prescription plan by May 15, 2006. However, you can choose a plan and enroll starting Nov. 15, 2005.
Medicare Savings Programs are for people who need help paying premiums for Medicare Part B, Medicare's Supplementary Medical Insurance. Medicare Savings Programs may also help you pay Medicare copayments and coinsurance.
You can apply for a Medicare Savings Program any time at your local county Office of Public Assistance.
Detailed information about Medicare prescription drug plans will be available in October. For more information, check out the Medicare & You 2006 handbook online at www.medicare.gov , call 1-800-MEDICARE (1-800-633-4227), or call the State Health Insurance Assistance Program at 1-800-551-3191.
(Dr. Robert Wynia is director of the Montana Department of Public Health and Human Services. This is the third in a series of monthly columns explaining the new Medicare Part D prescription drug benefit. To read others columns in this series, visit www.dphhs.mt.gov and click on "New Medicare Prescription Drug Benefit" under Features.)
Page last updated: 06/15/2006
