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A Joint Project of the Maine
Association of Interdependent Neighborhoods |
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Volume 10 No. 2 |
June 2006 |
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MAIN
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A Joint Project of the Maine
Association of Interdependent Neighborhoods |
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Volume 10 No. 2 |
June 2006 |
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Important Information! Medicare Part D
Get November 2006 update
The Part D prescription drug benefit is only for people who are in Medicare. If you are in MaineCare or the Low Cost Drug Program for the Elderly and Disabled (DEL) but you don’t have Medicare, your prescription drug benefit won’t change because of Part D.
If you are in Medicare and MaineCare (“dual eligible”), you don’t need to pay the Part D premium or deductible. You also won’t have a gap in coverage (“doughnut hole”). “Dual eligibles” who live in a nursing home or a residential care facility don’t have co-payments.
For other “dual eligibles,” the State will pay:
- Half the cost of the co-payment for brand name drugs. This reduces the cost from $3.00 to $1.50 per drug for most duals (some will pay $2.50, instead of $5.00 per drug); and
- For generic drugs, you will not pay a co-payment (this is a new change).
If you are in Medicare and the State helps you pay your Medicare Part B premium, you don’t need to pay the Part D premium or deductible. You also won’t have a “doughnut hole.” Your co-payments for brand name drugs will be $2.50 per drug. There will be no co-payment for generic drugs.
The State pays your Part B premium when you are in a Medicare Savings Program (also called QMB, SLMB or QI). You can have monthly income of up to $1,178 ($1,585 for a couple) to be in this program. There is no asset test. To apply, contact your local DHHS office or call the local Area Agency on Aging at 1-877-353-3771.
If you are enrolled in Medicare and the Low Cost Drug Program for the Elderly and Disabled (DEL) but aren’t in a Medicare Savings Program, the state will pay:
- Your Part D premium;
- Half of your deductible;
- Half (up to $10) of brand name drug co-payments; and
- $2.00 toward the co-payment for generic drugs
If you reach the “doughnut hole,” you will go back to your DEL coverage.
If you picked a plan (a “PDP”) on your own, you need to let DHHS know which plan you picked so you will be able to get these benefits. Call the Pharmacy Help Desk at 1-866-796-2463 to tell them.
The Part D plans don’t cover all drugs. If you have a prescription for a drug that isn’t covered by your plan, you can:
- Talk to your doctor about whether there is another drug you could take that is on your Part D plan.
- Talk to your doctor about asking your Part D plan for an “exception” to cover your drug. (You can call Legal Services for the Elderly at 1-877-774-7772 for help with this.)
- Check to see if there is another Part D plan that will cover all your drugs. (Duals can change plans anytime, but others have limits on when and how often they can change).
Important Phone Numbers
Pharmacy Help Desk (for help with most questions about your Part D coverage):
1-866-796-2463 or TTY 207-287-1828Legal Services for the Elderly Medicare Part D Hotline
(for help filing appeals and exceptions with the PDPs): 1-877-774-7772Area Agencies on Aging
(for help picking a plan): 1-877-353-3771
