MAIN
UPDATE

In Solidarity for 
Peace, Bread and Justice!

A Joint Project of the Maine Association of Interdependent Neighborhoods
and 
Maine Equal Justice

Volume 9  No. 2

 August 2005


Prescription Drug Changes Coming for 
People Enrolled in Medicare

If you’re enrolled in MaineCare or the Low Cost Prescription Drug Program (DEL) – and you get Medicare too – your prescription drug coverage will change on January 1, 2006. If you do not get Medicare, your prescription drug coverage will not change.

All over the country, seniors and people with disabilities who qualify for Medicare will be enrolling in the new Medicare prescription drug coverage, sometimes called “Medicare Part D.” Different Prescription Drug Plans will be offered under Medicare Part D in each state. In Maine we don’t know how many plans will be offered, but we have heard there may be between 8 and 10 plans. Each plan will have a different list of drugs which will be covered (called a formulary). If you’re enrolled in Medicare, you will need to decide which plan will work best for you.

Getting Help with the Costs of Part D

The plans will have premiums, co-payments, and deductibles, but if you are a MaineCare member you will be eligible for subsidies to reduce or eliminate these costs. Many people enrolled in DEL will also be eligible for subsidies. If you are enrolled in MaineCare or a Medicare Savings Plan (QMB, SLMB, or QI), you are automatically eligible for a subsidy and you don’t need to apply. 

If you are enrolled in DEL, but not a Medicare Savings Plan, you will need to fill out a subsidy application. The subsidy you get will depend on your income and assets. You should have received an application in the mail from Social Security earlier this summer. If you didn’t get one, you can call the DHHS Pharmacy Help Desk to get a subsidy application. The toll free number is 1-866-796-2463 or TTY 207-287-1828.

Enrolling in Part D

If you are a MaineCare member and enrolled in Medicare, you will be automatically enrolled in one of the Part D Prescription Drug Plans in October. In November, you will be able to change to another plan, if you think it will give you better coverage. If you are enrolled in DEL and Medicare, you will need to select the Prescription Drug Plan that will work best for you and enroll after November 15th.

Figuring out how this new coverage will affect you is complicated. It will depend on:

  • what coverage you have now,

  • what subsidies you will qualify for

  • what drugs are covered in the plan you pick, and

  • what additional coverage will be provided by the Department of Health and Human Services (DHHS).

All the information you need to pick the best plan for you isn’t available yet. By the end of September, we will know which plans will be offered in Maine and what drugs will be covered in each plan.

In the last session, the Legislature set aside $4 million to be used to help fill the gaps in prescription drug coverage for MaineCare and DEL participants who will be enrolled in Part D. This is not enough money to pay all the costs of prescription drugs now covered by MaineCare and DEL, but it will help make drugs more affordable for MaineCare and DEL members. With help from a “stakeholders’ group” (which includes a MEJP representative), DHHS will make final decisions on how to use the $4 million by November. The legislature will also reconsider whether additional assistance is needed when they reconvene in January.

In our next newsletter, we will include updates about Prescription Drug Plans and how to get help deciding on the best plan for you. By then we should also have more information about DHHS’s plan to fill the gaps in Part D coverage.

What if I’m not enrolled in Medicare?

If you are a MaineCare member, but don’t get Medicare, you will still get your prescription drugs through MaineCare; and, if you are enrolled in DEL but don’t get Medicare, you will still get the DEL discount on your drugs.

Information currently available on Part D 

To learn more about the Part D subsidies – who can get them and what they will cover – and Part D coverage, go to the health care section of the MEJP website. 

You can also call the DHHS Pharmacy Help Desk at 
1-866-796-2463 or TTY 207-287-1828 
or contact your local DHHS office

The State Health Insurance Assistance Program (SHIP)
1-877-353-3771 or Voice and TTY 1-800-750-5353

www.medicare.gov
1-800-MEDICARE (1-800-633-4227) 
or TTY 1-877-486-2048

 

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