Medicare and Part D Drug Coverage
Information for People Enrolled in MaineCare
or the Low Cost Drug Program (DEL)
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. Starting in
January, you will get most of your drugs from a Medicare Part D Prescription
Drug Plan (PDP). Several basic plans are offered in Maine.
Each one covers a different list of drugs. (If you do not get
Medicare, your prescription drug coverage will not change.)
I just got a letter from DHHS, telling me that they plan to automatically assign me to a Part D
Prescription Drug Plan. What should I do?
DHHS is working to try to make sure that you are enrolled in the best
Prescription Drug Plan for you. They are automatically assigning all
MaineCare and DEL participants (who are also enrolled in Medicare) to one of
the plans that has a contract with the State. They are basing your
assignment on:
- their records of your current drug needs;
- whether the plan has a pharmacy in your community; and
- the cost of the co-payments in the plan.
If you stay in this plan or ask the state to enroll you in another
plan that has a contract with the state, you will be able benefit from any
supplemental assistance the state will provide. (For more information about
the Part D costs see below.)
For many people, the state's auto-assignment will work well. You will find
out which plan you have been assigned to in mid-December. If you think
another plan will work better for you, you can call the DHHS Pharmacy Help
Line at 1-866-796-2463 or TTY 207-287-1828 and change to another plan.
You may decide not to have DHHS assign you to a plan. You may have other
"creditable" coverage, so you don't want to enroll in Part D. Or you
may want to pick your own plan. If you don't want DHHS to assign you to a
plan, you will need to call the DHHS Pharmacy Help Line at 1-866-796-2463 or
TTY 207-287-1828. Call by Wednesday, December 14 - the new deadline for
letting DHHS know that you do not want to be automatically assigned to a
plan.
Remember that, unless you allow DHHS to automatically assign you to a plan,
or you enroll in another plan through the DHHS Pharmacy Help Line, you will
not be able to receive supplemental help from the State.
What will my Part D Prescription Drug Plan cost?
The plans have premiums, co-payments and deductibles.
If you are a MaineCare member, you will not need to pay the
premium or deductible. Co-payments for most MaineCare members will be between $1 and $3,
depending on the drug.
If you are enrolled in DEL and the Medicare Savings Program
(also known as QMB, SLMB and QI), you will not need to pay the premium or
deductible. Most people enrolled in the Medicare Savings Program will have co-payments of between $2
and $5. Go to more
information about the Medicare
Savings Program, or call your local
DHHS office. Starting January 1, 2006 there will no longer be an
asset test for the Medicare Savings Program, so more people will be
eligible.
If you are enrolled in DEL, but not the Medicare Savings Program,
the Sate will pay your Part D premium if you enroll in one of the Plans that
the State has a contract with. You may also be able to get help with your
deductible and co-payments if you are enrolled in one of the Plans that has a
contract with the State. These contracts have not yet been signed, so we
don't know which Plans will have contracts. We will post the list here, as
soon as we have the information. It will depend on which plan you pick.
Maine is planning to pay the cost of your premium and at least part of your
deductible and co-payments, but only for some of the available Prescription
Drug Plans. When you call the DHHS
Pharmacy Help Desk, they will give you information that will help you
choose a plan with the best coverage for the lowest cost. They may also
suggest that you apply for the Medicare Savings Program or for "special
help" from Medicare.
What if one of my drugs isn't covered under my plan?
First, talk to your doctor about
whether there is another drug on your plan that would work as well
for you. If there isn't, your doctor can send forms to the people who run
your plan, asking them to let you keep taking your drug. This is called an
"exception." If they say no, you can appeal the decision. For help with
your appeal call Legal Services for
the Elderly at 1-800-750-5353 (voice and TTY). They
help seniors and people with disabilities who are enrolled in Medicare.
What if I want to change my plan?
You can change your plan any time before January 1, 2006. After that, MaineCare
and Medicare Savings Program participants can change plans once a
month. DEL participants who aren't in the Medicare
Savings Program will be able to change one time between January 1 and May
15, 2006.
What if I'm enrolled in MaineCare or DEL, but not Medicare?
Nothing will change. You will keep getting your prescription drugs with
your MaineCare or DEL card. If you get Medicare in the future, you will then
get most of your drugs through Part D.
Important Medicare Part D Contact Information
- For people enrolled in MaineCare or DEL:
DHHS Pharmacy Help Desk at 1-866-796-2463 or TTY 207-287-1828
- For people who are not enrolled in MaineCare or DEL:
The State
Health Insurance Assistance Program (SHIP) at 1-877-353-3771
- If you want to appeal your Prescription Drug Plan’s decision not to
cover a drug you need:
Legal Services for the Elderly at
1-800-750-5353 (voice and TTY)
More information about Medicare Part D
Maine State Health
Insurance Assistance Program
Medicare's
"Find a Prescription Drug Plan" search program
Enrollment
forms
Medicare fliers:
"Should
I Enroll"
"How to Compare Plans"
| New information is becoming
available weekly. Check
this page for up-to-date information. |
Updated December 12, 2005
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Maine Equal Justice Partners
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