Wyoming: Medicare Rx Fact Sheet
By: Source: AARP.org Date Posted: 2006-02-08 09:24:04
Medicare's new prescription drug insurance - called Medicare Part D-began January 1, 2006. To get this insurance, most people will have to sign up for one of the Part D Plans Medicare has approved. And the new Part D offers "Extra Help" to people with limited incomes. Medicare's Extra Help can reduce what you have to pay for prescriptions.
Wyoming already runs three programs that help people with limited incomes pay for drugs and a fourth program that helps pay for other Medicare-related costs like premiums. These programs are: Medicaid, Wyoming Prescription Drug Assistance Program, AIDS Drug Assistance Program (ADAP), and Medicare Savings Programs. But these programs are changing because of Medicare Part D. If you are now in one of these state programs, this fact sheet explains how they will work with the new prescription drug plans. Find your program below to see what effect the new plan will have, what choices you need to make, and how you can get more information.
Since changes are still being made in Wyoming's programs, it is always best to check with your program directly for the most current information and advice. You may also want to check with your program to see if you may be able to get more benefits. Contact information for each of the programs is included below.
For people on MEDICAID who are also on Medicare (Dual Eligible).
Will I have to sign up for a new prescription drug plan? And what about Extra Help? Yes. If you don't, Medicare automatically signed you up with a plan in October, but you can change to a different plan anytime. You are automatically eligible for Extra Help. This plan went into effect on January 1, 2006.
How will I know what my plan is? In October, Medicare should have sent you a letter telling you which plan you are signed up with and how to change plans if you want to. This plan went into effect on January 1, 2006.
Does it matter which plan I am signed up with? Probably. Each plan only pays for certain drugs. If your assigned plan does not pay for all the drugs you are taking now, you can switch to another. You can ask the Wyoming Senior Health Insurance Information Program (WSHIIP) to help you decide if you should switch plans.
What will I need to know to pick the best plan for me? Start by making a list of all the medicines you take. Then check the different plans to see if your drugs are on their list. You can ask the WSHIIP to help you decide which plan is best for you and how to change plans.
How much will I have to pay for drugs? It depends. You won't have to pay any premiums or deductible. If you live in a nursing home, there will be no costs. For others in Medicaid, the co-pay for each prescription will be $1 for generic drugs and $3 for brand names, which may be more or less than the $2 you pay right now for the same drugs.
Can I still fill my prescription if I can't afford the co-pay? Unlike Medicaid, your pharmacist cannot fill your prescription unless you have the co-pay.
Will my plan pay for all my drugs? Maybe, but there are different issues.
- No plan is allowed to pay for some types of medications, including barbiturates, some anxiety drugs, and drugs to help you gain or lose weight. Medicaid may still pay for some of these types of drugs.
- And each plan has its own list of drugs it pays for. But if your doctor says that you need a drug that isn't on the list, you may be able to get an "exception" from your plan to pay for the drug your doctor prescribed. If your plan won't give you an exception, you will have to pay for it yourself or switch to a different drug that is on your plan's list.
Will I have to pay for drugs my doctor says I need but that aren't on my plan's drug list? Maybe. Your doctor can ask the plan to give you an "exception" to pay for your drug. If your plan won't give you an exception, you will have to pay for it yourself or switch to a different drug that is on your plan's list.
Where can I get more information?
State Medicaid Office
307-777-6016
Wyoming State Health Insurance Information Program (WSHIIP)
1-800-856-4398 (Toll free)
307-856-6880 (Riverton)
307-634-1010 (Cheyenne)
307-235-5959 (Casper)
Wyoming Prescription Drug Assistance Program
The Wyoming Prescription Drug Assistance Program (PDAP) is a state funded pharmaceutical assistance program. For qualifying individuals, the benefit allowed three (3) prescriptions per month. Due to a funding shortfall, a freeze on new enrollments in the program was implemented June 1, 2003. Current eligible PDAP clients will continue to receive services until they have enrolled in a Medicare Part D prescription plan. The Wyoming prescription assistance plan will provide broader drug coverage, and lower co-pays for those with low income because it will "wrap around" a Medicare prescription drug plan and thus eliminate cost sharing requirements.
Will I have to sign up for a prescription drug plan? Yes. If you are on Medicare now, you will have to sign up with a plan. You will be able to choose from several different plans. You should have signed up between November 15 and December 31, 2005, so that you would have all your benefits in 2006.
Will I have to apply for Extra Help? Yes. You can apply at any local Social Security office, local Medicaid office, or the Wyoming State Health Insurance Information Program (WSHIIP).
What will I need to know to pick the best plan for me? Each plan only pays for certain drugs. Start by making a list of all the medicines you take. Then check the different plans to see if your drugs are on their list. You can ask WSHIIP for free personal help to decide which plan works best for you and how to change plans if you need to.
How will this change affect what I have to pay? It depends on your income, but you may pay less for your drugs than you do now if you qualify for Extra Help.
- If you qualify for Extra Help, you still won't have to pay a premium or a deductible.
- Your co-pay will be $2 for generic drugs and $5 for brand names, which is much less than you pay now for the same drugs.
Will my plan pay for all my drugs? Maybe, but there are two different issues.
- No plan is allowed to pay for some types of medications, including barbiturates, some anxiety drugs and drugs to help you gain or lose weight. You may have to pay for these types of drugs yourself.
- And each plan has its own list of drugs it pays for. But if your doctor says that you need a drug that isn't on the list, you may be able to get an "exception" from your plan to pay for the drug your doctor prescribed. If your plan won't give you an exception, you will have to pay for it yourself or switch to a drug that is on your plan's list.
Will I have to pay for drugs my doctor says I need but that aren't on my plan's drug list? Maybe. Your doctor can ask the plan to give you an "exception" to pay for your drug. If your plan won't give you an exception, you will have to pay for it yourself or switch to a different drug that is on your plan's list.
Where can I get more information?
Prescription Drug Assistance Program (PDAP)
307-777-5548
State Medicaid Office
307-777-6016
Wyoming State Health Insurance Information Program (WSHIIP)
1-800-856-4398 (Toll free)
307-856-6880 (Riverton)
307-634-1010 (Cheyenne)
307-235-5959 (Casper)
Social Security
1-800-772-1213 (Toll-free)
1-800-235-0778 (Toll-free TTY for people with hearing problems)
Wyoming Department of Insurance
1-800-438-5768
AIDS Drug Assistance Program (ADAP) pays for some drugs used to treat HIV/AIDS and related conditions for people.
Will I have to sign up for a prescription plan? Yes. If you are now on Medicare, you should have to signed up for one of the new plans between November 15 and December 31, 2005, to get help paying for your drugs in 2006.
Will I have to apply for Extra Help? Yes. You can apply at any local Social Security office, local Medicaid office, or the Wyoming State Health Insurance Information Program (WSHIIP).
What will I need to know to pick the best plan for me? Each plan only pays for certain drugs. Start by making a list of all the medicines you take. Then check the different plans to see if your drugs are on their list. You can ask WSHIIP for free personal help to decide which plan works best for you and how to change plans if you need to.
How will this change affect what I have to pay?
- Everyone in ADAP will pay more for the drugs ADAP now pays for.
- If you qualify for Extra Help, your other medications will be cheaper.
- If you do not qualify for Extra Help, you will have to pay a premium, deductible, higher co-pays, and other costs that you don't have to pay in ADAP.
Will my plan and ADAP pay for all my drugs? Maybe but there are two different issues.
- No plan will be allowed to pay for some types of medications no matter what plan you are on. These include barbiturates, some anxiety drugs, and drugs to help you gain or lose weight. You will probably have to pay for these drugs yourself.
- And each plan has its own list of drugs it pays for. But if your doctor says that you need a drug that isn't on the list, your doctor may be able to ask your plan an "exception" to pay for the drug prescribed.
Will I have to pay for drugs my doctor says I need but that aren't on my plan's drug list? Maybe. Your doctor can ask the plan to give you an "exception" to pay for your drug. If your plan won't give you an exception, you will have to pay for it yourself or switch to a different drug that is on your plan's list.
Where can I get more information?
AIDS Drug Assistance Program (ADAP)
307-777-5800
1-800-327-3577 (AIDS Hotline)
State Medicaid Office
307-777-6016
Wyoming State Health Insurance Information Program (WSHIIP)
1-800-856-4398 (Toll free)
307-856-6880 (Local)
Social Security
1-800-772-1213 (Toll free)
1-800-325-0778 (Toll free TTY for people with hearing loss)
Medicare Savings Programs (QMB or SLMB) pay your Medicare Part B Premium, and may pay your Medicare Part A Premium, deductibles, and/or co-pays
Will I have to sign up for a prescription drug plan? No, but it is always a good idea to sign up for a plan, even if you are not taking any prescription drugs now. There are no premiums and drug costs will be very low. If you don't sign up with a plan between November15, 2005 and May15, 2006, Medicare will select a plan for you and sign you up. Until then, you can decide which plan is best for you. You will be able to choose from several different plans.
Will I have to apply for Extra Help? No. You will automatically get Extra Help so you don't have to apply. This means that you only have to pay between $2 and $5 for each prescription. You should receive a letter soon (or you may have already) telling you that you qualify.
How will I know what my plan is? In May 2006, Medicare will send you a letter telling you which plan you are signed up with and how to change plans if you wan to.
Does it matter which plan I am signed up with? Probably. Each plan only pays for certain drugs. If the plan you are assigned to does not pay for all the drugs you are taking now, you can switch to another plan. You can ask the Wyoming State Health Insurance Information Program (WSHIIP) for help in choosing the best plan for you, but you are limited to the plans that work with the Medicare Savings Programs.
What will I need to know to pick the best plan for me? Start by making a list of all the medicines you take. Then check the different plans to see if your drugs are on their list. You can ask WSHIIP to help you decide which plan is best for you and how to change plans.
How much will I have to pay for my drugs? For drugs on your plans approved list, your co-pay for each prescription will be $2 for generic drugs and $5 for brand names.
Will my plan pay for all my drugs? Maybe. No plan is allowed to pay for some types of medications no matter what plan you are on. These include barbiturates, some anxiety drugs, and drugs to help you gain or lose weight. You will have to pay for these yourself.
And each plan has its own list of drugs it pays for. But if your doctor says that you need a drug that isn't on the list, you may be able to get an "exception" from your plan to pay for the drug your doctor prescribed. If your plan won't give you an exception, you will have to pay for it yourself.
Will I have to pay for drugs my doctor says I need but that aren't on my plan's drug list? Maybe. Your doctor can ask the plan to give you an "exception" to pay for your drug. If your plan won't give you an exception, you will have to pay for it yourself or switch to a different drug that is on your plan's list.
Where can I get more information?
Medicare Savings Program - QMB or SLMB
1-800-633-4227
State Medicaid Office
307-777-6016
Wyoming State Health Insurance Information Program
1-800-856-4398 (Toll free)
307-856-6880 (Riverton)
307-634-1010 (Cheyenne)
307-235-5959 (Casper)
Download The New Medicare Prescription Drug Coverage: Wyoming PDF
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