Extra Help for People with Limited Incomes: The New Medicare Prescription Drug Coverage
By: Source: AARP.org Date Posted: 2006-07-26 10:39:44.874315-04:00
What If I Already Get Government Assistance?
You may already be receiving some form of government assistance —for example, through Medicaid, a Medicare Savings Program that pays your Medicare Part B premium, or Supplemental Security Income (SSI). If so, you should have received a letter from Medicare saying that you will be automatically eligible for the Extra Help and need not apply. You will still need to pick and join in a Medicare-approved drug plan. If you don't choose one, Medicare will enroll you in one automatically.
It is important to know the rules for joining, as they vary slightly, depending on the type of government assistance you currently receive. The following section explains these rules.
If you're on Medicare and also get help from Medicaid:
Starting in 2006, you will receive your drugs through Medicare, not Medicaid. You should still keep your Medicaid card, because it will still help pay for your health services other than prescription drugs.
Because you are currently getting assistance through both Medicare and Medicaid, you will automatically be able to get Medicare's Extra Help and do not need to apply for it. But you'll still need to join in a Medicare-approved drug plan. You can choose a plan yourself between November 15, 2005 and December 31, 2005. If you don't choose one, Medicare will pick one for you so that your drug coverage will continue without interruption when Medicare's drug program begins on January 1, 2006. You'll be able to change your plan at any time if you find one that works better for you.
What if I go to my drugstore in January 2006 and try to use my Medicaid card?
They won't accept your Medicaid card to pay for your medicines. Instead, you should use your new Medicare prescription drug plan card. The first time you do this, take your drug plan information with you, in case the pharmacist doesn't know which plan you have. If you haven't chosen a plan yourself, Medicare will enroll you in one and send you this information at the end of 2005.
If you're in a Medicare Savings Program:
Medicare Savings Programs such as the Qualified Medicare Beneficiary (QMB), the Qualifying Individuals (QI) and the Specified Low Income Medicare Beneficiary (SLMB) programs are designed to pay Medicare premiums and in some cases co-pays for some people with limited incomes.
If you're in one of these programs, you will automatically be able to get the Extra Help and need not apply. You'll still need to join a Medicare-approved drug plan and can choose one between November 15, 2005 and May 15, 2006.
- If you join by December 31, 2005, your Medicare coverage will begin on January 1, 2006.
- If you join between January 1, 2006 and May 15, 2006, your Medicare drug coverage will begin on the first day of the month after you enroll in the plan.
- If you do not choose a plan by May 15, 2006, Medicare will enroll you in one and your new drug coverage will begin June 1, 2006. You'll be able to change your plan at any time if you find one that works better for you.
If you receive Supplemental Security Income:
If you have Supplemental Security Income, but do not receive help from Medicaid, you'll automatically be eligible for the Extra Help and do not need to apply. You'll still need to join a Medicare-approved drug plan and can choose one between November 15, 2005 and May 15, 2006.
- If you join in a plan by December 31, 2005, your Medicare drug coverage will begin on January 1, 2006.
- If you join between January 1, 2006 and May 15, 2006, your Medicare drug coverage will begin on the first day of the month after you join the plan.
- If you do not choose a plan by May 15, 2006, Medicare will enroll you in one and your new drug coverage will begin June 1, 2006. You'll be able to switch to another plan of your own choosing one time after June 1.
- After December 31, 2006, you will be able to change plans yearly between November 15 and December 31 of each year.
If you're in a state pharmacy assistance program:
Many states have pharmacy assistance programs to help residents pay for prescription drugs. Each state will determine how its programs will fit in with the new Medicare coverage. Your program will probably notify you about this before November 2005. If you have not heard from them by then, you should contact the program to find out what changes are being made and what you should do (if anything) about joining a Medicare drug plan.
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