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MEDICARE
PRESCRIPTION DRUG
COVERAGE
Medicare’s
prescription drug
coverage (Medicare
Part D) affects the
State of Missouri’s
prescription
coverage – both
Medicaid and Mo RX.
This page will cover
the basics, but it
can seem complicated
and confusing.
Please feel free to
contact our office
for further
information. We
have trained staff
who are ready to
answer your
questions and assist
you. You may call
the numbers at the
top of this
webpage.
MEDICARE
PART D
WHO IS ELIGIBLE?
ALL people with
Medicare – Part A
and/or Part B
DO I HAVE TO
ENROLL IN A PLAN?
No, this is a
voluntary program.
No one is required
to participate. If
you have
prescription
coverage through a
retiree plan, your
spouse’s work or
other programs AND
the coverage is
equal to or better
than the Medicare
Part D coverage,
including other
requirements, you do
not need to pick a
plan. If at a later
date, you decide to
enroll in a Medicare
prescription drug
plan, you will not
be penalized, if
you meet the prior
coverage
requirements. You
may call the Agency
office for further
information.
HOW MUCH IS THE
MONTHLY PREMIUM?
Premiums in Missouri
will vary. As with
all insurance, it
depends upon what
coverage you need
and want. If you
are on Medicaid,
there are plans
available that will
have no premium –
other plan premiums
will be reduced.
(You may also be
able to get extra
help through Social
Security to help pay
for your plan, if
your income and
resources, not
including your home,
meet the guidelines.
NWMOAAA has
information about
this extra help and
can answer questions
for you.)
IS THERE A
DEDUCTIBLE?
It depends on which
plan you choose.
Some plans have
deductibles and some
have none at all.
HOW MUCH WILL I
PAY FOR EACH
PRESCRIPTION?
It depends upon
which plan you
choose and whether
all the medicines
that you take are on
the plan’s
formulary. As with
all insurance plans,
each one has a list
of drugs (formulary)
that it covers.
Medicare Part D
plans must cover at
least two drugs in
each drug class;
however, each plan
also has different
co-pays or
coinsurance.
Medicaid
clients, and
those getting extra
help will pay less
than what the plan
normally charges.
The higher-tier
plans cover more
than lower-tier
plans. You will
need to decide which
plan meets your own
needs the best, and
that is why annual
comparisons are
recommended to make
sure you have the
best plan for your
unique situation.
HOW DO I PICK A
PLAN?
Many organizations
partner in order to
help you--Centers
for Medicare and
Medicaid, Missouri
RX (MoRX), CLAIM as
well as the Area
Agency and others.
Your family can also
help you.
We advise you to
start with the
user-friendly
Medicare web site (www.medicare.gov).
They have a plan
comparison tool in
which you can list
the medications you
take to find the
plans that cover you
the best, and for
the least overall
cost.
If you are not
computer savvy or do
not have family or
friends to help you,
we are here to
help. Call the
toll-free number
1.888.844.5626. We
will do the lookup
on the website and
help compare the
best plans for you;
however, it is up to
you to choose a
plan. The Aging
Resource Consultants
in the
ARCs can
help you, if you
live in their areas,
which include the St
Joseph area. You
can call the Agency
for contact
information.
WHEN DO I NEED TO
PICK A PLAN?
Annual enrollment
will be every
November 15th
through December
31st for benefits to
begin January of the
following year.
If you are new to
Medicare, call the
Agency for Medicare
Part D enrollment.
MEDICAID
PRESCRIPTION DRUG
COVERAGE
Medicare
automatically took
over coverage for
Medicaid clients who
are also on
Medicare, so
Medicaid no longer
pays for most
prescription drugs
for those who are
also covered by
Medicare.
Medicaid clients are
also automatically
enrolled in a plan,
if they do not
choose and enroll
themselves. If the
drug plan does not
cover their drugs
adequately, a
Medicaid client can
change plans as
often as once per
month, if necessary.
This group, as well
as residents of
long-term care
facilities, are the
only ones who are
allowed to change
plans outside of the
annual enrollment
period.
Mo RX
Mo Rx helps pay
deductibles,
co-pays, etc. It
does not pay any of
your premiums.
Enrollment is
currently available
to new clients, and
once you have
joined, you do not
need to do so again.
Eligibility is based
upon your income,
and the value of
assets is not
included.
Income limits change
from time to time,
so you can contact
the Agency for the
current guidelines.
OTHER
PRESCRIPTION DRUG
COVERAGE
There are other ways
to get help with
your prescription
drugs. Patient
Assistance programs
and other charitable
sources are
available. Contact
our office for more
information or ask
your pharmacist if
more information is
available in your
area.
Access to
Benefits Coalition-
online service for
Medicare
beneficiaries with
lower income. Click
HERE to access
it. This opens
into a website
outside the NWMOAAA. |
