MEDICARE PRESCRIPTION DRUG COVERAGE    

Enrollment Dates have been changed to

      October 15 through December 7, 2011         

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 staff who have received training and are ready to answer your questions and assist you.  You may call the numbers at the top of this page.   

 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?

Again, 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 Medicare web site at (www.medicare.gov).  They have a plan comparison tool in which you can list the medications you take to find the plans that best cover your prescriptions, 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?

The annual enrollment has been changed to

October 15 through December 7

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