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Family

Medicare / Medicaid



What is Medicare Part D?

Is the Medicare Part D Prescription benefit mandatory?

When is the enrollment period?

How many plans are there?

Is enrollment in Medicare Part D free?

What if a beneficiary does not have Medicaid, but has limited income and cannot afford to purchase a Part D Prescription Plan?

What if I already have prescription drug coverage through a private supplemental plan?

Who provides the medications and handles the transactions at the Home?

Will I have to change my medications when the new Medicare Part D medication benefit starts?

Where can I find further information about the Medicare Part D Prescription benefit?

What is Medicare Part D?
Medicare Part D is the name of the prescription drug benefit that Congress passed as part of the Medicare Modernization Act. This provides coverage for prescription drugs for anyone on Medicare, including those in nursing homes. Although it is a Medicare benefit, it is administered by private insurance companies.

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Is the Medicare Part D Prescription benefit mandatory?
Enrollment in a Medicare Part D Prescription Benefit Plan is voluntary for those with only Medicare. However, for those with both Medicare and Medicaid, who are so-called “dually eligible,” coverage is mandatory.

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When is the enrollment period?
For those living in nursing homes:
Beneficiaries who are Medicare only can sign up at any time, the sooner the better to avoid penalties. Those who are dually eligible must be enrolled once, into a “benchmark” plan. A dually eligible enrollee will have no out of pocket costs for covered drugs.
For those living the in community:
Beneficiaries who are Medicare only and who are enrolling for the first time can sign up at any time. The “open enrollment” period for those Medicare only beneficiaries wishing to make a change in their plan begins every November 15 and runs through December 31st each year. There may be deductibles or copays required under this coverage.

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How many plans are there?
In New York State, there are approximately 50 Part D plans available. However, only 9 of these plans are qualified to accept beneficiaries with both Medicare and Medicaid. A full list of available plans can be found on the Medicare web site at  www.medicare.gov.

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Is enrollment in Medicare Part D free?
For beneficiaries with Medicare only, each of the plans has monthly premiums. The premiums vary by plan; one can “comparison shop” at the medicare.gov web site. Deductibles and copayments will also be required.

For beneficiaries with both Medicare and Medicaid, there are no premiums, deductibles or co-pays provided that a “benchmark” plan is selected.

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What if a beneficiary does not have Medicaid, but has limited income and cannot afford to purchase a Part D Prescription Plan?
Financial assistance for the Medicare part D Prescription benefit is available for beneficiaries with limited financial resources. Information and applications may be obtained from the social security administration. This may be of particular interest to nursing home residents who are “Medicaid pending.” Further information can be obtained at your social security office or from the social security web site at: http://www.social security.gov/prescriptionhelp

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What if I already have prescription drug coverage through a private supplemental plan?
If you already have coverage with a private or retiree prescription plan, you should contact the plan administrator to determine whether it makes sense to keep your coverage, or to enroll in a Medicare D plan.

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Who provides the medications and handles the transactions at the Home?
ChemRx, the company that provides the Hebrew Home’s pharmacy services, submits claims for prescription drugs to the insurers that cover residents. Individual residents will be financially responsible for any deductibles or co-pays. For those residents with Medicare only, who opt not to enroll in a Medicare Part D Prescription plan, they will receive itemized bills for medications from ChemRx.

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Will I have to change my medications when the new Medicare Part D medication benefit starts?
Each Medicare Part D Plan has its own formulary of FDA approved drugs, representing 146 types of medications in 41 drug categories.  A formulary may change from month to month. It is possible that a medication currently being taken by the resident will not be covered by the plan. If that happens, the pharmacist and physician discuss all options. Either the physician can change medications to those available on the formulary, or coverage for a non-formulary drug may be requested through the plan’s exception process.

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Where can I find further information about the Medicare Part D Prescription benefit?
Information on finding a Medicare D prescription drug plan, which includes a comparison of plans and enrollment information:

Call 1-800- MEDICARE  (1- 800- 633- 4227) and have your Medicare number available.  You may also go to  http://www.medicare.gov and under Search Tools, click on “Compare Medicare Prescription Drug Plans” and answer the questions.  The site will help you select from different plans; you may then contact the plan directly by phone or via its’ website link.

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