How Does Other Insurance Programs Work With Part D?

How Other Insurance Programs Work With Part D

  • Employer or Union Health Coverage

  • COBRA

  • Medicare Supplement Insurance (Medigap) Policy

  • Medicaid

  • Supplemental Security Income Benefits

  • State Pharmacy Assistance Programs

  • Long -Term Care Facility

  • HUD Housing Assistance

  • Food Stamps

  • Federal Employee Health Benefits (FEHB) Program

  • Veterans’ Benefits

  • TRICARE (Military Health Benefits)

  • Indian Health Services

Employer or Union Health Coverage

Depending on your company’s employer coverage or union health coverage, you may be eligible for drug coverage. If you have prescription drug coverage based on your current or previous employment, your employer or union will notify you each year to let you know if your prescription drug coverage is creditable. Keep the information you get.

Call your benefits administrator for more information before making any changes to your coverage. Note: If you join a Medicare drug plan, you, your spouse, or your dependants may lose your employer or union health coverage.

COBRA

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There may be reasons why you should take Part B instead of, or in addition to, COBRA. However, if you take COBRA and it includes creditable prescription drug coverage, you’ll have a special enrollment period to join a Medicare drug plan without paying a penalty when the COBRA coverage ends.

Talk with your State Health Insurance Assistance Program (SHIP)to see if COBRA is a good choice for you.

Medicare Supplement Insurance (Medigap) Policy with Prescription Drug Coverage-It may be to your advantage to join a Medicare drug plan because most Medigap drug coverage isn’t creditable, and you’ll pay more if you go 63 days or more in a row without creditable prescription drug coverage.

Medigap policies can no longer be sold with prescription drug coverage, but if you have drug coverage under a current Medigap policy, you can keep it. If you join a Medicare drug plan, your Medigap insurance company must remove the prescription drug coverage under your Medigap policy and adjust your premiums. Call your Medigap insurance company for more information.

Medicaid

Your drug costs are covered by Medicare. You’ll need to join a Medicare drug plan for Medicare to pay for your drugs. In most cases, you’ll pay a small amount for your covered drugs. If you have full coverage from Medicaid and live in a nursing home, you pay nothing for covered prescription drugs. If you have full coverage from Medicaid and live in an Assisted Living or Adult Living Facility, or a Residential Home, you’ll pay a small copayment for each drug.

If you don’t join a plan, Medicare will enroll you in one to make sure you don’t miss a day of coverage. If you decide you want another plan, you can switch to another plan at any time.

Supplemental Security Income Benefits

Help you get from your state Medicaid program paying your Medicare premiums – You need to join a Medicare drug plan for Medicare to pay for your drugs. You automatically qualify for Extra Help for your prescription drug costs. If you don’t join a plan, Medicare will enroll you in one to make sure you don’t miss a day of coverage.

State Pharmacy Assistance Program - Each state decides how its State Pharmacy Assistance Program works with Medicare prescription drug coverage. Some states give extra coverage when you join a Medicare Prescription Drug Plan. Some states have a separate state program that helps with prescriptions. Contact your State Pharmacy Assistance Program to get more information.

Long-Term Care Facility - Long Term Care pharmacies contract with Medicare drug plans to give prescription drug coverage to their residents. If you’re entering, living in, or leaving a nursing home, you’ll have the opportunity to choose or switch your Medicare drug plan. This allows you to get a plan that contracts with the nursing home’s pharmacy.

HUD Housing Assistance -If you get housing assistance from the Department of Housing and Urban Development (HUD), you may want to join a Medicare drug plan. If you qualify for Extra Help, you won’t lose your housing assistance, but HUD may reduce your housing assistance as your prescription drug spending decreases. However, the value of the Extra Help paying your drug costs will make up for any decrease in your housing assistance.

Food Stamps -If you get food stamps, you may want to join a Medicare drug plan. If you qualify for Extra Help, your food stamp benefits may decline, but the value of Medicare’s Extra Help will make up for that decrease.

Compare your costs for your current drug coverage to what your costs would be with Medicare prescription drug coverage and the Extra Help. If you’re near the food stamps eligibility cutoff, you may lose your minimum food stamp benefits because you’ll be paying less for your prescription drugs. But remember that the value of the Extra Help paying your drug costs will make up for any decrease in food stamp benefits.

Federal Employee Health Benefits (FEHB) Program-FEHB plans usually include prescription drug coverage, so you don’t need to join a Medicare drug plan. However, if you decide to join a Medicare drug plan, you can keep your FEHB plan, and your plan will let you know who pays first.

For more information, contact the Office of Personnel Management. You can also call your plan if you have questions.

Veterans’ Benefits- You may be able to get prescription drug coverage through the U.S. Department of Veterans Affairs (VA) program. You may join a Medicare drug plan, but you can’t use both types of coverage for the same prescription at the same time. For more information, contact the VA.

TRICARE (Military Health Benefits)Most people with TRICARE who are entitled to Part A must have Part B to keep TRICARE prescription drug benefits. If you have TRICARE, you don’t need to join a Medicare Prescription Drug Plan. However, if you do, your Medicare drug plan pays first, and TRICARE pays second.

If you join a Medicare Advantage Plan with prescription drug coverage, your Medicare Advantage Plan and TRICARE may coordinate their benefits if your Medicare Advantage Plan network pharmacy is also a TRICARE network pharmacy. For more information, contact the TRICARE Pharmacy Program.

Indian Health Services- Many Indian health facilities participate in the Medicare prescription drug program. If you get prescription drugs through an Indian health facility, you pay nothing, and your coverage won’t be interrupted. Joining a Medicare drug plan may help your Indian health facility because the drug plan pays the Indian health facility for the cost of your prescriptions. Your local Indian health benefits coordinator can help you choose a plan that meets your needs and tell you how Medicare works with the Indian health care system.

Note:Keep any creditable prescription drug coverage information you get from your plan. You may need it if you decide to join a Medicare drug plan later. Don’t send creditable coverage letters/certificates to Medicare.

Medication Therapy Management Programs for Complex Health Needs

If you’re in a Medicare drug plan and you have complex health needs, you may be eligible to participate in a Medication Therapy Management (MTM) program. These programs help you and your doctor make sure your medications are working.

MTM programs include a free discussion and review of all of your medications by a pharmacist or other health professional to help you use them safely. You’ll get a summary of this discussion to help you get the most benefit from your medications. You may want to bring this summary when you talk with your doctors or other health care providers.

Participate in an MTM Program

If you take many medications for more than one chronic health condition, contact your drug plan to see if you’re eligible.