What is a Medigap plan?

A Medigap policy is a health insurance policy sold by private insurance companies that help pay the remainder of medical fees for physician office visits that are not covered by Medicare Part B.  Medigap plans will also pay a small percentage of prescription drug prices.  However, after January 1, 2006, companies cannot sell Medigap policies covering prescription drugs and anyone who currently has a Medigap prescription drug plan will have it terminated.  Therefore, people should sign up for Medicare Part D, because they will no longer be able to use their Medigap Plan for prescription coverage.

Do I need Medicare part D if I have a Medigap plan?

Medigap plans do not take the place of Medicare part D.  They are not credible coverage (See “Medicare with other plans” #1)

What is a State Pharmaceutical Assistant Program?

A State Pharmaceutical Assistance Program provides supplemental drug coverage based on the following criteria:

• Individual’s financial need

• age

• Medical condition

• Not on current or former employment status. 

In the state of Florida, there are no longer any Pharmaceutical Assistant Programs strictly for people >65, since Medicare Part D came about.  Currently the only pharmaceutical assistant programs available in Florida for people on Medicare are for people who also have HIV/AIDS.  These plans include Florida AIDS Inc. Program and Florida ADAP.

Florida AIDS Inc. Program is a program for HIV/AIDS residents who can no longer afford to pay insurance premiums because of low income. In order to qualify for Florida AIDS inc. Cont Programs, the client must have a diagnosis of AIDS or be HIV positive, must have had at least one symptom since diagnosis, and must have a gross income below 300% of federal poverty level.  If a patient is interested I joining they should call 1-800-FLA-AIDS.  The drugs that are covered from Florida AIDS Inc. Program will be covered separately from drugs covered by Medicare Part D.  There will be no joint coverage on the same drugs.

Florida ADAP is a program to help residents of Florida living with HIV & AIDS get medications free.  In order to qualify for Florida ADAP, a client must be a Florida resident, have less than $25,000 in assets (excluding car and home), and must not be a current Medicaid member.  The drugs that are covered from Florida ADAP will be covered separately from drugs covered by Medicare Part D.  There will be no joint coverage on the same drugs. (Called Florida ADAP/Florida AIDS Inc. 4/14/06)

If a client has VA coverage, do they have to sign up for Medicare Part D?

No, they should not to sign up for Medicare Part D, because VA coverage should be more beneficial.

What if a beneficiary already has prescription drug coverage?

They need a letter from the company stating that they have credible coverage.  If they have coverage of equal or greater value than Medicare standard prescription drug coverage, they may keep that coverage and not enroll in Medicare Part D.  Enrollment in Medicare Part D may cause them to loose their company drug coverage and medical care.  The client MUST contact their drug coverage provider for advice.

Will Florida Medicaid cover the drugs that Medicare Part D does not cover?

Florida Medicaid covers some of the drugs that Medicare Part D does not cover. For example, Medicare Part D does not cover Valium, but Medicaid will usually cover it.   Medicaid covers drugs based on a case-by-case basis. (Called Medicaid 4/18/06)

Will Florida Medicaid pay the remaining costs on a drug after Medicare Part D has covered part of the cost?

No, Florida Medicaid will only pay for drugs that are not covered.  They will not pay remaining costs for a medication, not even during the gap coverage period (doughnut hole). For example, Vytorin is a second tier drug and is usually more expensive; however, Medicaid will usually not cover the remaining costs. (See “plan costs” #1)

Will a client be able to use more than one Medicare drug plan?

No. Clients will only be able to join, and get coverage under, one Medicare drug plan at a time.

Will clients be able to use a drug store drug discount card (not a Medicare-approved drug discount card) with a Medicare drug plan?

Generally, drug store discount cards provide a discount on the retail price of the drug not otherwise covered by a patient's insurance. Since people with Medicare will be receiving coverage for prescription drugs, further discounts may not apply.

References

“Kaiser Family Foundation” http://www.kff.org/medicare/index.cfm. March 30, 2006.

“Medicare.gov FAQ’s” http://www.medicare.gov March 30, 2006.

“Mental Health Part D Site” http://www.mentalhealthpartd.org. April 10, 2006.

“Understanding Medicare Reform: What Pharmacists Need to Know” American Pharmacists Association. 2005. Module 4.

“Part D Benefit Parameter Chart” Office of the Actuary Centers for Medicare and Medicaid Services. April 5, 2006.
 

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The information in this document and the assistance provided by the presenter of this information is intended as an educational guide for Medicare participants. The Medicare recipient is solely responsible for making the final decision regarding his or her choice of Medicare Part D plans. Specific questions regarding Medicare Part D should be directed to Medicare at 1-800-MEDICARE.