Medicare Prescription Drug Coverage - Part D

Coverage under the new federal Medicare Prescription Drug Program began January 1, 2006. If you or a loved one participates in both MEDICARE and Medicaid ("dually eligible individuals") and received prescriptions through Medicaid before January 1, you should now be receiving your medications through the federal government's new MEDICARE Prescription Drug Program.

If you experience problems with the new federal prescription coverage, please contact your MEDICARE Prescription Drug Plan (see your acknowledgement letter or Drug Plan card for contact information), or call MEDICARE at (800) 633-4227 (1-800-MEDICARE). TTY users should call (877) 486-2048. Your pharmacist may also be able to assist you.

To learn about action Governor John Hoeven took in the early days of the new federal program to help assure that dually eligible individuals received needed medications through the N.D. Department of Human Services, see this news item (link to press release http://governor.nd.gov/media/news-releases/2006/01/060106.html) from the Governor's Office.

Enrollment Help is available by calling MEDICARE or using the on-line Tools at www.medicare.gov :

• Medicare Prescription Drug Plan Finder: Link to federal Web site intended to help people learn about the new Medicare prescription drug coverage; find and compare prescription drug plans that meet personal needs; and enroll in a prescription drug plan
• Formulary Finder : Link to federal Web site with information about prescription drug plans in your state that match your required drug list
• Landscape of Local Plans : Link to federal Web site with information about the prescription drug plans and Medicare Advantage plans available in each state

Important Information for N.D. Medicaid Clients:

• More Time to Fill the Prescriptions You Need: Information from the federal government about transitional supplies of medications that are not on a Part D plan's formulary.
• The federal Centers for Medicare and Medicaid Services randomly assigned individuals who have both MEDICARE and Medicaid coverage (dual eligible individuals) to MEDICARE Prescription Drug plans.
• The assigned plan may not meet a dually eligible person’s needs (cover their medications or be available at their preferred pharmacy).
• An individual who has both MEDICARE and Medicaid should review his or her assigned plan. If it does not meet his or her needs, the individual can and should change plans.

To Change Plans (Enrollment Assistance)

• Call 1-800-MEDICARE / 1-800-633-4227 or visit www.medicare.gov. TTY users should call (877) 486-2048.
• Contact The State Health Insurance Counseling (SHIC) Program at 1-888-575-6611.
• Contact the regional resource in your area using this - List of Aging Services Division’s contracted Enrollment Assistance Specialists . (12kb pdf)

Helpful Information for Providers

The federal Centers for Medicare and Medicaid Services (CMS) has added information about medication exceptions and appeals to their Web site at http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/04_Formulary.asp . This information is intended to be helpful to pharmacists and physicians if routine procedures do not work.

Other Helpful Resources:

• N.D. Senior Info Line - available Mon. - Fri., 8 a.m. - 5 p.m. at (800) 451-8693. TDD users should call (701) 328-8968.
• Medicare and You 2006: (409 kb pdf) Link to a federally produced publication. Large Print Medicare and You 2006 (443 kb pdf)
• A Guide To Medicare Part D Prescription Drug Coverage for People with Developmental Disabilities: Web site prepared by the Disability Policy Collaboration, a partnership between The Arc and United Cerebral Palsy to help individuals who receive both Medicaid and Medicare benefits,their families and caregivers, and advocates for people with disabilities to understand the new Medicare prescription drug coverage, called Part D.
• Centers for Medicare and Medicaid Services: Friends and Family Education Campaign on Medicare Prescription Drug Coverage

Other Information:

• Notice of Coverage Change to affected Medicaid recipients (December 2005) (42kb pdf)
• Letter to affected Medicaid recipients (October 2005) (35kb pdf)
• Medicare Part D Fact Sheet for people who qualify for both Medicare and Medicaid (49kb pdf)
• Medicare Part D Fact Sheet for people who participate in Medicare Savings Program (48kb pdf)
• N.D. Medicare Part D Implementation Plan -- Updated 12-2-05 (195kb pdf) - Specifically for Medicaid/Medicare Clients (Dual Eligible Individuals)
• PowerPoint Presentation: Medicare part D Implementation in N.D. (47kb pps) Presentation about North Dakota efforts

Background Information:

• About 100,000 North Dakotans qualify for Medicare Prescription Drug Coverage (Medicare Part D).
• Of these, about 10,400 individuals are enrolled in both Medicare and Medicaid (called "dual eligibles") and currently receive prescriptions through Medicaid.
• On January 1, 2006, prescription drug coverage for dual eligible individuals changed from the state administered Medicaid program to the new federal MEDICARE prescription drug program.

Background on Dual Eligible Individuals:

• About half of these individuals are over age 65
• About 36 percent are younger people with disabilities
• Over 28 percent live in nursing homes, and others reside in group homes or in their own homes
• Over 78 percent have incomes below 100 percent of the federal poverty level ($9,570 per year for one individual)

 

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