2005 Memorandums
IM-150      12/16/05




Beginning January 1, 2006, all people with Medicare are eligible for Medicare prescription drug coverage. Individuals who receive both Medicare and Medicaid are referred to as dual eligible. Dual eligible individuals are eligible for the “Extra Help” Low Income Subsidy Program. Effective January 1, 2006, Medicaid will no longer pay for a dual eligible individual's prescription drugs that are covered by Medicare Part D. Medicaid will continue to pay for their health care. This change only applies to prescription drug coverage.

The following is a list of frequently asked questions regarding Medicare Part D:

1. If a client has been auto-enrolled in a drug plan, how can they find out which plan they have been enrolled in?

In November 2005, Medicare mailed notices of auto-enrollment to individuals with Medicare and Medicaid. The notice includes the name of the plan. The individual can also visit, call 1-800-MEDICARE (1-800-633-4227) 24 hours a day and talk to a customer service representative, or beginning January 2006, most pharmacies will be able to access that information.

2. How will Medicare Part D impact spenddown clients?

If a client has met their spenddown in any of the months beginning May 2005, they should have been auto-enrolled in Medicare Part D. Once they have been enrolled in Part D they will remain eligible for calendar year 2006.

3. If a client is enrolled in Medicare Part D, do they have to continue meeting their spenddown?

Medicare Part D only covers prescription drugs, if the client has or needs other medical care it is their option whether to meet spenddown.

4. If a client is enrolled in Medicare Part D, are all his/her prescription drugs covered?

This depends on each individual's prescription drugs and the plan in which s/he is enrolled. Individuals should check with their drug plan provider to ensure their medications are covered. Some medications will not be covered by Medicare Part D; these include barbiturates, benzodiazepine and some over the counter drugs. If a prescription drug is currently covered by Medicaid, but will not be covered by Medicare Part D, Medicaid will continue to cover a limited number of these drugs. Individuals can contact the Division of Medical Services at 1-800-392-2161 to see if their drugs are going to be covered by Medicaid.

5. Will Medicare Part D premiums and co-payments be allowed to meet spenddown?

Yes, if the client is responsible for paying the expense.

6. Will the state pay the Part D premiums and co-payments?

No. However, dual eligible individuals who choose the most basic plan will not have to pay a premium and little or no co-payments. If a dual eligible chooses a plan that covers more than the basic plan, s/he may have to pay a premium. If so, the cost to the individual would be the difference between the cost of the basic plan and the cost of the premium for the chosen plan.

7. Will Blind Pension recipients be auto-enrolled in a plan?

No. The Blind Pension program is a state funded program and is not considered in meeting the definition of a dual eligible. Missouri Medicaid will continue to cover their prescriptions.

8. If a client is assigned to a drug plan, can they change plans?

Yes, dual eligible individuals can change plans at any time. Individuals who have Medicare only are allowed to change plans once during the calendar year.

9. What will happen to Medicaid clients who are approved for Medicare later?

They will be auto-enrolled in a plan in their area and will be notified by the Social Security Administration of their options.

10. What will happen to Medicare beneficiaries who are approved for Medicaid later?

If they had not previously selected a plan, they will be auto-enrolled in a plan and will be notified by the Social Security Administration of their options.

11. What will happen to new Medicare beneficiaries who do not have Medicaid?

They will be notified by the Social Security Administration of their options and can enroll in a plan up to three months prior and three months after their Medicare begins.

12. How long will a person have to enroll in a plan?

Medicare beneficiaries have until May 15, 2006, to enroll in Medicare Part D. If they choose to enroll later, they may have to pay a penalty.

13. Will nursing home residents have a co-payment for their prescription drugs?


14. Will residents in a Residential Care Facility (RCF) have a co-payment for their prescription drugs?

Since RCFs are not considered medical institutions, their residents are considered as living in the community and therefore, will have a small co-payment.

15. Some individuals are being told to contact their caseworker about Medicare Part D. What should we do?

Individuals with questions should be instructed to call 1-800-MEDICARE (1-800-633-4227) or visit

16. Will all pharmacies accept Medicare Part D?

No, pharmacies have the option of whether to participate in the program.

17. How can I find the drug plans in my area?

On the Internet, go to Click on Landscape of Local Plans then click on Missouri.

18. What will happen if a dual eligible individual goes to the pharmacy on January 1, 2006 and has not been enrolled in Medicare Part D or a drug plan?

Participating pharmacies will have a plan in place to allow clients to get their approved prescriptions and will notify a national plan to assist them in the enrollment process.



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