You can call 1-800-Medicare (1-800-633-4227) or visit www.medicare.gov. Medicare can answer any questions you may have about your enrollment into a Part D plan, how to change plans or how to disenroll from a Part D plan. Medicare is also your best source for information if you are experiencing problems with your Part D plan.
The best sources for assistance are: Medicare or call 1-800-MEDICARE (1-800-633-4227); Area Agencies on Aging (AAA); and CLAIM at 1-800-390-3330, which provides free health insurance counseling to Medicare participants in Missouri.
Missouri's 2008 benchmark premium is $26.71. If a dual eligible joins a plan that has a premium higher than the benchmark, they will have to pay the difference.
Only the pharmacy benefit changes for individuals who become dual eligibles. Dual eligibles will receive pharmacy benefits through their Medicare Part D plan and MoRx.
The MoRx benefit will pay 50% of co-pays, deductibles and costs remaining on prescription drugs after the Medicare Prescription Drug Plan pays. For dual eligibles, certain drugs excluded by Medicare law will continue to be paid by MO HealthNet.
For MO HealthNet participants, MO HealthNet will continue to pay for drugs excluded from Medicare Part D coverage that are covered by MO HealthNet. Medicare Part D excluded drugs that are generally covered by MO HealthNet include barbiturates, benzodiazepines, and certain over-the-counter medications.
No.
No. Individuals eligible for Blind Pension do not need to enroll in a Part D plan. If you lose your blind pension later you will not be subject to a penalty when you enroll in Part D, provided you enroll within 63 days of losing the Blind Pension.
Medicare co-pays for full benefit dual eligibles should not exceed $2.00 for generic and $5.00 for brand name prescriptions.
After the first full month of residence in a skilled nursing facility, an intermediate care facility for the mentally retarded or an inpatient psychiatric hospital, dual eligibles will have no co-pay.
Medicare co-pays for full benefit dual eligibles should not exceed $2.00 for generic and $5.00 for brand name prescriptions.
MoRx will pay for half of the Medicare co-pay, but you will need to pay the rest. Medicare Part D co-pays are real co-pays. Unlike MO HealthNet co-pays, your pharmacy may refuse you service if you do not pay your portion of the co-pay.
No. A dual eligible must be enrolled in a Part D plan for MO HealthNet to pay for Part D drugs.
Yes.
MO HealthNet does not pay for Part B drugs.
No.
No. These are Medicare Part B drugs and the participant may continue to get these drugs through the Part B provider.
Blood Glucose Test Strips are covered by Medicare Part B and the participant may continue to get these supplies through the Part B provider.
No. MoRx does not work with mail order pharmacies. You can fill your prescriptions at any non-mail order pharmacy that is contracted with your Part D plan and MoRx will provide wrap-around benefits. Many MoRx-participating pharmacies provide home delivery services at minimal or no additional charge.
No. The MoRx benefit will not cover a 90-day supply of medication. If your doctor writes a prescription for a 90-day supply, simply turn it into your pharmacy and ask them to fill it in 30 or 31 day increments. The MoRx benefit will cover up to a 31-day supply of each prescription at a time. You can get a full day's prescribed dosage for each day of the month with a maximum of 31 days each month.
MO HealthNet will continue to pay for drugs excluded from Medicare Part D coverage, including certain over-the-counter medications for dual eligibles. Claims for these drugs will need to meet current MO HealthNet edits.
Yes, if medical services other than prescription drugs are required.
Yes. If a participant prepays their spenddown they are eligible for the entire month and MO HealthNet will cover their Part D excludable drugs for the entire month.
No, but the cost of the excludable will count toward spenddown.
MoRx will pay 50% of the co-pay for Part D drugs. Spenddown does need to be met for MO HealthNet to pay for Part D excludable drugs.
Yes, if they are prescribed by a physician.
If the participant pays the premiums, this amount will count toward their spenddown.
No.
08/30/07
