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Prescription Drug Coverage for People with Disabilities
who have MaineCare and Medicare


This page is specifically for people with disabilities who have both MaineCare and Medicare coverage. Effective January 1, 2006, those with both MaineCare and Medicare will have a change in who covers their prescription drugs. Due to changes in the Federal law, MaineCare will no longer cover your medications. Your prescription drugs will be covered by Medicare through a prescription drug plan. This change is not only for people with disabilities. Older people will also be affected by these changes.

Resources and Contact Information to Learn More:

SHIP (State Health Insurance Assistance Program)
Can answer questions about the new Medicare Prescription Drug Coverage

MaineCare Pharmacy Help Desk
If you have MaineCare, you can call to ask questions about your prescription drug coverage

  • 1-866-796-2463
  • TTY: (207) 287-1828
Medicare
Call for information about the Medicare Prescription Drug Coverage

Benefits Specialists
Learn more about how your benefits are impacted by working or increasing your work.

Protection and Advocacy for Beneficiaries of Social Security (PABSS Project)
Assistance with problems related to coverage for medications through the Medicare Prescription Drug Progam for people with disabilities who have Social Security and are in cash payment

  • Disability Rights Center
    1-800-452-1948

MaineCare for people with disabilities who are working
You might be able to earn more than you think, and still receive MaineCare.


Frequently Asked Questions:

Is this change only for people with disabilities?

No. This change will be for anyone who has MaineCare and Medicare.

How will this change affect me? How do I know who will cover my medications?

Because you already receive MaineCare, you will automatically be enrolled in a Medicare prescription drug plan that will give you prescription drug coverage. If the plan isn’t right for you, you can switch plans later. In October, you will be sent a letter to let you know which prescription drug plan you will be enrolled in. Here are a couple of examples of how this will work:

Keisha has Medicare and MaineCare. MaineCare currently covers her prescriptions. On January 1, 2006, Medicare will start to cover her prescriptions instead of MaineCare through a Medicare prescription drug plan. She waits and doesn’t choose a Medicare prescription drug plan by December 31, 2005, so Medicare enrolls her in one so she doesn’t lose drug coverage. Her Medicare prescription drug coverage begins January 1, 2006.

Martha has Medicare and MaineCare. She has never had to pay for her prescriptions because MaineCare covers them. Beginning January 1, 2006, Medicare will cover her prescriptions through a Medicare prescription drug plan instead of MaineCare. In the fall of 2005, she looks in her ”Medicare & You 2006” handbook to find out which Medicare prescription drug plans are available in her area. She gets more information from the plans and enrolls in the plan that meets her prescription drug needs. Martha will pay a few dollars for each prescription she fills at the pharmacy no matter which Medicare prescription drug plan she enrolls in.

Will the new plan cover all of my medications?

It is important to know what prescription drugs you are currently taking and if these will be covered by the new plan. If you want to be in another plan, you can choose to switch plans starting November 15. Each prescription drug plan can cover different medications, so it is important to know if the medications you need are covered by the plan you are enrolled in. You can also talk with your doctor to see if there are any substitute medications you could take in case the ones you are currently taking are not covered by your new drug plan. Here is an example of how to switch plans:

Larry has Medicare and MaineCare. MaineCare currently covers Larry’s prescriptions. On January 1, 2006, Medicare will start to cover his prescriptions instead of MaineCare through a Medicare prescription drug plan. Larry waits and doesn’t choose a Medicare prescription drug plan by December 31, 2005 so Medicare enrolls him in one so he doesn’t lose drug coverage. If Larry feels the Medicare prescription drug plan he’s been enrolled in is meeting his needs, he doesn’t have to do anything. However, if the drug plan he was enrolled in isn’t meeting his needs, he can call 1-800-MEDICARE to find another plan and enroll in that plan at any time. Help is also available locally through the resources listed above.

Who can I contact to learn more about how this change will affect me? There are counselors available free of charge that you can answer all your questions. If you want to talk with someone on the phone or in person, contact your local SHIP (State Health Insurance Assistance Program) at 1-877-353-3771. If you have MaineCare, you can also call the MaineCare Pharmacy Help Desk at 1-866-796-2463 or 1-800-423-4331 (TTY).