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Home -> Prescription Drug Coverage - Resource for Providers -> People with Disabilities
Prescription Drug Coverage for People with Disabilities
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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.
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| Resources and Contact Information to Learn More: |
SHIP (State Health Insurance Assistance Program) |
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MaineCare Pharmacy Help Desk |
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| Medicare Call for information about the Medicare Prescription Drug Coverage |
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Benefits Specialists |
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Protection and Advocacy for Beneficiaries of Social
Security (PABSS Project) |
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MaineCare for people with disabilities who are
working |
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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: |
| 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). |
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