Medicaid/Medicare dual eligibility and Prescriptions - Disabilities Message Board

hugg724 · 12-19-2008, 12:25 AM

I am really confused about something and hope someone can help clarify this for me.

I was just approved for Medicaid via my SSI application that was submitted with my SSDI claim (which was approved in October). Medicare will be primary with Medicaid secondary.

Today I received a letter. It states, "You now have Medicare to pay for your prescription drugs. So, starting January 17, 2009: Tenncare Medicaid will STOP paying for your prescription drugs. You'll have NO prescription drug coverage through Tenncare Medicaid."

Medicare doesn't have a prescription drug benefit which is why we have to get a Part D supplement. What the heck are they talking about? Is there some type of program with Medicare for those who are disabled with dual eligibility?

I am trying to determine if I need to get a Part D supplement or if there is something in all this that covers my prescriptions. This is all so confusing to me.

Thanks for any help you can offer!!

KellyCz · 12-27-2008, 09:33 PM

Hello,
I receive social security disability from my father's record due to being born with cerebral palsy. I just became eligible for medicare on 11/1/08. Previously, medicaid Michigan covered my prescriptions, but no longer does, because I have a medicare D plan. You need to sign up for one, or (from reading your post) it is my understanding that you will no longer have drug coverage. When I signed up for my drug plan, I talked with a medicare representative, who asked me my current medications, and then told me the plan that was best for me. (Some plans cover drugs that others don't, and vice versa.) When you tell the rep your meds, it is important to remember to include the as needed drugs (if any) or you may run into problems getting those covered when the need arises. I am new to medicare myself, and it is all very confusing, so don't worry. I had/have to learn as I go along. I hope I was able to answer at least a few of your questions. Take care.

Kelly

hugg724 · 12-28-2008, 01:07 AM

Thank you Kelly! I will find a Medicare Part D. I am not sure I will ever completely understand how medicare works. I am sure I am going to learn the hard way lol

Hope you have a happy new year!

mscat40 · 12-29-2008, 09:10 PM

YES, it is very confusing! I also have both Medi-cal and medicare , i n Ca. it is called Med-Cal. It has to do with your income. WHat you are eligibe for. It sound slke you are eligible mainly for medicare which is very good too.
My prescription drug plan was picked for me, and I do not have to pay anything. Medicare did it for me, so it maded things easy. You can call medicare and see what your choices are, or to see if they picked for you. That iswhat i would do. Also, if they pick for you, you should recieve a perscription drug card in the mail.

hugg724 · 12-30-2008, 01:55 AM

I received a letter today from the Department of Health & Human Services. Because I have Medicare and Medicaid, they enrolled me in a prescription drug plan. There is no premium, no deductible....my copay is $1.10 for generic or $3.20 for brand name.

All it states is that as long as I am eligible for Medicaid, this will be my prescription plan. I will always be eligible for Medicaid because of the pass along amendment here in TN.

I am relieved to have this part taken care of. After the huge stack of medical bills I still have to pay, it will be comforting to know that I don't have to worry about any more bills and can get my prescriptions!

Thanks for the info mscat, I was ready to do that until I checked the mail today lol