Medicare Part D for People with Medicare and Medical Assistance
As someone with Medicare and Medical Assistance (dual-eligible), you have two options. You can enroll in a Medicare managed care plan (HMO) called a "Special Needs Plan." These plans include prescription drug coverage along with medical care. Or, you can participate in fee-for-service Medicare and enroll in a stand-alone Medicare D prescription drug plan. As a “dual-eligible,” you are able to switch your plan choice at any time throughout the year.
Medicare Special Needs Plans (HMOs)
If you choose a managed care plan, you should consider your current doctors, prescription medications, pharmacy, and other preferences. You should consider questions such as:
- Does the managed care plan have my doctors enrolled in it, and if not, is it important to be able to keep the same doctors?
- Will the managed care plan keep prior authorizations and step therapy information from my current MA managed care plan?
- How important are extra benefits, such as vision, hearing, or dental?
Also, remember that even if a plan option lists costs associated with it, the only costs that those who are dual-eligible will need to pay are prescription drug co-pays.
The Healthcare Option Comparison Grid will help in comparing the four Special Needs Plans available in Allegheny County.
Stand-Alone Plans (PDPs)
If you choose to have fee-for-service Medicare, you can go to any doctor that accepts Medicare but you will not get extra benefits. You also must enroll in a stand-alone prescription drug plan. There are 20 plans that offer $0 premiums to dual-eligible beneficiaries.
Stand Alone PDPs
You can research their formularies, benefits, and pharmacy options at www.medicare.gov.
If you think that you are already enrolled in a Part D plan, but do not know which one, you can go to www.medicare.gov, and click on “Check Current Enrollment.”
Medicare D Information for people who have both Medicare and Medical Assistance