700.005 Medicare Part D

1.0 Purpose

The purpose of this policy is to ensure HIV-infected Medicare eligible clients have continued access to medications.
 

2.0 Authority

Ryan White Care Act, 2000; Centers for Medicare and Medicaid Services
 

3.0 Background

On January 1, 2006, the Centers for Medicare and Medicaid Services introduced prescription drug coverage for all people with Medicare. This benefit is called Medicare Part D and is being marketed to the public as Medicare Prescription Drug Benefit. Insurance companies and other private companies are working with Medicare to offer a variety of plans. This benefit is provided through Prescription Drug Plans (PDP), Medicare Advantage Plans (MA), and some employers and unions for their retirees. Medicare Part D offers comprehensive drug coverage for prescription drugs including HIV medications.
 

4.0 Definitions

Medicare – A federally-funded health insurance program for people age 65 or older, people under age 65 with certain disabilities, and people of all ages with end-stage renal disease.

Low-Income Subsidy (Extra Help) – A federal program administered by the Social Security Administration that assists with the out-of-pocket costs associated with Medicare Part D.

Medicare Savings Programs – A federal program that assists with out-of-pocket costs associated with Medicare Part B. This includes the following benefits: Medicaid and Qualified Medicare Beneficiary (MQMB), Qualified Medicare Beneficiaries (QMB), Specified Low-Income Medicare Beneficiaries (SLMB), and Qualified Individuals (QI). Individuals who receive these benefits are automatically approved for the Low-Income Subsidy.

Wrap Around Resources – Services from Ryan White financial assistance and state-funded agencies that can be provided to Medicare beneficiaries to help pay for out-of-pocket costs associated with Medicare Part D including premiums, deductibles, co-pays and/or coinsurance.
 

5.0 Policy

Medicare beneficiaries who qualify for the full low-income subsidy must be enrolled in a Medicare Part D Prescription Drug Plan (PDP) and access medications through their PDP prior to receiving medication assistance from Ryan White and/or state-funded providers.
 

6.0 Persons Affected

This policy affects HIV-infected Medicare beneficiaries seeking medication assistance from Ryan White and/or state-funded providers.
 

7.0 Revision History