Medicare Part D Frequently Asked Questions
- How does Medicare Part D affect the services I receive through GHPP?
- What is a Medi-Medi or a dual eligible client?
- Can I dis-enroll from Medicare Part D?
- I cannot afford my Medicare Part D co-payment. Where can I get help to pay it?
- Will GHPP require me to enroll into Medicare Part D if I am eligible to enroll?
- What is the Medicare Part D donut hole?
- Can GHPP pay for my Medicare part D co-pay and/or donut hole?
- Will GHPP cover my medication if it is not covered by Medicare Part D?
- What can I do if my Part D plan is not paying for my medications?
- What agencies can I get more information about Medicare Part D?
1. How does Medicare Part D affect the services I receive through GHPP?
When you are enrolled into Medicare Part D, you lose drug coverage through GHPP except for medications that are specifically excluded from coverage by Medicare Part D. These include:
- agents when used for anorexia, weight loss, or weight gain
- agents when used to promote fertility
- agents when used for cosmetic purposes or hair growth
- agents when used for the symptomatic relief of cough and colds
- prescription vitamins and mineral products
- nonprescription drugs
- outpatient drugs for which the manufacturer seeks to require that associated tests or monitoring services be purchased exclusively from the manufacturer or its designee as a condition of sale
- barbiturates
- benzodiazepines
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2. What is a Medi-Medi or a dual eligible client?
Dual eligible clients are those clients who have Medi-Cal and Medicare. It is mandatory for dual eligible/Medi-Medi clients to be enrolled with Medicare Part D.
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3. Can I dis-enroll from Medicare Part D?
a. If you voluntarily enrolled with Part D and you are not considered dual eligible, you may dis-enroll from Medicare Part D. However, you may pay a higher premium, later if you decide to re-enroll with Medicare Part D.
b. If you are a dual eligible (Medi-Medi) client, you cannot dis-enroll with Medicare Part D. However, you can:
- Change your Medicare Part D plan every month if you want to.
To enhance your benefits through Medicare Part D, choose a drug plan that will cover or pay most of your medications. Each drug plan has a different list of medications that they will pay for.
To help you choose a drug plan that will benefit you the most, please go to the Medicare website or talk to your local pharmacist.
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4. I cannot afford my Medicare Part D co-payment. Where can I get help to pay it?
GHPP does not cover Medicare Part D co-payments, however, if you are considered low income you may be able to obtain extra help through the Social Security Administration. The phone number for the Social Security Administration is 1-800-772-1213
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5. Will GHPP require me to enroll into Medicare Part D if I am eligible to enroll?
At this time, GHPP clients who are not dual eligible are not required to enroll with Medicare Part D. You have to decide if enrolling with Part D would add value to your care.
Clients who are dual eligible are automatically enrolled with Part D.
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6. What is the Medicare Part D donut hole?
The standard Medicare Part D drug plan provides coverage divided into three phases. Depending on your drug plan, in the first phase you may pay a deductible and about 25% of drug costs. In the third phase, you pay about 5%. In between, there is a gap in coverage which is called the donut hole when the client must pay 100% of drug costs out of their own pocket. Many plans offer enhanced coverage, meaning paying a higher monthly premium, deductibles and/or co-payments and the donut hole may be reduced or eliminated.
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7. Can GHPP pay for my Medicare part D co-pay and/or donut hole?
No. GHPP can not pay your Part D co-pay and donut hole. Some pharmacies may be able to pay your co-pay. Please ask your local pharmacy if they have this program.
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8. Will GHPP cover my medication if it is not covered by Medicare Part D?
GHPP will only cover those medications specifically excluded from Medicare Part D coverage. See Question #1 for a list.
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9. What can I do if my Part D plan is not paying for my medications?
You may file an appeal with your Part D plan. You can also change to another drug plan during open enrollment.
The key in maximizing your benefits from Part D plan is to choose a drug plan that will cover most or all of your medications.
To help you choose a drug plan that will benefit you the most, go to the Medicare website or talk to your local pharmacist.
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10. What agencies can I get more information about Medicare Part D?
Centers for Medicare and Medicaid Services: 1-800-MEDICARE
Health Insurance Counseling and Advocacy Program (HICAP): 1-800-434-0222
Social Security Administration: 1-800-772-1213
Websites:
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Medicare Information about Medicare Part A, Part B, and Part D
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CalMedicareBasic information about Medicare in California
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BenefitsCheckUpHelp people explore their drug coverage options and their
eligibility for assistance with medication costs
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