| A publication of Pine Tree Legal Assistance |
Summer 2006
Important Information for People who are eligible for MEDICARE & MEDICAID and for People who are on MEDICARE & ConnPACE
The following article appears on the LARCC Webpage. Click on the "Hot Topic" Link and click on "Medicare & ConnPACE."
If You Are Dually Eligible for Medicare and Medicaid...
YOU CANNOT BE CHARGED A COPAY!
- The new Medicare Drug Program ("Part D") calls for co-pays for all prescription drugs. However, the State of Connecticut has said that it will cover the costs of any co-pay on your behalf.
- If the pharmacist asks you for a co-pay, just tell him or her that, under the law, the pharmacist MUST give you the prescriptions and bill the State of Connecticut Departmentof Social Services for the copay.
GET THE PRESCRIPTIONS YOU NEED
- If you are dually eligible, the Department of Social Services also will pay for your prescription drugs with no co-pay if they are not on your current Medicare Part D plan’s formulary.
If You Are on Medicare with ConnPace...
- You may not be charged a co-pay of more than $16.25 for any drug.
- The Connecticut Department of Social Services will pay for your prescription drugs, even if they are not on your Medicare Part D formulary.
- Show the pharmacist the attached card which will explain the new laws.
- Keep the card with you for the next time.
- Tell others that these cards are now available at Statewide Legal Services (in both English and Spanish)
If you have any questions or problems call:
Statewide Legal Services at 1-800-453-3320
Center for Medicare Advocacy (800) 262-4414
Dept. of Social Services Pharmacy Unit (860) 424-5150
Attorney General-Health Fraud Unit (860) 808-5355
New Haven Legal Assistance Association (203) 946-4811
I am a ConnPACE recipient and also on Medicare Part D.
I MAY NOT BE CHARGED A COPAY OF MORE THAN $16.25 FOR ANY DRUG.Rather, the Connecticut Department of Social Services
MUST be billed for any copays in excess of $16.25 under all
Part D drug plans. DSS Provider Bulletin PB 2005-75, pages
2-3 (Dec. 2005); PB 2006-21 (April 2006).See Other Side for Information About DSS Coverage for Drugs Not Covered Under Medicare Part D Plans.
ConnPACE/ Medicare recipients are covered by the Dept. of
Social Services for most drugs not covered by their Medicare
Part D plans. Pharmacists are required to bill DSS directly
when the Part D plan says a drug is not covered.
See PA 05-2 (Nov. 2, 2005 Spec. Sess.); DSS Provider Bulletins PB
2005-75 (Dec. 2005) & 2006-21 (Apr. 2006)Questions?
Attorney General-Health Fraud Unit (860) 808-5355
Center for Medicare Advocacy (800) 262-4414
Statewide Legal Services (800) 453-3320 (also contact SLS for
updates of this card, which was issued May 22, 2006)