Thanks, Ralph. Sorry to get back to you so late. Really appreciate your answer.
In summary, we'll likely keep the secondary insurance coverage through the retirement annuity survivor benefit and would then add Part D, if required, on top of that. According to what our state has posted online, it looks having Medicare Part D, Medicaid, and other insurance is a legal possiblity for which they account.
The big question is now that we're in official limbo status...Medicaid pending and now eligible since the beginning of November, do we have to pay the pharmacy bill? The question doesn't apply this month because they didn't send us a bill. Next month they probably will and we'll owe them. Should we pay the pharmacy or should we wait for Medicaid once it approves?
Sounds like a quick call to 800-MEDICARE might be in order, and we really appreciate that advice.
Part D takes effect the month of Medicaid eligibility. The applicant may have to private pay until the enrollment in Medicaid goes through at which point the Medicaid recipient will be sent a check to reimburse for premiums paid.
Let's clarify: You said that mom has supplemental coverage that includes prescription costs except for a co-pay. Are you looking to drop the supplemental Rx coverage (not the supplement itself) and substitute Part D or are you looking for Part D to cover the co-pays not covered by the supplemental Rx coverage?
I don't believe you can have Rx coverage from a private plan AND Part D but I am not sure. Perhaps the business office at the facility can give you the answer to whether you can have both plans simultaneously. If they are not sure, or you want to double check, 1-800-MEDICARE does a great job answering questions of this nature.
I do know, however, that most states will allow the Medicaid recipient to pay for recurring unreimbursed medical expenses from their income BEFORE the nursing home is paid. In Florida, this is called the "Uncovered Medical Expense Deduction" and is based on the expenses of the last six months and is re-evaluated every six months. So, if you wanted to keep the supplemental Rx, which you might want to do if, for instance, if the supplemental formulary has drugs that the Part D plan may not, you could have the co-pays covered by mom's income with no penalty to her. (Part D for a Medicaid recipient falls under the "Low Income Subsidy" (LIS) program. The premium is paid by the state and each state has a maximum premium they will pay for an LIS plan. Because these are generally the lower cost plans, it is possible that the formulary may be limited in some respects. I suggest asking the facility which Part D plan they recommend for their Medicaid recipients as they will have to administer the program. You can then go to Medicare.gov and check the formulary of the plan against your mother's Rx needs.)
Thanks, Ralph! We're going to be in that situation hopefully sooner or later with a Medicaid application pending and a supplemental insurance policy paid from Mom's survivor annunity from Dad's federal retirement. The supplemental has paid prescription costs with the exception of a co-pay. Mom is currently in a LTC facility.
We're working to have Mom Medicaid eligible by Nov 1st.
At what point would Medicare part D take effect? Would any of that be retroactive and cover prescriptions costs from the point at which she became Medicaid eligible or is this a totally separate situation that takes effect later with no retroactive period?
Reason we're asking is that we need to know if we should pay the pharmacy costs with the remainder of her funds going to the LTC facility while waiting for Medicaid to approve.
When in a nursing home and receiving Medicaid long-term care benefits the recipient required to have a Medicare Part D Rx plan. The recipient will automatically be enrolled in the "Low Income Subsidy" program (LIS) and can switch between Part D plans at will. If the recipient does not choose a plan one will be chosen for him/her at random. The premium is paid by the state and the maximum premium amount allowed varies by state (you can search for "low income subsidy premiums by state" to find your state's maximum allowable premium - do not choose a plan with a premium higher than this amount). Rx deductibles and co-pays are also paid for by Medicaid. I always recommend asking the nursing home which plan to choose since they will be responsible for navigating pharmacy needs.
With respect to Medicare supplements, a Medicaid recipient may keep a Medicare supplement and the premium can be paid from the recipients income before Patient Responsibility is paid to the nursing home. You must receive approval for the premium payment from the Medicaid agency. The only negative consequence to retaining the supplement is that the premium may reduce income that can be diverted to the community spouse if there is one. Otherwise, since there is no other negative consequence to retaining a Medicare supplement and, depending on the state, perhaps some advantage, I generally recommend keeping the supplement.
Ask Medicaid in your state what their requirements are regarding prescriptions and if you should still be paying the premiums for Medicare or to Medicaid.
I'm not sure if I understand the question but when my Mom was in this situation we continued these payments. The ltc facility paid the premiums out of Mom's monthly social security and pension income, all if which went directly to them. I never gave it much thought...just figured there may be a benefit for the facility if the insurance continued to be paid. My only concern was that Mom was given the care she needed and that she was comfortable and content.
In summary, we'll likely keep the secondary insurance coverage through the retirement annuity survivor benefit and would then add Part D, if required, on top of that. According to what our state has posted online, it looks having Medicare Part D, Medicaid, and other insurance is a legal possiblity for which they account.
The big question is now that we're in official limbo status...Medicaid pending and now eligible since the beginning of November, do we have to pay the pharmacy bill? The question doesn't apply this month because they didn't send us a bill. Next month they probably will and we'll owe them. Should we pay the pharmacy or should we wait for Medicaid once it approves?
Sounds like a quick call to 800-MEDICARE might be in order, and we really appreciate that advice.
Part D takes effect the month of Medicaid eligibility. The applicant may have to private pay until the enrollment in Medicaid goes through at which point the Medicaid recipient will be sent a check to reimburse for premiums paid.
Let's clarify:
You said that mom has supplemental coverage that includes prescription costs except for a co-pay. Are you looking to drop the supplemental Rx coverage (not the supplement itself) and substitute Part D or are you looking for Part D to cover the co-pays not covered by the supplemental Rx coverage?
I don't believe you can have Rx coverage from a private plan AND Part D but I am not sure. Perhaps the business office at the facility can give you the answer to whether you can have both plans simultaneously. If they are not sure, or you want to double check, 1-800-MEDICARE does a great job answering questions of this nature.
I do know, however, that most states will allow the Medicaid recipient to pay for recurring unreimbursed medical expenses from their income BEFORE the nursing home is paid. In Florida, this is called the "Uncovered Medical Expense Deduction" and is based on the expenses of the last six months and is re-evaluated every six months. So, if you wanted to keep the supplemental Rx, which you might want to do if, for instance, if the supplemental formulary has drugs that the Part D plan may not, you could have the co-pays covered by mom's income with no penalty to her.
(Part D for a Medicaid recipient falls under the "Low Income Subsidy" (LIS) program. The premium is paid by the state and each state has a maximum premium they will pay for an LIS plan. Because these are generally the lower cost plans, it is possible that the formulary may be limited in some respects. I suggest asking the facility which Part D plan they recommend for their Medicaid recipients as they will have to administer the program. You can then go to Medicare.gov and check the formulary of the plan against your mother's Rx needs.)
We're working to have Mom Medicaid eligible by Nov 1st.
At what point would Medicare part D take effect? Would any of that be retroactive and cover prescriptions costs from the point at which she became Medicaid eligible or is this a totally separate situation that takes effect later with no retroactive period?
Reason we're asking is that we need to know if we should pay the pharmacy costs with the remainder of her funds going to the LTC facility while waiting for Medicaid to approve.
With respect to Medicare supplements, a Medicaid recipient may keep a Medicare supplement and the premium can be paid from the recipients income before Patient Responsibility is paid to the nursing home. You must receive approval for the premium payment from the Medicaid agency. The only negative consequence to retaining the supplement is that the premium may reduce income that can be diverted to the community spouse if there is one. Otherwise, since there is no other negative consequence to retaining a Medicare supplement and, depending on the state, perhaps some advantage, I generally recommend keeping the supplement.