04.45.05 Medicare Part D and Minnesota Health Care Programs (MHCP)

*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***

Medicare Part D and Minnesota Health Care Programs (MHCP)

Enrollment in Medicare Part D is not required as a condition of MA eligibility. However, there are specific rules established for clients eligible for Medicare Part D who fail or refuse to enroll in, or opt out of, that program.

Federally and state-funded MA programs cannot pay prescription drug costs that would be covered by Medicare Part D for eligible Part D beneficiaries who do not enroll.

Medicare beneficiaries enrolled in federal and state-funded MA will not have prescription drug coverage, other than the limited categories of drugs that these programs continue to cover, if they do not have other creditable drug coverage and they:

l Are not enrolled in a Medicare Part D plan or Medicare Advantage Plan that includes Part D coverage.

l Do not enroll in a Medicare Part D plan or a Medicare Advantage Plan that includes Part D coverage.

Example:
June applies for and is approved for MA in April. She is eligible to enroll in Medicare Part D but has chosen not to enroll.

Action:
Claims submitted to DHS for drug expenses covered by Medicare Part D will be denied. June should contact the Senior LinkAge Line® or Medicare to enroll in a Medicare Part D plan if she wants her drug costs covered.

MA will pay for some specific drugs prescribed for Medicare beneficiaries, such as over-the-counter drugs that are not covered under Medicare Part D. For information about MA covered services, clients can contact the MHCP Member Helpdesk at (800) 657-3739.

The MMIS User Services Help Desk identifies MA enrollees each month who become entitled to Medicare and sends a Benefit Change Notice about the reduction in MA prescription drug coverage once a person qualifies for Medicare Part D.

l The MMIS User Services Help Desk sends the Benefit Change Notice to the enrollee and enters a MAXIS case note.

l Workers will receive a copy of the Benefit Change Notice from the MMIS User Services Help Desk through interoffice mail.

l Encourage clients to enroll in a Medicare Part D plan as soon as possible after receiving the Benefit Change Notice, unless they have creditable drug coverage, to continue prescription drug coverage after the effective date of the MA benefit change with limited disruption.

l Enrollees have the right to appeal these benefit changes. Enrollees may be able to continue prescription drug coverage through MA during the appeal process if they appeal before the effective date of the change, or within ten days of receiving the Benefit Change Notice.

n an enrollee appeals the change in prescription drug coverage. The first line of the description should be ”Medicare Part D Appeal.”

n an appeal has been decided. The first line of the description should be ”Medicare Part D Appeal Update.”

MA and Medicare Savings Programs (MSP) enrollees who qualify for Medicare Part D are automatically eligible for the Extra Help subsidy.

Note: Enrollees who are not enrolled in a Medicare Part D Benchmark Plan may want or need to switch to a benchmark plan to avoid the monthly Part D premium cost.

State-Funded MA and MinnesotaCare

State-funded MA enrollees with Medicare and MinnesotaCare enrollees who will qualify for Medicare due to turning age 65 or reaching the end of the 24-month waiting period for Medicare as a disabled person are not:

These people must apply for Extra Help through the SSA to receive subsidies for Part D cost-sharing expenses. See Medicare Part D for more information on how a person can apply for Extra Help.

l Do not use the premium amount or cost-sharing amounts paid by Extra Help as either of the following:

l Do permit the premium amount or cost-sharing amounts, such as copays paid by the applicant or enrollee, as medical expenses to meet a spenddown or as a deduction on a long-term care income calculation.

Note: Amounts that an enrollee pays out of pocket for non-benchmark Medicare Part D plans may be used as a medical expense to meet a spenddown or as a deduction on a long-term care income calculation, since they will not be paid by the Extra Help subsidy. The amounts in excess of the benchmark premium change each year, as the plan offerings, the benchmark amount, and the plan prices change. See "2015 Amounts in Excess of Medicare Part D Benchmark to Apply as Medical Expense".

See Medicare Part D Benchmark Plan for more information on plans available to clients receiving Extra Help and the benchmark premium costs.

Clients enrolled in Minnesota Senior Health Options (MSHO) or Special Needs Basic Care (SNBC) who are eligible for Medicare are full benefit dual eligibles. All plans for MSHO and SNBC are benchmark Medicare Part D plans with fully subsidized Extra Help.

l disenroll from MSHO or SNBC must sign up for a new Medicare Part D plan before they disenroll, or they may have a gap in their prescription drug coverage.

l enroll in another Medicare Part D plan will be automatically disenrolled from MSHO or SNBC.

MSHO enrollees may need to re-establish home and community-based services managed through the county if they are not required to enroll in managed care for Medical Assistance.

MSHO and SNBC enrollees whose MA eligibility is closed may continue to receive Medicare Part D and other Medicare benefits through the MSHO or SNBC plan for up to three calendar months. Clients who enroll in a Medicare Part D plan prior to three calendar months will receive Part D benefit coverage through the chosen plan.

Chapter 04 - Social Security Administration (SSA) Benefits	Effective: December 1, 2014
04.45.05 - Medicare Part D and Minnesota Health Care Programs (MHCP)	Archived: June 1, 2016 (Previous Versions)