Persons receiving both Medicare and Medicaid are called dual-eligibles. If this applies to you, you need to apply to enroll in a Prescription Drug Plan if you are not already enrolled in one. Otherwise, you will be randomly assigned to a plan that has a monthly premium set at or below the average premium for plans available in Illinois.
If you do not receive Medicaid, but you do receive SSI or help from the State paying your Medicare expenses through the Qualified Medicare Beneficiary Program (QMB), or one of the other Medicare savings programs, you can apply to enroll in a Prescription Drug Plan when your SSI or QMB becomes effective. Otherwise, when your SSI or QMB becomes effective, you will be assigned randomly to a plan that has a monthly premium set at or below the average premium for plans available in Illinois.
Your coverage will begin on the first day of the month after the month you join.
If you have other prescription drug coverage
If you already have prescription drug coverage through an employer or union, check with your plan administrator to learn how your plan coordinates with Part D. You need to learn whether your drug coverage is at least as good as Medicare’s standard drug coverage (creditable coverage).
If you continue to have employee or retiree prescription drug coverage, you have 3 choices:
- If your plan covers as much as or more than Medicare’s standard drug plan, you can keep it and not buy Medicare drug coverage. You can later enroll in a Medicare Part D plan without paying the penalty described above, as long as you enroll within 63 days of losing or dropping your coverage.
- If your plan covers less than Medicare’s standard drug plan, you can drop it and buy Medicare drug coverage. Be sure to find out if you can drop your current drug coverage without losing needed health benefits. Also keep in mind that if you drop your employer-based coverage, you may not be able to get it back. If you drop coverage for yourself, you may also have to drop coverage for your spouse and dependents.
- If your plan will work with Medicare’s drug coverage, you can keep it and buy Medicare drug coverage, as well.
If you have creditable coverage, do not sign up for Medicare Part D unless you have received one-on-one, trustworthy counseling from SHIP, or another reliable source. Enrolling in Medicare Part D may terminate your current prescription drug coverage, and you may risk losing your retiree or supplemental general health coverage as well.
Costs for dual-eligibles in long term care
If you are dual-eligible, you will not pay any cost sharing in your Medicare PDP if you live in a Long Term Care (LTC) Facility. This means that in addition to not having to pay a premium or a deductible, you will not have to pay any co-payments, either. Medicare pays for it all.
For purposes of Medicare drug coverage, LTC facilities include skilled or unskilled nursing facilities, inpatient psychiatric hospitals, and intermediate care facilities that are residential facilities for developmentally disabled adults (ICF/MR).