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Full Benefit Medicare-Medicaid Enrollees

Formallly known as "Dual Eligible Population."

The Medicare Modernization Act of 2003 established a Medicare prescription drug benefit called Medicare Part D effective January 1, 2006. An individual is eligible to enroll in a Medicare prescription drug plan if the individual is entitled to Medicare Part A and/or B and permanently resides in the service area of the prescription drug plan. For those who are eligible for Medicare only, enrollment in a prescription drug plan is voluntary.


Individuals who have Medicare and Medicaid (dual eligibles) will be enrolled into a Medicare prescription drug plan by Medicare if they do not select a plan on their own. As of January 1, 2006, Medicaid will not pay for drugs for dual eligibles; except for those drugs listed in the document below.


The Medicare Part D drug program includes a low income subsidy provision. The subsidy assists Medicare beneficiaries with limited financial means in paying for plan premiums and co-payments. Those who have Medicare only must apply for this benefit through the Social Security Administration (1-800-772-1213) or state Medicaid eligibility sites to determine if they qualify. Dual eligibles automatically receive the low income subsidy benefit.


For assistance in enrolling in a Medicare prescription drug plan, individuals can contact Medicare at 1-800-633-4227 or the State Health Insurance Assistance Program at 1-888-696-7213. Other resources include the Medicare and You handbook mailed out each fall to Medicare beneficiaries and the Medicare Web site.


Medicare Excluded Drugs Covered by Medicaid



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