March 17, 2006 Kidney Health Care (KHC) Program Benefit Notice
Your selection indicates you are a Medicare beneficiary and you have been receiving some of your prescription drugs through the State of Texas Kidney Health Care Program. The information presented in this section of the Web site addresses your specific situation as it relates to the Medicare Part D prescription drug program. More detailed information is available at the website for the Texas Department of State Health Services.
Beginning January 1, 2007, the Kidney Health Care Program began coordinating drug benefits with the new Medicare Part D prescription drug program for all recipients who were eligible for Medicare. Once you become eligible for Medicare, Medicare will be your primary source for drug coverage. At that point, the Kidney Health Care Program will no longer be the primary payer for your prescription drugs.
If you are not a Medicare beneficiary, the Medicare Part D coverage will not apply to you. The Kidney Health Care Program will continue to cover four of your prescription drugs per month.
Click on the question below to get further information or just scroll down and read.
What does this mean for me?
What do I need to do?
Will there be out-of-pocket costs?
What prescription drug plans are covered by "extra help?"
What is covered under Medicare Part D prescription drug coverage?
How can I get more information?
What does this mean for me?
Medicare Part D prescription drug coverage is an opportunity for you to have full prescription drug coverage. If you are eligible for Medicare, the Kidney Health Care Program requires that you enroll in a Medicare Part D prescription drug plan. The Kidney Health Care Program also requires that you apply for the extra financial help from the Social Security Administration to determine if you are eligible for this benefit. You can get an application to apply for extra help by calling 1-800-772-1213 or go to www.socialsecurity.gov and click on the link “Medicare Prescription Drug Plan.” You will receive a letter in the mail telling you if you qualify for this extra help.
But remember, whether you qualify for the extra help or not, you will still need to enroll in a Medicare Part D plan unless you have private drug insurance.
The Kidney Health Program will not provide assistance to recipients who already have private drug insurance, or to those who enroll in a Medicare Advantage Plan.
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What do I need to do?
Watch your mail and be on the lookout for information about Medicare Part D and the various prescription drug plans available in Texas. Compare and choose one of these plans that covers the prescriptions you need. If you have questions about this, please call 1-800-MEDICARE (1-800-633-4227) or talk to your social worker or dialysis or transplant coordinators for assistance.
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Will there be out-of-pocket costs?
All plans will have out-of-pocket costs, including the monthly premium, a yearly deductible, co-payments and coinsurance. There is also a period of time called the “gap” or “donut hole” during which Medicare will not pay for prescription drugs.
The Kidney Health Care Program will provide limited assistance for these costs. The Kidney Health Care Program will assist you with your Part D deductible and coinsurance, as well as drugs that are excluded from Medicare coverage, such as vitamins and over the counter products, if they are on the Kidney Health Care Program formulary. The Kidney Health Care Program will also pay for four medications per month during time that you are in the “gap” or “donut hole” if those drugs are on the Kidney Health Care Program formulary.
The Kidney Health Care Program also will coordinate with Medicare to help you pay for your Part D premiums up to $35 a month, minus any subsidized amount.
Remember that you must apply for extra help from the Social Security Administration before the Kidney Health Care Program will assist you with these costs.
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What prescription drug plans are covered by "extra help?"
For more information about these plans and others that are available to you, please contact your renal social worker or view the list of plans on this website.
Basic-level Medicare Part D prescription drug plans available in Texas
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What is covered under Medicare Part D prescription drug coverage?
Most of the prescription drugs you are taking now should be covered under the Medicare Part D prescription drug program. There are certain drugs that will not be covered, including over-the-counter medications, sedatives, and anti-anxiety agents. However, there will be no limit to the number of monthly prescriptions you can get under the Medicare Part D program.
If you get your immunosuppressive drug (ISD) coverage through Medicare Part B, your coverage will not change - you will continue to receive your ISDs from Medicare Part B.
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How can I get more information?
You will receive detailed information in the mail about your choice of Medicare Part D prescription drug plans available in your area. You may also receive mail from companies promoting their Medicare-affiliated drug plans. It is important you review this information carefully and make sure the drug plan you choose covers the prescription drugs you need.
For more information on who can get extra help with Medicare Part D prescription drug costs and how to apply, call the Social Security Administration at 1-800-772-1213, or visit www.socialsecurity.gov on the Web. TTY users should call 1-800-325-0778.
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- Key information for beneficiaries of the Kidney Health Care Program
- Visit the Kidney Health Care Program website
- Use the Medicare Prescription Drug Plan Finder
- Call 1-800-MEDICARE (1-800-633-4227)
- TTY users call 1-877-486-2048
