Your selection indicates you are a Medicare beneficiary and you have been getting mental health (MH) prescription drugs or HIV prescription drugs through a State of Texas assistance 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.
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?
All Medicare beneficiaries are eligible for the new Medicare Part D prescription drug program. Medicare Part D represents an opportunity for you to have a full prescription drug benefit that will cover other medications in addition to the mental health or HIV medications the Department of State Health Services (DSHS) or community organizations may be helping you with.
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What do I need to do?
For now, watch your mail and look for information about Medicare Part D and the various drug plans available in the program. Three months before you become eligible for Medicare, you should receive an enrollment packet, “Welcome to Medicare.” This packet will explain how to enroll in a Medicare Part D plan. Your opportunity to enroll in one of the Medicare prescription drug plans will begin when you receive the “Welcome to Medicare” packet in the mail.
If you have private drug coverage you will have to review your coverage and decide if your private insurance or a Medicare Part D prescription drug plan is the best for you.
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Will there be out-of-pocket costs?
For most people there will be some out-of-pocket costs, however, for people with very low incomes extra financial help is available through the Social Security Administration. You can get an application for extra help online or call 1-800-772-1213 and ask that one be sent to you. TTY users should call 1-800-325-0778. If you apply, you will be sent a letter in the mail telling you if you qualify. If you don’t qualify for extra help, enrolling in a Medicare Part D prescription drug plan may still save you money on prescription drugs. Also, the MH or HIV clinic you use may assist you with your out-of-pocket expenses.
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What prescription drug plans are covered by "extra help?"
In Texas, there are 12 basic-level Medicare Part D prescription drug plans that have monthly premiums fully covered by the low-income subsidy otherwise known as "extra help." If you qualify for the full low-income subsidy and select and enroll in one of these 12 basic-level plans, you will pay no monthly premium. If you select a plan that is not one of the 12 basic-level plans, you will be responsible for paying a portion of the monthly premium.
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?
Medicare will cover most of your necessary prescriptions. Specific information on the prescription medicines each drug plan covers is available from the plan itself. All Medicare Part D prescription drug plans must cover “all or substantially all” drugs in key categories such as antidepressants, antipsychotics, anticonvulsants, anticancer, immunosuppressants, and HIV/AIDS categories of drugs. There are certain categories of drugs Medicare Part D will not cover including over-the-counter medications, barbiturates (sedatives), and benzodiazepines (anti-anxiety agents). There will be no monthly limits to the number of prescriptions you can get through your Medicare Part D prescription drug coverage.
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How can I get more information?
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.
Individuals who are currently receiving assistance with their HIV medications from the Texas HIV Medication Program (THMP) can contact the program directly at 1-800-255-1090 or visit the Texas HIV Medication Program (THMP) website for additional information.
Individuals who are eligible to receive community health services may also qualify for assistance in getting their medications. Click here to find services in your area.
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In the meantime you can also:
- Look at the "Medicare and You 2007" handbook
- Use the Medicare Prescription Drug Plan Finder
- Call 1-800-MEDICARE (1-800-633-4227).
- TTY users call 1-877-486-2048.
