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MMA 2003

Information About Enrolling in the Medicare-Approved Prescription Drug Discount Card Program

Please read this information and the instructions accompanying these forms, before applying for a Medicare-approved prescription drug discount card.


The Centers for Medicare & Medicaid Services (CMS) has provided a standard enrollment form for State Health Insurance Assistance Program (SHIP) counselors and other community-based organizations to assist Medicare beneficiaries in enrolling in a Medicare-approved drug discount card. This form is also available directly to beneficiaries on the www.medicare.gov web site. CMS will provide information about Medicare-approved drug discount card sponsors, including contact information, phone and fax numbers, and mailing addresses on the www.cms.hhs.gov web site, and will also provide this information to SHIP counselors and other community-based organizations in your area.

The following are some general questions and answers about the use of this form.

  1. At the top of the form it asks for card sponsor name, product name, and sponsor ID number. Is this information necessary and if so, where do I get it?
  2. Since this form may be returned to any Medicare-approved drug card sponsor, and because some sponsors are offering more than one product, it is important to clearly identify exactly which card you are interested in joining. To ensure you get the card you want, you should complete this section of the form to the best of your ability. Your form will not be rejected if this information is incomplete; however, your enrollment could be delayed as the sponsor will have to contact you to determine which card you really want.

  3. The enrollment form for the Medicare-Approved Drug Discount Card AND additional assistance in Paying for Your Prescription Drugs asks to record the enrollment fee of the card I am applying to. I thought there was no enrollment fee if I qualify for this additional assistance. What do I write down for that item?
  4. If you qualify for the additional credit of up to $600 in additional assistance Medicare will pay the enrollment fee for you. Some drug card sponsors are offering more than one product and these different products often have different enrollment fees, ranging from $0.00 - $30.00. By indicating the enrollment fee associated with the card product you have chosen, you will help ensure the sponsor receiving your enrollment form will know exactly what you want. Again, you do not have to pay the annual enrollment fee if you qualify for the additional credit of up to $600; Medicare pays this fee, if any, for you.

  5. Can you explain the statements in Step One of the drug card enrollment forms?
  6. To be eligible to enroll in a Medicare-approved drug discount card, you must have Medicare Part A or Medicare Part B, or both and you cannot have outpatient prescription drug benefits under your State Medicaid program at the time you enroll.

    So, you should answer the first two questions on the enrollment form as shown below:

    "I have Medicare Part A or Medicare Part B: yes or no."

    • If this sentence is true and you have Medicare Part A and/or Medicare Part B, answer "yes."


    • If you do not have either Part A or Part B of Medicare, answer "no."

    "I do not have outpatient prescription drug benefits under my State Medicaid program."

    • If this sentence is true and you do not have outpatient prescription drug benefits under your State Medicaid program, answer "yes" to this question.


    • If this statement is false and you do have outpatient prescription drug benefits under Medicaid, answer "no" to this question.

    If you get some kind of help with prescription drug costs from your State's pharmaceutical assistance program (such as an annual allowance to help you pay for your drugs), but do not have drug benefits under Medicaid, answer "yes" to this question.

  7. When will enrollment in a Medicare-approved drug discount card become effective?
  8. Enrollment in a Medicare-approved drug discount card, including the $600 credit if applicable, becomes effective on the 1st of the month following the month the sponsor receives a completed enrollment form from an eligible beneficiary. If you are applying near the end of a month, you should consider faxing the enrollment form to the appropriate sponsor to get the soonest possible effective date. (You may want to keep a copy of the form for your records.) Once you have submitted your enrollment form, you must stay with the card you have selected until the next available opportunity to enroll in a different card.

    Once your enrollment form has been processed, the company will send you its Medicare-approved drug discount card. You can start using the card the first day of the following month. For example, if the company receives your completed enrollment form on June 5, 2004, you can start using your Medicare-approved drug discount card on July 1, 2004.

  9. When can I change cards?
  10. Generally, once you have submitted your enrollment form to the Medicare-approved drug discount card sponsor you must remain enrolled in that card for the rest of the year. From November 15, 2004 through December 31, 2004 you may switch to another card, which will become effective on January 1, 2005.

    There are some special circumstances in which you may disenroll from your current card and enroll in another one during the year. These are:

    • If you move out of the service area of your current discount card
    • If you enter or leave a long-term care facility (like a nursing home)
    • If you enroll in or disenroll from a Medicare managed care plan
    • If the discount card you are currently enrolled is no longer offered.

    In 2004, if you choose to leave the discount card you are currently enrolled in for any reason other than those listed above, you can only apply for a new discount card between November 15 and December 31, 2004, which you can begin using on January 1, 2005.

    In 2005, if you choose to leave the discount card you are enrolled in for any reason other than those listed above, you cannot apply for a new discount card.

  11. I am enrolled in a Medicare managed care plan. Can I enroll in a drug card with the standard form?
  12. You should call your Medicare Managed Care plan (or check the information available on www.medicare.gov) to see if it offers a Medicare-approved drug discount card only to its plan members. If it does, you can choose to join only this discount card and cannot use this form.

    If your Medicare Managed Care plan does not offer a drug card, you may use this form to enroll in a drug card program that serves the area in which you live.

  13. I am enrolled in my State's Pharmacy Assistance Program (SPAP). Can I enroll in a drug card?
  14. Some states are making enrollment in a Medicare-approved drug discount card even easier for beneficiaries enrolled in SPAPs. At this time, we are working with Connecticut, Maine, Massachusetts, Michigan, New Jersey, New York, Ohio, Pennsylvania, and Rhode Island to make it easier for beneficiaries enrolled in these programs. You should contact your SPAP for information before applying.


Page Last Updated: May 20, 2004

 

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