If you have Extra Help and do not choose a Part D Part D, also known as the Medicare prescription drug benefit, is the part of Medicare that provides prescription drug coverage. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with a Medicare Advantage Plan. plan, Medicare will automatically enroll you in a benchmark The Extra Help benchmark amount, also known as the Extra Help Premium Amount, is the amount of money that full Extra Help will pay for the monthly premium of a Part D plan that offers basic benefits. Benchmarks vary by state, and if you enroll in a Part D plan with a monthly premium above your state’s benchmark amount, you will have to pay the difference. Part D plan. Benchmark Part D plans have a premium below the specified amount for your state, which means that Extra Help will pay the full cost of your Part D premium. Medicare will send you a notice telling you which plan it enrolled you in and what your costs are. If this plan does not fit your needs, you can choose another plan by calling 1-800-MEDICARE.
Note: In some cases, if you have Medicaid Medicaid is a federal and state program that provides health coverage for certain people with limited income and assets. or a Medicare Savings Program (MSP) Medicare Savings Programs (MSPs), also known as Medicare Buy-In programs, help pay your Medicare costs if you have limited income and savings. There are three main MSPs, each with different benefits and eligibility limits: Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individual (QI) program. The Qualified Disabled Working Individual (QDWI) program is a less common MSP for people who are under 65, have a disabling impairment, and continue to work. and certain kinds of employer, union, or retiree drug coverage, you may not be enrolled in Part D or can ask not to be. You may want to delay Part D enrollment if it would cause you to lose other creditable drug coverage. Contact your local Medicaid office to learn how to decline Part D without losing Medicaid. If you later want Part D, you can enroll at any time without penalty if you are still enrolled in Medicaid or the MSP.
If you have Extra Help, you either applied or you automatically qualified because you have/had Medicaid, Supplemental Security Income (SSI) Supplemental Security Income is a monthly benefit for people with limited incomes and assets who are 65 or older, blind, or have a disability. , or an MSP. In either case, your Part D coverage should begin within two months of your enrollment in Extra Help. During that period, Medicare may enroll you in the Limited Income Newly Eligible Transition (LI NET) program to give you temporary coverage. LI NET must cover all your prescriptions, at any pharmacy, as long as they are not excluded from Part D coverage. When you are at the pharmacy, show the automatic enrollment notice from Medicare (typically a yellow notice) to prove that LI NET should cover you.
- LI NET also offers retroactive coverage back to your Medicaid or SSI start date (so long as you had Medicare then) or to your last enrollment in a Part D plan, whichever is later. For example, if you were approved for Medicaid in April but your Medicaid start date is retroactive to January 1, LI NET provides coverage back to January 1.
- To get reimbursed for payments made during LI NET’s retroactive coverage period, send copies of the following to LI NET:
- Drug receipts
- Proof of your Medicaid or SSI eligibility, or proof of your last Part D enrollment
- And, a prescription drug reimbursement form.
- To get reimbursed for payments made during LI NET’s retroactive coverage period, send copies of the following to LI NET:
If you are charged the wrong copayment or coinsurance at the pharmacy, you may need to show proof, or Best Available Evidence (BAE), that you have prescription drug coverage and Extra Help. Show your pharmacist one of the following as evidence of coverage:
- Medicaid card that shows your name and eligibility date from July through December of the previous calendar year
- Screen print or other state document from Medicaid that shows your active Medicaid status in a month after June of the previous calendar year
- Letter from the Social Security Administration that shows that you receive SSI
- Or, Notice from the Social Security confirming that you automatically qualify for Extra Help
Note that you may be able to use other forms of BAE if you are enrolled in Institutional Medicaid or a home and community-based services Medicaid waiver program.
If you need assistance with LI NET drug coverage, call LI NET’s Help Desk at 1-800-783-1307.