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December 16, 2005
Dear Medicaid-Eligible Recipient:
On November 21, 2005 we notified you of coming changes to your
Medicaid benefits. In that letter we informed you of the following
information.
Beginning on January 1, 2006, Medicare will help pay for your
prescription drugs instead of Medicaid, except for a small number of
drugs not included in the new Medicare drug benefit. This new benefit
is known as Medicare Part D. Medicaid will still pay for your other
health care costs that Medicare does not cover.
Wisconsin Medicaid will only continue to cover certain drugs that
are excluded from Part D coverage. These drugs are benzodiazepines,
barbiturates, and over-the-counter (OTC) drugs currently covered by
Wisconsin Medicaid.
Starting January 1, 2006, you will need to take your Medicare
Part D card to the pharmacy in order to get your prescriptions filled.
Medicare has contracted with private companies to run Medicare Part
D. These private companies are called Medicare drug plans. You may
enroll in the Medicare drug plan of your choice. If you do not choose a
Medicare drug plan on your own, Medicare will enroll you in a plan.
The federal agency that runs the Medicare program sent you a letter
telling you the name of the Medicare drug plan that you will be
enrolled in if you do not choose and join a Medicare drug plan on your
own by December 31, 2005.
Again, we strongly encourage you to look carefully at the
Medicare drug plan that you will be enrolled in to make sure it
covers the drugs you take and that you can get your drugs from a
pharmacy near you. If it does not cover the drugs you take or if you
cannot get your drugs from your preferred pharmacy, you should look at
the other low-cost Medicare drug plans available to you and join a plan
that works best for you. With any of the low-cost plans, you will pay
only a small copayment amount each time you fill a prescription covered
by the plan. You will not pay a monthly premium or a deductible.
For questions about Medicare Part D or Medicare drug plans, you may
contact any of the following:
- The Medicare program at 1-800-MEDICARE (1-800-633-4227) or
www.medicare.gov/.
- Wisconsin Prescription Drug Helpline at 1-866-456-8211 for
Medicare beneficiaries age 60 and older with questions about Medicare
Part D. This Helpline is sponsored by the Coalition of Wisconsin
Aging Groups’ Elder Law Center.
- Disability Drug Benefit Helpline at 1-800-926-4862 for persons
under age 60 who receive Medicare coverage due to a disability. This
Helpline is sponsored by the Wisconsin Coalition for Advocacy.
- Your County Department on Aging if you are age 60 and older and
you would like to speak to an elderly benefit specialist.
We now want you to know that because this change in your
prescription drug coverage from Medicaid to Medicare Part D is based on
a change in the federal law, you may only request a hearing if you
believe the new law does not apply to you. This means that you have a
right to a hearing only if you disagree that you currently receive both
Medicare and Medicaid benefits. If you wish to request a fair hearing
for this reason, you may do so in writing or in person with the
Department of Health and Family Services at the location shown on the
front of this notice. You may also write to the State Department of
Administration, Division of Hearings and Appeals, PO Box 7875, Madison,
WI 53707. Your request must be received by February 14, 2006. If you
file your request for a hearing before January 1, 2006, the Division of
Hearings and Appeals will determine if your Medicaid drug coverage
should continue during your appeal.
If you have any questions about your Medicaid coverage or hearing
rights, please contact Recipient Services at 1-800-362-3002 or
1-608-221-5720.
Sincerely,
Mark B. Moody
Administrator
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