New York Medicaid and Medicare Part D: Working Together

The state of New York has several major public health insurance programs, including Medicaid, commonly known as “Regular Medicaid.”

While Regular Medicaid in New York offers extensive health care services including: dental care; diagnostic testing; home care; hospitalization; mental health support; out-patient care at hospitals and community clinics; and physical therapy, clients of Medicaid in New York must receive their prescription drugs via Medicare Part D.

Any individual currently receiving or about to begin receiving New York State Medicaid must join a Medicare prescription drug plan, or they will lose their Medicaid benefits. When an individual becomes eligible for both Medicare and Medicaid, he or she will automatically be assigned to a Medicare Prescription Drug Plan in order to not miss even one day of coverage. Though a prescription drug plan is mandatory, enrollment in Medicare Part D is not; enrollment in another plan which better meets prescription drug needs is allowed. Patients are able to switch to another plan at any time.

Typically, as part of Medicare Plan D, the patient must pay a nominal amount, like a copayment, for the medication. Individuals who have full coverage from Medicaid while living in a residential home, an adult living or assisted living facility will likely be required to pay a small medication copayment for each  medication. If an individual has full Medicaid coverage and resides in a nursing home, he or she will not be required to pay anything for covered prescription drugs.

Medicare’s State Pharmacy Assistance Program (SPAP) for prescription drug coverage is determined by each state.  New York State’s Medicare’s State Pharmacy Assistance Program may determine that a patient should receive additional coverage when they join the Medicare Prescription Drug Plan, or may require the patient to enroll in a separate state program for prescription payment assistance.

Clients of New York Regular Medicaid must receive health care services through their managed care plan. Regular Medicaid in New York is available to single adults, childless couples at lower income levels, caretaker adults, the elderly, the disabled, and children, subject to some restrictions. Regular Medicaid may also provide retroactive coverage.

 

For more information, visit www.elderlawnewyork.com.

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