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Can a nursing home resident who is private pay at present, but has Medicare Part B, opt to get a Medicare discount drug card? The resident is currently paying out-of-pocket for all drugs.

Compliance Monitor, September 17, 2004

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Medicare offers three approved prescription drug cards to assist in covering out-of-pocket prescription drug costs for Medicare beneficiaries residing in a nursing home, who get their prescribed medications through the home's contracted long term care pharmacy, and who qualify for a $600 credit. 

The $600 credit cannot be used if Medicare Part A is paying for a resident's stay.

According to CMS, if a resident meets all of the following conditions she should apply for one of these cards and for the $600 annual credit:

1. The resident has Medicare Part A and/or Part B.
2. The resident doesn't have outpatient prescription drug benefits from Medicaid.
3. The resident's stay in the nursing home is not being paid by Medicaid.
4. The resident gets drugs through the nursing home pharmacy, not from an outside source, such as a community pharmacy or mail order.
5. The resident's monthly income is no more than $1,048 if single or no more than $1,406 if married. This means she qualifies for a $600 credit in 2004 and another $600 credit in 2005.

To get one of the three Medicare-approved drug discount cards, the resident should:

• call the company offering the drug discount card through the nursing home pharmacy and ask for enrollment materials.
• fill out the enrollment form for the card and $600 credit.
• send the signed enrollment form with this information to the card sponsor.
• the sponsor will let the resident know whether she is eligible. If she is eligible, she will get a letter and her Medicare-approved drug discount card.
• the card sponsor and pharmacy will apply the $600 credit. The $600 credit cannot be used while Medicare is paying for her stay in the nursing home.
  

Resources:
Fact sheet on the drug discount card and nursing homes: http://www.medicare.gov/MedicareReform/savingsfactsheet.asp  

Guide to Choosing a Medicare-Approved Drug Discount Card: http://www.medicare.gov/Publications/Pubs/pdf/11062.pdf

General Medicare prescription drug card program information: 1-800-MEDICARE (1-800-633-4227); TTY users should call 1-877-486-2048) or http://www.cms.gov/medicarereform/

Prescription Drug & Assistance Program: http://www.cms.hhs.gov/discountdrugs/overview.asp

This question was answered by Maria D. Buckley, of counsel and member of the healthcare and life sciences practice groups at Nutter, McClennen & Fish, LLP, in Boston.

Editor's note: Thanks to all who submitted responses to this week's question. We regret we could only run one.

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