Florida ADAP Premium/Plus AIDS Drug Assistance Program
Client’s Frequently Asked Questions -MEDICARE PART D/TrOOP
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In order to receive Medicare Part D coverage, persons who are eligible to receive Medicare must sign up for a prescription drug plan (PDP) that is either stand-alone or offered through a Medicare Advantage plan. Part D provides an outpatient prescription drug benefit for anyone
receivine Part A or enrolled in Part B.
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1. What is TrOOP?True out-of-pocket (TrOOP) costs are expenses
that count toward your Medicare drug plan out-ofpocket
costs of $4,550 (for 2010 and 2011).
2. What is Low-Income Subsidy (LIS)Low-Income subsidy is also known as “extra help”.
It lowers the costs of your Medicare prescription
drug coverage. If you are eligible to receive
Medicare, you should apply for LIS.
3. How do I qualify for the Low-Income Subsidy
(LIS)? You may be able to get extra help to pay
for your monthly premiums, annual deductibles,
and co-payments related to the Medicare
Prescription Drugs. You must be enrolled in a
Medicare Prescription Drug plan to get this extra
help. For more information call Social Security tollfree
at 1-800-772-1213 (TTY 1-800-325-0778) or
visit: http://www.socialsecurity.gov .
Your case manager or ADAP contact in your area
may be able to assist.
4. When will ADAP dollars be eligible to count
towards TrOOP?Beginning January 1, 2011.
5. Will I be able to remain in ADAP if I cannot
afford to access (i.e., pay deductibles or
co-pays) my Medicare benefits?Yes. ADAP will continue to serve you if you cannot
afford to access your Medicare plan.
6. If ADAP count towards TrOOP, will ADAP be
able to help me pay my deductible and/or copayments?
In April 2011, ADAP will contract with a provider to
assist with co-payments and possibly deductibles.
7. What are my responsibilities while enrolled as a
client of the ADAP Premium Plus Program?You must pay your deductible and maintain your
plan premiums for Medicare Part D. If you are
unable to cover your deductibles, ADAP will serve
you. See Question 5.
You must apply for the Low-Income Subsidy (LIS),
also known as, Extra Help.
8. What is ADAP Premium Plus?ADAP Premium Plus is a new module within
the ADAP database specifically created to manage
clients with private insurance and Medicare Part D.
9. Will I be able to remain in ADAP after I have
gotten through the Donut Hole?Yes. ADAP will continue to serve as your
medication benefits coordinator.
10. How will I be notified when I reach catastrophic
coverage?Your Medicare Prescription Plan keeps track of
your TrOOP costs. Every month that you buy or
receive prescriptions covered by your plan, you will
get an explanation of benefits (EOB) in the mail
showing your TrOOP costs to date.
11. Will I be terminated from ADAP Premium Plus if
I don’t continue my Medicare Part D premiums?Yes. A client who is eligible must be enrolled in
Medicare Part D in order to continue to receive
ADAP services and assistance with TrOOP.
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For more information regarding Medicare Part D call Social Security toll-free at
1-800-772-1213 (TTY 1-800-325-0778) or visit: http://www.socialsecurity.gov .
Your case manager or ADAP contact in your area may also be able to assist you.
A question? The donut hole this year. When you reach the donut hole this year (2011) will the 50% discount then take place? If so will that 50% plus the 50% you pay out of pocket be counted together as 100%? Therefore, are you spending less out of pocket this year then last? Or, are your out of pocket monies the same and it just takes you longer to get out of the donut hole? Just regular Part D no ADAP.
Regarding Ed’s question,
The 50% brand name discount plus the 50% you pay in the Doughnut Hole do count as 100% toward getting you to Catastrophic, which is the greater of $2.50/$6.30 or 5%.
You also pay 93% of the cost of generic drugs in the doughnut hole with a 7% government subsidy that increases each year.
There is a very good chart of how the doughnut hole will close for both brand and generic drugs at http://www.medicarerights.org/pdf/Closing-the-Doughnut-Hole-Chart.pdf.