Re: Medicaid medication coverage

February 17, 2011

I just took Bill's medicaid card to Walgreens and haven't paid a penny

since.

In a message dated 2/17/2011 4:05:09 P.M. Central Standard Time,

susiruss@... writes:

My 20 year old son receives SSI and recently receives Medicaid.

How do I get prescription medication coverage from Medicaid?

We have family coverage with my husband's employer, but would like to use

the Medicaid for expensive our of pocket co-pay for his medication.

Anyone been in this situation?

Thank you.

------------------------------------

Groups Links

February 17, 2011

Does your son have Medicare A B and D?Â

From: <susiruss@...>

Subject: Medicaid medication coverage

IPADDUnite

Date: Thursday, February 17, 2011, 10:04 PM

Â

My 20 year old son receives SSI and recently receives Medicaid.

How do I get prescription medication coverage from Medicaid?

We have family coverage with my husband's employer, but would like to use the

Medicaid for expensive our of pocket co-pay for his medication.

Anyone been in this situation?

Thank you.

February 17, 2011

Add Medicaid as secondary insurance for your son at the pharmacy you typically

get scripts filled. We use Walgreens. They asked us to show her Medicaid

'card' (that slip of paper that comes in the mail every month) once, in the very

beginning, but now they must have access to her records thru the computer

because they've never asked us again. Sometimes they ask which insurance to

bill, but mostly they bill directly to Medicaid and then the cost to your son

should be $0.

They will not, so far as I know, pay for the 3-month supplies so many of us came

to love before going on Medicaid. For us, they'll only approve 1 month at a

time for 's meds. And sometimes they refuse to pay for certain

'formularies' (like getting a more expensive liquid form of a certain med

compared to the cheaper pill form) but in general we've felt very fortunate.

Others here have needed to appeal Medicaid decisions, but we have not. So far.

Hope this helps.

From:

Sent: Thursday, February 17, 2011 4:04 PM

IPADDUnite

Subject: Medicaid medication coverage

My 20 year old son receives SSI and recently receives Medicaid.

How do I get prescription medication coverage from Medicaid?

We have family coverage with my husband's employer, but would like to use the

Medicaid for expensive our of pocket co-pay for his medication.

Anyone been in this situation?

Thank you.

February 17, 2011

I would agree with Laurie--can't remember the last time we showed his card to

Walgreens.

The cost should be $0 BUT occasionally, we've had to pay a co-pay. With

Medicaid, they always go with the generic BUT if the medication is only

available as a name brand, they charge a co-pay. Our co-pay was $3. Since he

isn't taking that med any longer, no co-pay.

Marie

>

> Add Medicaid as secondary insurance for your son at the pharmacy you typically

get scripts filled. We use Walgreens. They asked us to show her Medicaid

'card' (that slip of paper that comes in the mail every month) once, in the very

beginning, but now they must have access to her records thru the computer

because they've never asked us again. Sometimes they ask which insurance to

bill, but mostly they bill directly to Medicaid and then the cost to your son

should be $0.

>

> They will not, so far as I know, pay for the 3-month supplies so many of us

came to love before going on Medicaid. For us, they'll only approve 1 month at

a time for 's meds. And sometimes they refuse to pay for certain

'formularies' (like getting a more expensive liquid form of a certain med

compared to the cheaper pill form) but in general we've felt very fortunate.

>

> Others here have needed to appeal Medicaid decisions, but we have not. So

far.

>

> Hope this helps.

>

> From:

> Sent: Thursday, February 17, 2011 4:04 PM

> IPADDUnite

> Subject: Medicaid medication coverage

>

> My 20 year old son receives SSI and recently receives Medicaid.

>

> How do I get prescription medication coverage from Medicaid?

> We have family coverage with my husband's employer, but would like to use the

Medicaid for expensive our of pocket co-pay for his medication.

>

> Anyone been in this situation?

> Thank you.

>

February 18, 2011

We have both private insurance and Medicaid for our sons with disabilities.

With doctor/clinics, the private insurance is billed first and then Medicaid

pays whatever they will pay, which takes care of the copays (assuming the doctor

takes Medicaid.)

For medication, it works the other way. Medicaid is primary and we only use the

private insurance for the one medication not covered by Medicaid. (It isn't

covered because it is available over the counter.) Occasionally there are

glitches, but they are easily resolved, but I wanted to point out that Medicaid

is the PRIMARY coverage for medication, (based on insurance regulations?); it is

not a choice given to consumers.

Pam/Chicago

>

> I just took Bill's medicaid card to Walgreens and haven't paid a penny

> since.

>

> In a message dated 2/17/2011 4:05:09 P.M. Central Standard Time,

> susiruss@... writes:

>

> My 20 year old son receives SSI and recently receives Medicaid.

>

> How do I get prescription medication coverage from Medicaid?

> We have family coverage with my husband's employer, but would like to use

> the Medicaid for expensive our of pocket co-pay for his medication.

>

> Anyone been in this situation?

> Thank you.

>

> ------------------------------------

>

> Groups Links

>

February 18, 2011

I don't think you can choose the order of insurance...I believe Medicaid

will always be 'secondary', with ANY private coverage being 'primary'...just

went through this..not sure how the pharmacy secondary coverage would work,

if at all.

Al

On Thu, Feb 17, 2011 at 4:24 PM, Shirley Linden <slpanda2@...>wrote:

>

> Does your son have Medicare A B and D?

>

> From: <susiruss@...>

> Subject: Medicaid medication coverage

> IPADDUnite

> Date: Thursday, February 17, 2011, 10:04 PM

>

> My 20 year old son receives SSI and recently receives Medicaid.

>

> How do I get prescription medication coverage from Medicaid?

> We have family coverage with my husband's employer, but would like to use

> the Medicaid for expensive our of pocket co-pay for his medication.

>

> Anyone been in this situation?

> Thank you.

>

February 18, 2011

Medicaid, by definition, is always the payor of last resort.

At an Illinois acute care hospital, any commercial insurance or Medicare is

primary. Medicaid always pays last.

At a physician, any commercial insurance or Medicare is primary. If the doctor

accepts Medicaid, then Medicaid will pay.Â Currently,Â if you are over 18 years

old, there is a $2Â co-pay for the dr visit. Â If the doctor does NOT accept

Medicaid, the co-payment that the insurance or Medicare will need to be paid.

IL Pharmacies,Â they do NOTÂ like toÂ bill more than one insurance. The rules

state that they should be billing both but, in practice, they do not. The rules

state that the commercial insurance or Medicare is primary. Since pharmacies

tend not to want to bill 2 insurances, most people like Medicaid's co-pays for

drugs (currently $0 for generic and $3 for name brand) so they use the Medicaid

first. What will happen is that we pay the nicer co-pays but then Medicaid goes

after reimburesement from the commercial insurance. There is actually a whole

department in Springfield that contacts health insurance companies and Medicare

for reimbursement.

Hope this helps.

-Sherri

________________________________

From: Pamela <psc1106@...>

IPADDUnite

Sent: Fri, February 18, 2011 9:34:27 AM

Subject: Re: Medicaid medication coverage

Â

We have both private insurance and Medicaid for our sons with disabilities. With

doctor/clinics, the private insurance is billed first and then Medicaid pays

whatever they will pay, which takes care of the copays (assuming the doctor

takes Medicaid.)

For medication, it works the other way. Medicaid is primary and we only use the

private insurance for the one medication not covered by Medicaid. (It isn't

covered because it is available over the counter.) Occasionally there are

glitches, but they are easily resolved, but I wanted to point out that Medicaid

is the PRIMARY coverage for medication, (based on insurance regulations?); it is

not a choice given to consumers.

Pam/Chicago

>

> I just took Bill's medicaid card to Walgreens and haven't paid a penny

> since.

>

> In a message dated 2/17/2011 4:05:09 P.M. Central Standard Time,

> susiruss@... writes:

>

> My 20 year old son receives SSI and recently receives Medicaid.

>

> How do I get prescription medication coverage from Medicaid?

> We have family coverage with my husband's employer, but would like to use

> the Medicaid for expensive our of pocket co-pay for his medication.

>

> Anyone been in this situation?

> Thank you.

>

> ------------------------------------

>

February 19, 2011

So Sherri, then if your child has Medicaid, and is covered under a private

insureance as well (BCBS), then you are saying it is " legal " , to use the

Medicaid for MEDICATIONS/ PHARMACY benefits?

Diane S.

> >

> > I just took Bill's medicaid card to Walgreens and haven't paid a penny

> > since.

> >

> > In a message dated 2/17/2011 4:05:09 P.M. Central Standard Time,

> > susiruss@ writes:

> >

> > My 20 year old son receives SSI and recently receives Medicaid.

> >

> > How do I get prescription medication coverage from Medicaid?

> > We have family coverage with my husband's employer, but would like to use

> > the Medicaid for expensive our of pocket co-pay for his medication.

> >

> > Anyone been in this situation?

> > Thank you.

> >

> > ------------------------------------

> >

February 20, 2011

It's really wrong for the pharmacy NOT to bill two insurances.

I know that many people use Medicaid as primary at the pharmacy - eventhough

Medicaid is always the payor of last resort - by definition.

If this happens, Medicaid will pursue reimbursement from the commercial

insurance if Medicaid knows about the commercial insurance.

This can be easily known:

Look at your Medi-plan slip. Turn it to the side without your address. On the

right side of this slip, it should have:

TPL ____.Â Â Â Â This means ThirdÂ Party Liability. The numbers after the " L "

Â indicate which insurance you have. Â

It is very important for your card to reflect TPL if you have commercial

insurance -especially now with Medicaid going HMOish. My understanding is that

if you have Medicare OR a commercial insurance, you do not need to enroll in the

integated (managed) care program. This is the main way that Medicaid knows you

have another coverage. If you have changed insurance carriers, you must let

Medicaid know who the current carrier is so that the code is for your current

carrier.

________________________________

From: swedegrl2005 <swedegrl@...>

IPADDUnite

Sent: Sat, February 19, 2011 11:25:30 PM

Subject: Re: Medicaid medication coverage

Â

So Sherri, then if your child has Medicaid, and is covered under a private

insureance as well (BCBS), then you are saying it is " legal " , to use the

Medicaid for MEDICATIONS/ PHARMACY benefits?

Diane S.

> >

> > I just took Bill's medicaid card to Walgreens and haven't paid a penny

> > since.

> >

> > In a message dated 2/17/2011 4:05:09 P.M. Central Standard Time,

> > susiruss@ writes:

> >

> > My 20 year old son receives SSI and recently receives Medicaid.

> >

> > How do I get prescription medication coverage from Medicaid?

> > We have family coverage with my husband's employer, but would like to use

> > the Medicaid for expensive our of pocket co-pay for his medication.

> >

> > Anyone been in this situation?

> > Thank you.

> >

> > ------------------------------------

> >

February 20, 2011

Sherri, you are truly a wealth of helpful and interesting information. Thanks.

I had no idea about this, but it may help explain what happened to us last week.

's been taking Risperdal/Risperdone for about 10 years. She's always

gotten it in the liquid formulation, because she doesn't swallow pills, she

chews them, or I crush them, and her doctor thought with this med she was better

off not doing that. (She takes others that we DO crush, in yogurt, no problem

-- what a trooper!). Anyway, what happened last week for the very first time is

Walgreens called me and said 'Medicaid is refusing to pay, they're telling us to

submit it to your private insurance'. Which for us cost about $450 for a

one-month supply (we're on a high deductible policy which means we pay

out-of-pocket the first $6,000/year). Now the pharmacist tells me Medicaid is

refusing to allow a refill for a different med (again, that she's been on for

maybe 4 years) and that they've been paying for since she turned 18, no problems

or questions asked. They told the pharmacy on that refill, 'send it to the

private insurance' too.

So, all, it appears that what Sherri says is absolutely true and I was wrong in

earlier posts to suggest you just use your Medicaid at the pharmacy (if your

loved one is also covered under another insurance plan, that is). We learn

something new everyday, don't we?

Laurie

From: Sherri Schneider

Sent: Sunday, February 20, 2011 6:31 PM

IPADDUnite

Subject: Re: Re: Medicaid medication coverage

It's really wrong for the pharmacy NOT to bill two insurances.

I know that many people use Medicaid as primary at the pharmacy - eventhough

Medicaid is always the payor of last resort - by definition.

If this happens, Medicaid will pursue reimbursement from the commercial

insurance if Medicaid knows about the commercial insurance.

This can be easily known:

Look at your Medi-plan slip. Turn it to the side without your address. On the

right side of this slip, it should have:

TPL ____. This means Third Party Liability. The numbers after the " L "

indicate which insurance you have.

It is very important for your card to reflect TPL if you have commercial

insurance -especially now with Medicaid going HMOish. My understanding is that

if you have Medicare OR a commercial insurance, you do not need to enroll in the

integated (managed) care program. This is the main way that Medicaid knows you

have another coverage. If you have changed insurance carriers, you must let

Medicaid know who the current carrier is so that the code is for your current

carrier.

________________________________

From: swedegrl2005 <swedegrl@...>

IPADDUnite

Sent: Sat, February 19, 2011 11:25:30 PM

Subject: Re: Medicaid medication coverage

So Sherri, then if your child has Medicaid, and is covered under a private

insureance as well (BCBS), then you are saying it is " legal " , to use the

Medicaid for MEDICATIONS/ PHARMACY benefits?

Diane S.

> >

> > I just took Bill's medicaid card to Walgreens and haven't paid a penny

> > since.

> >

> > In a message dated 2/17/2011 4:05:09 P.M. Central Standard Time,

> > susiruss@ writes:

> >

> > My 20 year old son receives SSI and recently receives Medicaid.

> >

> > How do I get prescription medication coverage from Medicaid?

> > We have family coverage with my husband's employer, but would like to use

> > the Medicaid for expensive our of pocket co-pay for his medication.

> >

> > Anyone been in this situation?

> > Thank you.

> >

> > ------------------------------------

> >

February 21, 2011

Whoa, okay wait. Sometimes I guess I can be very simple minded in certain

areas. Please someone break this down for me into the simplest of actual

physical steps for me, if you would be so kind.

Ok, so I have Medicaid for my 18 y.o son. I also have 2 additional primary

insurances (primary his dad's, and mine aside from the Medicaid. So when I

wanna go pick up ERic's meds I is very expensive- Abilify; how does this work

then? Am I paying the copay or price after it's run through the insurance, or

am I getting reimbursed the rest from the secondary insurance and then through

the Medicais or should Walgreen's be ending it through all these providers and

then cahrging me whatever is left? I'm confused!

Obviously I can't direct Walgreen's what to do or what they should do if they

try to weasle out the quick easy way, b/c I don't know how to explain the

process to them. HELP!!!!!!!

Diane S.

> > >

> > > I just took Bill's medicaid card to Walgreens and haven't paid a penny

> > > since.

> > >

> > > In a message dated 2/17/2011 4:05:09 P.M. Central Standard Time,

> > > susiruss@ writes:

> > >

> > > My 20 year old son receives SSI and recently receives Medicaid.

> > >

> > > How do I get prescription medication coverage from Medicaid?

> > > We have family coverage with my husband's employer, but would like to use

> > > the Medicaid for expensive our of pocket co-pay for his medication.

> > >

> > > Anyone been in this situation?

> > > Thank you.

> > >

> > > ------------------------------------

> > >

February 27, 2011

THANK YOU, for your comprehensive information!

I will keep you posted!!

March 20, 2011

Thank you for all of your posts.

I brought the new prescriptions to Osco. Osco filled them -- $3 for brand name

and $0 for generic medication.

No problem.

Thanks, again,

>

> THANK YOU, for your comprehensive information!

>

> I will keep you posted!!

>

March 21, 2011

try walgreens also

Re: Medicaid medication coverage

Â

Thank you for all of your posts.

I brought the new prescriptions to Osco. Osco filled them -- $3 for brand name

and $0 for generic medication.

No problem.

Thanks, again,

>

> THANK YOU, for your comprehensive information!

>

> I will keep you posted!!

>

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