Is there financial assistance for prescriptions co-pays?

1 answer | Last updated: Sep 14, 2017
A fellow caregiver asked...

We now have my dad on Medicaid. He is in a nursing home. My mother is still paying for medications that his union insurance doesn't pay, around $350.00 per month. She can't afford to do that. What do we do?

Expert Answers

If your father is on Medicaid in a nursing home, there is no reason for him to have to pay these high drug costs. If he is also enrolled in Medicare, he is eligible for a Medicare Part D prescription drug plan. Medicaid will pay the monthly premium for that drug plan, and will pay most of the cost of any copayments. The only restriction on his choice of plans is that he must enroll in a plan that Medicaid participates in -- Medicaid doesn't pay for the higher-cost plans. When choosing a Medicare Part D plan, though, he has to make sure that the plan covers all the particular drugs he regularly takes. Once he's enrolled in a Medicare Part D plan plus Medicaid, his out-of-pocket drug costs should be very low.

Even if your father is not enrolled in Medicare, his Medicaid coverage by itself should cover most of the cost of his prescription drugs. You should talk to your father's Medicaid case worker about enrolling him in a Medicare Part D plan (if he's a Medicare beneficiary) or having Medicaid directly cover his drug costs if he's not enrolled in Medicare. You can also talk to the ombudsman at the nursing home, who can help connect you with the right Medicaid person. Finally, you can get free help from an experienced counselor at a local office of the State Health Insurance Assistance Program (SHIP), in some states called the Health Insurance Counseling and Advocacy Program (HICAP). These counselors can help you choose among different Medicare Part D prescription drug plans available to a dual Medicare-Medicaid beneficiary.