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Maryland State Pharmacy Assistance Programs

Maryland Senior Prescription Drug Assistance Program


Eligibility Requirements:
  • Maryland residents enrolled in MedicareRx may be eligible for prescription drug subsidies under the Maryland Senior Prescription Drug Assistance Program (SPDAP).

  • You may be eligible for SPDAP if you are enrolled in a MedicareRx plan or Medicare Advantage Prescription Drug plan.
  • Reside in Maryland for at least 6 months.

  • Have income up to 300% FPL, have no other prescription drug benefits, and are not eligible for full federal extra help with MedicareRx coverage (Low Income Subsidy).
Important Notes:
  • SPDAP will pay up to $50.00 per month for a member’s Medicare Rx prescription drug plan premium, as long as the individual is enrolled in an approved Medicare prescription drug plan or a Medicare Advantage prescription drug plan. There are 58 different prescription benefit plans and Medicare Advantage drug plan options from which to choose. A complete list of Stand Alone Rx Plans may be found here. Follow this link for a complete list of Medicare Advantage Plans.

  • Note: The SPDAP Coverage Gap subsidy was discontinued at the end of 2020.

  • If you are approved in SPDAP, we will notify Medicare of your membership in the program. Medicare will then advise us of the Medicare Rx prescription drug plan or Medicare Advantage Plan in which you are enrolled. This process may take 60 to 90 days. If you wait to enroll in a drug plan, the process will take longer.

  • Once Medicare informs us of the Medicare Rx prescription drug plan or Medicare Advantage Plan in which you are enrolled, we will pay up to $50 for each month after your effective date with SPDAP.

  • DO NOT have your Medicare Rx premium automatically deducted from your Social Security check. If you are currently having your premium deducted from your Social Security Check, contact your Prescription Drug Plan and request direct billing.

  • PLEASE NOTE: SENDING AN INCOMPLETE APPLICATION OR NOT ENCLOSING THE REQUIRED DOCUMENTATION MAY RESULT IN A DELAY AND REDUCTION IN THE AMOUNT OF SPDAP SUBSIDES YOU RECEIVE THIS YEAR.
Contact Information: Phone
(800) 551-5995

Address
Maryland SPDAP

c/o Pool Administrators
628 Hebron Avenue
Suite 212
Glastonbury, CT 06033
» Maryland Senior Prescription Drug Assistance Program




Maryland Kidney Disease Program


Eligibility Requirements: The Kidney Disease Program (KDP) provides reimbursement for approved services required as a direct result of end-stage renal disease (ESRD). KDP eligibility is offered to Maryland residents who are:
  • Citizens of the United States or aliens lawfully admitted for permanent residence in Maryland;
  • Diagnosed with ESRD; and
  • Receiving home dialysis or treatment in a certified dialysis or transplant facility.
Eligibility Requirements: A patient is eligible to request financial assistance from the Kidney Disease Program when he/she begins chronic maintenance dialysis in a certified hospital or certified freestanding dialysis facility, or receives a renal transplant in a certified transplantation center.

Based upon financial information provided by a patient at the time of certification/recertification, the Kidney Disease Program may assess an annual Program participation fee. This fee is based on 5% of the amount by which the family income exceeds 175% of poverty level and/or liquid assets exceed 200% of the poverty level guideline adjusted for the family size. The annual participation fee is due quarterly by specified payment dates. Annual recertification is required in order to maintain continuity of Kidney Disease Program coverage.

Covered services related to ESRD include:
  • Chronic maintenance in-center and home dialysis,

  • Renal transplantation,

  • Approved inpatient and/or outpatient hospital care,

  • Physician fees,

  • Laboratory tests,

    • Prescription and over-the-counter items in the Kidney Disease Program Reimbursable Drug List (for enrollees who are not Medicare beneficiaries),
  • Approved Medicare deductibles and coinsurance.
Program will be the secondary payor for people enrolled in a Medicare Prescription Drug Plan Part A, B & D.
Eligibility Requirements: Phone
(410) 767-5000
(800) 226-2142

Address
Maryland Kidney Disease Program
201 West Preston Street - Room SS-3
Baltimore, MD 21201
» Maryland Kidney Disease Program




Primary Adult Care Program (PAC)


Eligibility Requirements: You may receive health care services from PAC if you:
  • Are a Maryland resident ages 19 and over,

  • Are not on Medicare,
  • Are a U.S. citizen or a qualified alien who meets all requirements for benefits, and
  • Have income below 116% of the Federal Poverty Level (about $13,537 for one person
    or $18,247 for two people).
  • You do not need to have a medical disability to qualify.

  • You may apply for benefits for yourself or for you and your spouse on the same application.
Important Notes: Persons who are not Medicare beneficiaries and are not eligible for full Medicaid benefits may qualify for coverage of pharmacy benefits through the Primary Adult Care program (PAC).

PAC helps low-income individuals, age 19 and older, pay for the full range of pharmacy services covered under the Medical Assistance Program. The PAC program also covers basic health services.

On January 1, 2014, all active PAC particiapnts will automatically receive full Medicaid benefits.
Contact Information: Phone
(800) 226-2142

Address
Primary Adult Care Program
P.O. Box 386
Baltimore, MD 21203
» Primary Adult Care Program (PAC)




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Tips & Disclaimers
  • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
    Statement required by Medicare:
    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
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