10-144-332 Me. Code R. § 2-10

Current through 2024-51, December 18, 2024
Section 144-332-2-10 - REQUIREMENT TO APPLY FOR MEDICARE
I. Individuals who apply for Medicaid and DEL and who are eligible for Medicare Parts A, B and/or D must be enrolled in or apply for these programs and a Medicare Part D Prescription Drug Plan, through the Social Security Administration, at the next available opportunity to do so.
II. Individuals who are enrolled in Medicaid and DEL and subsequently become eligible for Medicare Parts A, B and/or D must be enrolled in or apply for these programs and a Medicare Part D Prescription Drug Plan, through the Social Security Administration, at the next available opportunity to do so.
III. There is good cause for not enrolling in Medicare and/or Medicare Part D Prescription Drug Plan if:
A. The individual is not eligible for Medicaid and DEL to pay any premiums and cost sharing for Medicare Parts A and/or B as described in Part 8.
B. The individual is denied enrollment by Medicare or by a Medicare Prescription Drug Plan due to circumstances beyond their control,
C. The individual has prescription drug coverage which is determined by the insurer to be creditable coverage. Creditable coverage means that the coverage on the average is at least as good as the standard Medicare Prescription drug plan. or
D. Enrollment is not cost effective as determined by the Pharmacy Benefits Manager.

10-144 C.M.R. ch. 332, § 2-10