People eligible for both KHC and Medicare must apply for a stand-alone Medicare Part D plan. Medicare Part D will become the primary payer for prescription drugs, and KHC will become the secondary payer for the quantity covered by Medicare, up to a 90 day supply. When KHC is the secondary payer for claims coordinated with Medicare Part D, the person will have a zero copay. A copay is assessed when KHC is the sole payer for the claims. KHC does not coordinate with Medicare Advantage Plans.
KHC will coordinate benefits with Medicare Part D for deductibles, co-insurance, and gap coverage only for KHC formulary products. If the drug is a Part D included drug, but not covered by the person’s Part D plan, it will not be covered by KHC. KHC will cover Medicare Part D wrap-around drugs that are on the KHC formulary.
KHC will only provide assistance with four (4) prescriptions per month. KHC will waive day supply limitations for Medicare Part D drugs when paying secondary claims. KHC may apply a co-payment for coordinated claims.
The KHC program is a State Pharmacy Assistance Program (SPAP), and any payments made by the program for Medicare-allowable drugs will count toward the person’s out-of-pocket expenses.