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What's Covered Under MA-EPD?

MA-EPD has the same benefit set that MA clients receive. Some of those services include but are not limited to:

Home care services.

Inpatient hospital services.

Medical equipment services.

Mental health services.

Personal assistance services.

Physical, occupational and speech therapy.

Physician and health clinic visits.

Prescription drugs (for those not on the Medicare Prescription Drug Program).

There are co-pays for some services such as prescription drugs, non-preventative care visits and eyeglasses.

In addition to the services above, MA-EPD also pays the Medicare Part B premium for MA-EPD enrollees whose income is no greater than 200% FPG and are currently receiving Medicare. Do not deem spousal income when calculating income for Part B reimbursement.

Service Delivery

Generally, MA-EPD enrollees receive their medical services through a fee-for-service system as described in the online MA Fundamentals course.

Exception: Enrollees age 65 and older do not meet an exclusion from managed care even if they remain eligible for MA-EPD.

When an enrollee is no longer eligible for MA-EPD and enrolls in basic MA, he/she will need to enroll in a managed care plan unless he/she meets another managed care exclusion.

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