H-2500, Medicare Part D Related Expenses

Revision 16-2; Effective June 1, 2016

Medicare Part D related expenses may include:

  • Part D premiums;
  • prescription drug co-payments/costs;
  • prescription drug deductibles; and
  • non-formulary Part D drugs.

Allow Medicare Part D related expenses as an incurred medical expense (IME) deduction for a recipient who:

  • has Medicare;
  • has a co-payment; and
  • is receiving home and community-based waiver services, or is residing in a long-term care (LTC) facility.

If a recipient provides verification of payment of an out-of-pocket Medicare Part D related expense, allow the expense as an IME.

Form H1263-A, Certification of Medical Necessity, is not necessary to request an IME deduction for Medicare Part D related expenses, but may be used for documentation of a request. If a recipient is unable to make a request and has no authorized representative, facility staff or home and community-based waiver case managers may provide verification and request an IME deduction.