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Introduction to Medicare Part D Part D is the newest addition to Medicare. Part D is prescription drug coverage. You must be enrolled in Medicare before you can apply for Part D coverage. …read full article Your Prescription Drug Coverage Medicare prescription drug coverage (Part D) helps you pay for drugs you need. It is coverage that adds to, or is included with, your Medicare health care coverage depending on the type of Medicare plan you join. You must choose and join a Medicare drug plan to get Medicare prescription drug coverage…read full article Pick The Prescription Drug Coverage That Fits Your Needs Take time to consider all of your choices for prescription drug coverage before making a decision. This may include looking at the prescription drug coverage you already have, like coverage from an employer or union, TRICARE, the Department of Veteran’s Affairs, the Indian Health Service, or a Medigap policy...read full article How much will my drug coverage cost? Your costs for Medicare prescription drug coverage will vary depending on which drugs you use, which Medicare drug plan you join, and whether you get extra help paying for your drug costs…read full article How can I pay my Medicare drug plan premium? In general, there are 4 ways you can pay your Medicare drug plan premiums: Deducted from your checking or savings account When can I join, switch, or drop a drug plan? You can join, switch, or drop a Medicare drug plan at these times:
You can switch from your current plan at the times listed above by joining a different plan. Joining a different Medicare drug plan will disenroll you from your current plan. You don’t need to tell your current Medicare drug plan you are leaving or send them anything. You should get a letter from your new Medicare drug plan telling you when your coverage begins. Contact the company that offers the plan you want to join, and ask how to join the plan. Depending on the company, you may be able to join by calling the plan, by mailing or faxing a completed enrollment form to the company, or by enrolling through the company’s website. What happens if I don’t join a Medicare drug plan when I am first eligible? In most cases, you will pay a late enrollment penalty if you don’t join when you are first eligible for Medicare, and you have been without creditable prescription drug coverage for 63 continuous days or more. Also, if you have a break of 63 continuous days or more in creditable prescription drug coverage at any time you are eligible for Medicare prescription drug coverage, you will have to pay a late enrollment penalty if you later join a Medicare drug plan. How much is the late enrollment penalty? The cost of the late enrollment penalty depends on how long you waited to join a Medicare drug plan. Your exact late enrollment penalty will be calculated when you join a Medicare drug plan. To estimate your penalty amount, multiply 1% of the national base beneficiary premium for the current year ($27.93 for 2008) by the number of full months you were eligible to join a Medicare drug plan but didn’t. Round this to the nearest 10 cents. This penalty amount is added each month to your Medicare drug plan’s premium for as long as you have the plan. Will I get a separate card for my Medicare drug plan? Yes, when you join a Medicare Prescription Drug Plan that works with the Original Medicare Plan, the plan will mail you a separate card to use when you fill your prescriptions. Your red, white, and blue Medicare card won’t change. You will still use your red, white, and blue Medicare card for hospital and doctor services. If you join a Medicare Advantage Plan or other Medicare Health Plan with prescription drug coverage, you may or may not get a new card depending on the plan. Where can I get my prescriptions filled? Once you join a Medicare drug plan, the company will send you a pharmacy provider directory. Generally, you must go to one of the pharmacies listed in this directory for your plan to cover your prescriptions. Medicare requires plans to have pharmacies for you to choose from. Plans can’t require you to use a mail order pharmacy, but you may have the option to do so. What are the special rules for people with End-Stage Renal Disease (ESRD)? If you have ESRD (permanent kidney failure requiring dialysis or a kidney transplant) and you are in the Original Medicare Plan, you can join a Medicare Prescription Drug Plan. You generally can’t join a Medicare Advantage Plan…read full article What drugs are covered by Medicare drug plans? The drugs covered by each plan vary, so there is no single drug list that applies to all plans. All Medicare drug plans must make sure that the people in their plan can get medically-necessary drugs to treat their conditions…read full article Each Medicare drug plan has a list of prescription drugs that it covers. Plans may cover both generic and brand-name prescription drugs. There are certain drugs that Medicare drug plans aren’t required to cover, such as benzodiazepines, barbiturates, drugs for weight loss or gain, and drugs for erectile dysfunction…read full article A generic drug is the same as a brand-name drug in safety, strength, quality, the way it works, how it’s taken, and the way it should be used. Generic drugs use the same active ingredients as brand-name drugs and work the same way…read full article To have lower costs, many plans place drugs into different “tiers” on their lists, which cost different amounts…read full article Plans may have drugs that require prior authorization. Prior authorization means before the plan will cover a particular drug, your doctor must first show the plan that there is a medically-necessary reason why you must use that particular drug. Plans do this to be sure these drugs are used correctly and only when medically necessary. Contact your plan about its prior authorization requirements before you talk with your doctor. Step therapy is a type of prior authorization. With step therapy, in most cases you must first try a certain less-expensive drug on the plan’s list that has been proven effective for most people with your condition, before you can move up a “step” to a more expensive drug. Quantity Limits On Your Prescription Drugs For safety and cost reasons, plans may limit the amount of drugs that they cover over a certain period of time. For example, most people who are prescribed heartburn medication take 1 tablet per day for 4 weeks. Therefore, a plan may cover only an initial 30-day supply of heartburn medication. Should you need more medication, you may need your doctor’s help in providing more information for a refill. What if I’m taking a drug that isn’t on my plan’s drug list when my drug plan coverage begins? Your drug plan will provide a one-time, temporary 30-day supply of your current drug during your first 90 days in a plan. Plans are required to give you this temporary supply so that you and your doctor have time (30 days) to find another drug on the plan’s drug list that will work as well as the drug you are taking now…read full article What if I join a plan and then my doctor changes my prescription? If your doctor needs to change your prescription or prescribe a new drug, give your doctor a copy of your Medicare drug plan’s current drug list…read full article What if I need help applying for extra help or joining a Medicare drug plan? Some people can help, or act on your behalf, to enroll you in a Medicare drug plan and/or to apply for extra help paying Medicare prescription drug coverage costs…read full article How do I protect myself from fraud and identity theft? Call 1-800-MEDICARE (1-800-633-4227) if you aren’t sure if a plan is approved by Medicare. Knowing how Medicare Advantage Plans and Medicare Prescription Drug Plans can market to you can help you protect yourself…read full article What if my enrollment in a Medicare drug plan is denied? Medicare drug plans generally have to accept all eligible applicants who live in their service area, no matter what your age or health status. If your enrollment form is denied, the company will send you a letter explaining the reason why. You may contact the plan for more information about your options. What do I do if my plan won’t cover a drug I need? If your pharmacist tells you that your Medicare drug plan won’t cover a drug you think should be covered, or it will cover the drug at a higher cost than you think you are required to pay, you have the right to the following…read full article |
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