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Mary Brotherton
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Inside my Brain

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Saturday, May 20, 2006

Medicare Prescription Drug Plans – Now what?

Whether or not you signed up for a Medicare drug plan by the May 15th due date, you may be filled with more questions than answers. Lynn Meagher, of S.H.I.N.E. (Serving Health Insurance Needs of Elders) is always ready to answer questions and set your mind at ease.

· I missed the May 15th deadline to sign up for a Medicare prescription drug plan. Now what?

Don’t Panic. Seniors can always still sign up by calling 1-800-Medicare.

· If I sign up late, are there any penalties?

If you didn’t join a plan by May 15, 2006, and you don’t currently have a drug plan that covers at least as much as standard Medicare prescription drug coverage, you will have to wait until November 15, 2006 to join. When you do join, your premium cost will go up at least 1% per month for every month that you wait to join.

· How long will I have to pay the penalty for signing up late?

You will have to pay this penalty as long as you have Medicare prescription drug coverage.

· I’m going to be 65 later this year. How soon should I sign up for a Medicare prescription drug plan?

People can apply 3 months before their 65th birthday, so that by the time they are eligible, the coverage is in place.

· I wasn’t eligible last month, but my situation has changed, and I am now eligible due to lowered income or recent widowhood. Now what?

If you are recently widowed or just turned 65, call the Social Security Administration or SHINE to see if you are eligible for assistance. If you now qualify because your income or asset level has changed, you can still be considered eligible.

· I thought that once the May 15th deadline had passed, that was it until November. How can I get coverage before November 15th?

Once you are deemed eligible you have a one-time shot at anytime enrollment. This is called amnesty.

· I missed the May 15th deadline, and Medicare tells me that I am not eligible for immediate coverage. Now what?

If you have not enrolled by May 15, 2006 and are not eligible for immediate coverage, you can enroll from November 15th to December 31, 2006.

· I don’t feel that the plan I chose is right for me. Now what?

If you are on a Medicare drug plan that is not filling your prescription drug needs, you have the option to change to another plan, just as you would with any kind of insurance policy. However, you must make changes to your plan during the enrollment period between November 15th and December 31st.

· How many prescription drug plans may I join?

You will only be able to join, and get coverage under, one Medicare drug plan at a time.

  • I already have coverage under Medigap, but I want to join a Medicare drug plan too. Will I be able to do that?

No person can have prescription drug coverage through Medigap and through a Medicare drug plan at the same time.

  • One of my prescriptions is not covered, but my doctor said that I must continue to take it. It’s very expensive. Now what?

If your doctor believes you need to take your current prescription drug and should not switch to another covered prescription drug, you or your doctor can contact your plan and ask it to give you an exception which means the plan agrees to pay for your current drug.

  • How would my doctor go about contacting my plan to ask for an exception for me?

Your doctor should fax a letter to the insurance company to explain why it is medically necessary for a specific, non-covered drug to be covered for you.

  • I signed up before the deadline, but I have not gotten any kind of card or received notification that I am covered. Now what?

Don’t panic. That does not mean you are not covered. You could still be covered in the system, but since so many people were signing up at the same time you have to expect a little backlog.

  • If I am signed up, and covered, but have been told I am not yet in the system. Now what?

Don’t panic. Just keep your receipts and you will be reimbursed.

  • I chose to have my premiums deducted from my social security check, when I signed up; but my check is still the same as it was last month. Does that mean I am not enrolled?

Don’t panic. You are enrolled. It may take 2-3 months for the premiums to begin being deducted from your check.

  • Two or three months! My check isn’t that big. What happens if the total of all these premiums is more than my social security check?

Don’t Panic. If your combined premium turns out to be more than the amount of the check, you will be billed for the difference.

  • Which is better: to have my premiums deducted from my social security, or to pay the insurance company directly?

If your insurance premiums are being deducted from your social security, it may take a little longer to start to show up than if you were paying the insurance company directly. You have to choose which works best for your particular situation.

  • How do I pay for my Medicare prescription drug plan premiums?

In general, there are three ways you can pay your Medicare drug plan premiums:

  1. You can give permission to the company that offers your chosen Medicare drug plan to deduct the premium automatically from your bank account.
  2. You can have your premium deducted every month from your Social Security benefits
  3. You can pay the prescription drug plan directly for your premium by mailing them a check or money order each month.
  • Is there any way to avoid paying a premium?

Some people who qualify for extra help will have their premium paid up to a certain limit. If you qualify for this much extra help, there will be plans available in which you would pay no premium. The amount of extra help you qualify for will be based on your income and resources, and your total premium will depend on the plan you join.

  • Is it necessary for me to join a Medicare prescription drug plan, if I don’t want to?

Joining a Medicare drug plan is your choice. You aren’t required to join a Medicare plan, and you shouldn’t join until you are sure how it would affect your financial situation. Do your homework. In some cases, if you join a Medicare drug plan, you could lose your retiree health coverage as well as your prescription drug coverage. In other cases, you could save thousands of dollars each year.

  • What is the preferred drug list I keep hearing about?

A preferred drug list is a special list of drugs that your plan has determined are less costly and as effective as other drugs. The plan’s formulary may include preferred drugs, and you may pay less money if you use preferred drugs than other drugs on your drug plan's formulary.

  • What is a formulary?

A formulary is just another name for the list of the specific prescription drugs that a plan will cover.

  • I have a special situation (like depression, cancer, or HIV/AIDS) and am finally stabilized on my prescription. Will I be forced to change prescriptions if mine is not on my plan’s formulary?

You don’t have to switch to a different prescription drug. Please talk to your doctor or pharmacist to see if your prescription drugs qualify.

  • I’ve been told that my prescription drugs do not qualify, and my plan administrators are not willing to work with my doctor to grant me an exception. Now what?

If the plan refuses to give you an exception, you can appeal the plan’s decision. Your Medicare drug plan will send you information about its appeal procedures. Read the information carefully and call your plan if you have any questions.

· I’m still very confused about all of this. Where can I find answers and help to be sure that I understand my options and rights?

Call 1-800-Medicare (1-800-633-4227)

Call the Elder Help Line 1-800-963-5337

Call SHINE 321-631-2747