The Med Diva

An insider's guide to Medicare Part D and more

Archive for the category “Information for Caregivers”

Countdown to Medicare Part D Open Enrollment: Day 9

Open Enrollment for 2012 begins on Saturday, October 15, and ends on Wednesday, December 7, 2011.

Day 9: Making a list and checking your Part D plan twice

With the Fall Open Enrollment period quickly approaching, it’s time to review your current Medicare prescription drug plan and make a list of questions you’ll need to ask if you choose to look for a new plan.

As I’ve shared with you before, it’s super important to review your Part D plan every year, because private Medicare plan sponsors can change their costs and the list of drugs that they cover every year. And even if you’re happy with your current plan, you should still check every to see if there is another plan in your region that offers a lower total cost for your medications.

To help you find the best plan for you, here is a list of questions you should always ask when comparison shopping:

• How large is the plan’s formulary? You want to make sure the plan offers a comprehensive formulary (list of covered drugs) that provides coverage for the majority of commonly prescribed medications.
• Are my drugs covered? Next, check to see that the drugs you take on a regular basis (at least 3 months or more) are covered under the plan’s formulary.
• Does the plan pay any of my costs during the Coverage Gap stage? During the Coverage Gap stage (donut hole), you are responsible for paying most of your drug costs. Some plans, however, offer additional coverage in the Gap, which could help you save money if you take many medications. Types of additional coverage can include:
     o Low co-payments for generic drugs when you use a retail pharmacy
     o $0 co-payments for generic drugs when you use a mail-order pharmacy
     o Full coverage in the Gap (a few plans, such as some employer-sponsored plans, do not have a Coverage Gap stage)
• Does the plan have a mail-order pharmacy with free delivery? Not only is mail order with free home delivery very convenient if you’re taking medications on a long-term basis, but mail-order pharmacies often cost significantly less than a retail pharmacy. (For example, you may be able to get a 3-month supply of drugs by mail for the same price as a 1-month supply at a retail pharmacy.)
• Can I compare my drug prices online? Many plans have cost-comparison tools on their websites, which let you compare your drug costs with available lower-cost medications that may also be right for you.
• Does the plan offer Coverage Gap alerts? Some plans offer notifications by e-mail, phone, or website to let you know how close you are to the Gap and how you can save on the medications you take regularly.

Tomorrow I’ll tell you about some programs that are available to help you pay for your prescription drug costs if you have a limited income.


Countdown to Medicare Part D Open Enrollment: Day 12

Open Enrollment for 2012 begins on Saturday, October 15, and ends on Wednesday, December 7, 2011.

 Day 12: Tips for caregivers–Helping someone choose a Part D plan

If your parent or someone you care for is joining a Medicare Part D plan for the first time or looking to switch plans, it’s important that you first understand the person’s prescription drug coverage needs. Here are some questions to ask and take note of before visiting Medicare’s Plan Finder website or calling the enrollment centers for specific plans:

  • What kind of health and prescription drug benefits does the person have now?
  • Does the person currently have Medicare coverage?
    • If so, what type of coverage is it (for example, Part A, Part B, Part C, a Medigap policy)?
  • What medications does the person take now?
    • What will the drugs cost under each plan?
    • Are the medications covered under the plan’s formulary (drug list)?
  • Does the person receive financial help?
    • If not, is it possible that he or she would qualify for Extra Help from Medicare?
  • Would the person be able to continue to use his or her local pharmacy?
    • Is the person interested in saving time and money by getting prescriptions by mail?
  • What specific questions does the Medicare-eligible person or you have?

Determine current coverage and prescription drug needs

One of the most important things you must do when helping someone enroll in a Medicare Part D plan is make sure the person doesn’t already have prescription drug coverage through a former employer or other health insurance plan. If your loved one has coverage as good as the standard Medicare benefit (called “creditable coverage”), he or she may forfeit that coverage by enrolling in a Part D plan.  Creditable coverage could include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, the Department of Veterans Affairs, or other health insurance coverage that includes prescription drug coverage.

 Plans must tell their Medicare-eligible members each year if their drug coverage is creditable coverage. This information may be sent to members in a letter (called a “Notice of Creditable Coverage”) or included in a newsletter from the plan. Make sure your loved one keeps this information, because he or she may need it if he or she joins a Medicare drug plan after the Initial Enrollment Period when first becoming eligible for Medicare.

 Another important step for caregivers is to compile a list of the person’s drugs, including the strengths, so you can find out if they are covered under the plan’s formulary (drug list). Most plans offer online tools that allow you to confirm which drugs are on the plan’s formulary and what they will cost. You can also call the plan directly and ask the customer service representative to tell you whether the drugs are covered or not.

Additional information you should know:

  • Find out if the person you’re helping receives financial help or would qualify for Extra Help with Part D costs.
  • When comparing plans, make sure the person will be able to continue to use his or her local retail pharmacy.
  • In addition, check to see if the plan has a mail-service pharmacy for savings on long-term medications (such as those used to treat high blood pressure or high cholesterol).

For answers to other questions about Medicare Part D, you can call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. (TTY/TDD:  1-877-486-2048).

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