The Med Diva

An insider's guide to Medicare Part D and more

Archive for the category “Part D Formularies”

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).


Countdown to Medicare Part D Open Enrollment: Day 13

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

 Day 13: Ensuring that your plan still has you covered in 2012

If you are currently enrolled in a Medicare prescription drug plan, one of the first things you should do sooner than later is confirm that your current plan is going to continue covering your medications in 2012. You should also make sure that your drugs will be in the same cost-sharing tier next year.  If your plan is not going to cover one or more of your medications next year—or your drug is being moved to a higher cost-sharing tier (for example, it’s switching from a Tier 1 to a Tier 2 drug), you may want to shop around for a new plan during the Open Enrollment period.

Although Medicare requires all Part D plans to cover at least two drugs in each therapeutic drug category, each Medicare prescription drug plan has its own list of covered prescription drugs, which is called a formulary. Formularies include both generic drugs and brand-name drugs.

 Pay Special Attention to the Annual Notice of Change

All Part D plans can make changes to their formulary for the coming year, so you should never assume that your current plan will have you covered in 2012 just because it covers all your drugs this year. That’s why it’s critical to review your plan’s Annual Notice of Change, which you should have received by September 30.  

 Take a moment now to review the plan’s formulary, which should have been included in the Annual Notice of Change documentation. Ignoring the formulary now and not double-checking that your drugs will be covered  in 2012 could leave you stuck in a plan that may not be right for you—and may end up costing more than you should have to pay for your Medicare prescription drug benefit.

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