The Med Diva

An insider's guide to Medicare Part D and more

Archive for the tag “Part D”

Spread the Word: Only 2 Shopping Days Left for Medicare Part D Open Enrollment

There may still be 19 shopping days left until Christmas, but this year the shopping season for Medicare Part D ends on December 7. That means there are only 2 more days (after today) in which you can switch your prescription drug plan for 2012.

You can thank Healthcare Reform for the early deadline this year: The 2010 Patient Protection and Affordable Care Act mandated the earlier enrollment period to give you more time to weigh your plan options and the drug plans more time to complete paperwork and get membership cards and plan materials to beneficiaries by January 1, 2012. The intention was good, but unfortunately, the execution has been poor.

In fact, one recent survey shows that almost 20 percent of seniors are still unaware of the Wednesday deadline.

According to the survey conducted by Opinion Research Corporation and sponsored by PlanPrescriber, one in five seniors 65 years of age and older with Medicare prescription drug coverage were still aware that the Open Enrollment period ends December 7. The national phone survey was conducted between October 28 and October 31, 2011.

Please spread the word

Hopefully, this number has improved during the past month. Ideally, 100 percent of seniors are now aware of the early deadline. However, it’s more likely that a small percentage of beneficiaries are still in the dark about the deadline – which means we must still work hard to get the word out. That’s why I’m asking all of my readers, Facebook friends, and Twitter followers to talk to all the seniors in your lives and remind them that the last day to switch their Medicare Part D plan is Wednesday, December 7.  Thank you everyone!


New online tool available for comparing Medicare Part D plans

Although I always promote use of Medicare’s Plan Finder Tool during Open Enrollment to help you find the right Medicare Part D plan, today I came across another handy prescription drug plan search tool on the Q1Medicare website. This tool gives Medicare beneficiaries a chance to review all of the different Part D plans available for 2012 for their areas quickly and easily. Plus, it has advanced options to help you further refine your search.

What is the maximum you want to pay?

One of the best features of this tool is the option to limit your search by the maximum monthly premium, annual deductible, and co-payment for generic drugs you want to pay. For example, if you don’t want to pay any more than $50 a month for your premium, you can enter this amount and eliminate all the plans that are out of your budget. You can also select the type of coverage you need in the Coverage Gap (aka, donut hill), such as no coverage at all or coverage for generic drugs.

The tool also allows you to get other information about the plans, such as which plans offer mail service, how many people nationwide (or in your state) are members of the plan, and the number of drugs covered on the plan’s formulary (list of covered drugs). You can also ask the tool to display plans by premium (lowest to highest or vice versa), star ratings, state enrollment, or plan name.    

Remember, Open Enrollment ends early this year – December 7th.  So to avoid a last-minute rush—especially smack in between Thanksgiving and the winter holidays—consider doing your homework now. This new plan comparison tool is a great place to start.

Saving Money with the Mail-Order Pharmacy: Give it a Try!

Open Enrollment for 2012 is October 15 through
 December 7, 2011.

  You may recall a very popular 1970s TV commercial for Life Cereal, in which two brothers are discussing “some cereal” that’s “supposed to be good for you.” Neither wants to give it a try, so they push it toward their little brother, Mikey. Turns out little Mikey, who supposedly hates everything, really likes it.

For many seniors enrolled in Medicare prescription drug plans, a similar scenario often plays out. You may be constantly bombarded by letters from your plan telling you that switching to a mail-order pharmacy is good for you because it will help youlower your out-of-pocket costs and delay entering the Coverage Gap (donut hole). But you’re reluctant to give it a try for various reasons (procrastination, perhaps?) so you toss the information in the garbage.

I have to admit I was a little hesitant to try my mail-order pharmacy at first, simply because I didn’t want to deal with the paperwork involved. I thought it would be a hassle to switch my one prescription from my favorite retail pharmacy, but when I used my plan’s price comparison tool on its website and discovered I would pay $100 less a month with mail, I immediately made the switch. 

Guess what? It wasn’t a hassle at all! The customer service rep did all the work for me–she even called the doctor with my permission to get my prescription–and in a few days my medication arrived in a secure package in my mailbox.

Today I have nothing but good things to say about my mail-order pharmacy. I can order up to a 3-month supply of my medication for a lot less money than a 30-day supply at the local pharmacy. My drugs arrive in my mailbox, so I don’t have to drive to the pharmacy and use up gas or wait 15 minutes in line. (There’s never a line at my mailbox!)

If I have to work late, I don’t have to worry about the pharmacy closing before I get home — after all, my mailbox never closes!  And If I have a question about my medication I can call my plan and talk to a pharmacist any hour of the day, for as long as I want, without having to worry that I’m holding up the line. Best of all, my mail-order pharmacy sends me automatic refill reminders by e-mail, and I can order refills online.

I like to tell my friends and family that switching to mail order is like the switch we all made from typewriters to computers. Many of us were reluctant to try computers because switching required us to change our ways and learn a new skill. But wasn’t it wonderful once we got the hang of the Internet, e-mail, word processing, and Facebook? We like it! Hey Mikey!

Countdown to Medicare Open Enrollment: Day 4

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

Day 4:  Open Enrollment is open season on Medicare fraud

Yesterday I discussed the importance of being alert to Medicare fraud and scams, particularly this time of year when Medicare Part D marketing is in full swing. According to a 2010 Nightline investigation, Medicare fraud costsU.S.taxpayers more than $60 billion a year. Yes, billions with a “b.”

 To help you better identify fraud and protect yourself—and others—from being scammed, here are a few things to be on the alert for at all times:

  • You’re asked for money or for your personal information (e.g., Medicare
    or Social Security numbers, bank account number, credit card number, etc.) by someone pretending to represent Medicare, Social Security, and/or a Medicare plan sponsor.
  • Another person asks to use your Medicare prescription drug card to obtain drugs at the pharmacy.
  • You’re asked to sell your Medicare prescription drug card.
  • Several payers (insurance plans), including Medicare Part D, are billed for the entire cost of the same prescription.
  • Your Explanation of Benefits (EOB) statement or Medicare Summary Notice lists prescriptions for medications you are not taking or services that were not ordered by you or your doctor.

In addition to being on the alert, you should also carefully review and keep records of your health care visits, services, prescriptions filled, medical equipment provided, significant lab work, etc. It’s also important to file copies of any bills or notices from insurance companies, doctors, hospitals, pharmacies, etc., as well as your canceled checks. Then every time an EOB statement arrives in the mail, read through it carefully and compare it to your receipts to make sure everything is correct.

To learn more about you can help stop Medicare fraud, visit the U.S. Department of Health & Human Services and the U.S. Department of Justice’s Stop Medicare Fraud website. The site has answers to frequently asked questions, as well as important information to help you better understand your EOB statements and find out what to look for in these documents.

The Senior Medicare Patrol (SMP)

If you want to get even more proactive in the fight against Medicare fraud, consider becoming a volunteer with the Senior Medicare Patrol (SMP). SMP is a group of highly trained volunteers who help beneficiaries avoid, detect, and prevent health care fraud. There are SMPs in every state and many U.S. territories—to find the SMP nearest you, click here.

Countdown to Medicare Part D Open Enrollment: Day 5

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

Day 5: Beware of Medicare…Medicare scams that is, this time of year

When Medicare Part D first started in 2006, professional scammers immediately jumped on the bandwagon. They started by devising clever ways to trick seniors into giving them money or other information that would allow the scammers to access their bank accounts. For example, in the “$299 Ring” Scam (see video), callers would identify themselves as Medicare employees and ask for checking account information in order to “sell them a Part D drug plan for $299.”  Other scammers called Medicare recipients and told them they would deposit money into their bank accounts if they provided their account numbers. They would also ask them for their Social Security numbers and threaten them by saying they would lose their Medicare coverage if they did not provide this information.

Fortunately, most people were leery of the callers and notified either the Centers for Medicare & Medicaid Services (CMS) or other local authorities. Many of the calls were traced to phone numbers outside  the United States.

According to CMS, you should always call your local police if you receive a call from an unknown person and are asked to provide personal information over the telephone. Here are some other helpful tips from CMS to keep top of mind, especially during the Open Enrollment period, when professional scammers know you may be searching for a new Medicare plan:

  • Protect your Medicare number. This number is as important as your Social Security number, credit card information, computer passwords, etc. Never give your card or number to anyone—not only is it illegal for someone else to use your card or number, it can lead to identify theft. And if you card is lost or stolen, report it right away to Social Security.
  • If you don’t trust, don’t talk. Only give out your personal information to people or organizations you trust, such as your doctor, trusted friend or family member, attorney, accountant, government organization such as Social Security, or a Medicare-approved plan. (Once you decide to enroll in a Medicare plan—or you decide to switch plans—you will need to provide your Medicare number to the plan.)
  • Never join a plan over the phone—unless you initiate the call.
  • Know the marketing no-no’s. There are many things that Medicare prescription drug plans and the people who represent them cannot do. For example, they can’t:
    • Charge you a fee to join a plan
    • Come to your home uninvited to try to sell you a plan
    • Offer you cash, free meals, or other gifts while trying to sell a plan to you
    • Enroll you into a plan over the phone unless you call them and specifically ask to be enrolled
    • Ask you for payment over the phone or Internet (they must send you a bill)
    • Try to sell you other products other than the plan you agreed to hear about
    • Try to enroll you in a plan during an educational conference or health fair

If you think a plan or plan representative has broken the rules, or you believe you have received a phone call or e-mail from a professional scammer, you should report the incident to Medicare by calling 1-800-MEDICARE (1-800-633-4227);  TTY/TDD: 1-877-486-2048.  Not only will you help CMS to alert others to the scam or tactics, but you will also be playing a very vital role in reducing Medicare fraud.

Tomorrow, I’ll give you some more tips on helping to reduce Medicare fraud, waste, and abuse.

Countdown to Medicare Part D Open Enrollment: Day 7

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

Day 7: The Medicare Part D Coverage Gap Discount Program helps you save when you’re in the donut hole 

 The Affordable Care Act, otherwise known as Obamacare, includes provisions to close the Medicare Part D Coverage Gap (aka “donut hole”) to help lower prescription drug costs for Medicare beneficiaries. One of the major provisions is the Coverage Gap Discount Program, which went into effect January 2011. According to the Centers for Medicare & Medicaid Services, more than 1.7 million Medicare beneficiaries had taken advantage of program through August 31, 2011, resulting in a total savings of almost $930 million.

 Under the Discount Program, if you have Part D coverage but don’t get Extra Help from Medicare, you get a 50 percent discount on “applicable” brand-name drugs if and when you reach the Coverage Gap.  This discount applies at either retail or mail-order pharmacies, but does not include the cost of the pharmacy dispensing fee.  Another good thing is that the full cost of the drug counts toward your out-of-pocket spending, which helps you move out of the Gap and into the Catastrophic Coverage stage.

 In addition, this year you’ll pay only 86 percent of the total cost of generic drugs and supplies used for the delivery of insulin when you’re in the Gap.  

How the Coverage Gap Discount Program works

 Let’s say you have reached the Coverage Gap and go to your pharmacy to fill a prescription for a brand-name drug, such as Diovan®. The full price of Diovan at this pharmacy is $50 and the dispensing fee is $2. Once the 50% discount is applied, the price of Diovan is now only $25. The pharmacy charges a $2 dispensing fee, so your total cost for the medication would be $27. The entire amount, however–$52–will be counted as out-of-pocket spending and will help you move out of the Gap.

Who is eligible for this savings while in the Coverage Gap?

You must meet all of the following criteria to be eligible for discounts under the Medicare Coverage Gap Discount Program:

  • You are currently enrolled in a Medicare prescription drug plan (PDP) (including employer-sponsored plans called Employer Group Waiver Plans), or a Medicare Advantage Plan that includes prescription drug coverage.
  • You do not get Extra Help from Medicare for your prescription drug costs.
  • You have reached the Coverage Gap stage of your benefit.
  • You fill a prescription for a covered brand-name drug.

If you are fortunate enough to be enrolled in a Part D plan that don’t have a Coverage Gap stage, you’ll still be eligible to get a discount on brand-name prescriptions once you reach the defined standard initial coverage limit (ICL). In 2012, the standard ICL is $2,930

In coming weeks I’ll explore the Discount Program further, and tell you some things the drug makers don’t want you to know about it.

Countdown to Medicare Part D Open Enrollment: Day 8

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

Day 8: Getting Extra Help with your prescription drug costs

 In a recent poll conducted for the National Council on Aging (NCOA), more than half of the Medicare beneficiaries surveyed (53 percent) said they were not aware of Extra Help from Medicare, which helps pay for some or all prescription drug costs for those with low incomes. If you or a loved one that you care for takes medication on a regular basis and has a limited income and investments, it’s important to be aware of this benefit.

To qualify for Extra Help, you must:

  • Have Medicare Part A (hospital insurance) and/or Medicare
    Part B (medical insurance); and
  • Live in one of the 50 states or Washington DC; and
  • Have combined savings, investments, and investment real estate worth no more than $25,260 (if you are married and living with your spouse) or $12,640 (if you are not currently married or not living with your spouse.)

When considering your total worth, do not include the home you live in, your cars or other vehicles, personal possessions, burial plots, or back payments from Social Security or Supplemental Security Income (SSI). Also, if you have Medicare and SSI or you have Medicare and Medicaid, you are automatically getting Extra Help for your prescription drugs so you do not have to do anything else.

 For more information about Extra Help, click here, contact your local Social Security office, or call Social Security at 1-800-772-1213. (TTY: 1-800-325-0778).  You will need to complete and submit an application, which will be reviewed by Social Security to determine if you qualify. Social Security will notify by letter if you qualify or not.

State Pharmaceutical Assistance Programs (SPAPs)

Many states and the U.S. Virgin Islands offer help paying drug plan premiums and/or other prescription drug costs. Each state has its own set of eligibility requirements; for example, in New York your income must not be more than $50,000 if married, while in New Jersey a married couple cannot have an income higher than $39, 956. Click here to find out if your state has a SPAP.

In tomorrow’s countdown, I’ll review the Coverage Gap Discount Program, which was enacted under health care reform legislation and is already helping thousands of seniors substantially lower their drug costs.

Countdown to Medicare Part D Open Enrollment: Day 11

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

Why it’s important to choose a plan with the lowest total cost

A few days ago, I suggested that if you’re shopping around for a new Medicare Part D plan, you should look for a plan that offers the lowest total cost based on the medications you take. I really can’t stress this point enough.

All too often, Medicare beneficiaries will choose a plan with the lowest monthly premium, only to find out weeks or months later that they’re going to end up paying more in the long run. It may be that the co-payments for their medications are higher in this “low-cost” plan, or they have a higher annual deductible. As I have mentioned before, remember to consider the monthly premium plus the annual costs for all your medications when making your decision.

Total prescription drug plan costs will vary by plan

As a member of a Part D plan, you will pay a monthly premium in addition to any premiums you pay for Medicare Parts A and B. You may also be responsible for paying some of your prescription drug costs in the form of co-payments or coinsurance. Keep in mind that your total drug plan costs will vary, depending on the following criteria: 

  • Amount of coverage your plan offers (for example, some plans offer full or partial coverage in the Coverage Gap, or “donut hole”)
  • Annual deductible amount
  • Your current Part D benefit stage (for example, Initial Coverage or Catastrophic stage)
  • Region where you live (monthly premiums vary by state)
  • Medications you use (generics usually cost less than brand-name medications)
  • Pharmacies you use (retail or mail; in-network or out-of-network)
  • Whether your drugs are covered on the plan’s formulary (list of covered drugs)
  •  Whether you qualify for Extra Help paying your Part D costs 

Coverage stages affect your drug costs

Drug costs vary throughout the year based on your current Part D benefit stage (or coverage stage). There are 4 standard Part D benefit stages as follows:

Stage 1: Deductible stage
• The amount you must pay out of pocket before the plan begins covering your drugs.
• The standard Medicare Part D deductible is $320 in 2012.
• Some plans may have no deductible at all; others may have a deductible only for certain drugs, such as brand-name drugs.

Stage 2: Initial Coverage stage
• This stage begins after you have met any deductible and continues until your total drug costs (the amount that both you and your plan pay) reach $2,930.
• During this stage, you will generally pay a portion of your drug costs and the plan will pay the rest. What you and your plan pay combined is what counts toward your total drug costs—and what moves you towards the Coverage Gap.

Stage 3: Coverage Gap stage (“Donut Hole”)
• This stage begins when your total drug costs exceed $2,930 and continues until your out-of-pocket costs reach $4,700. (Out-of-pocket costs do not include payments made by your plan.)
• During this stage, you get a 50% discount on brand-name drugs from manufacturers who have agreed to participate in the Coverage Gap Discount Program. 
• In this stage, you pay only 86% of the cost of generic drugs.

Stage 4: Catastrophic Coverage stage
• You will reach this stage after your out-of-pocket costs exceed $4,700.
• The standard co-payment in this stage is $2.60 for generic/preferred drugs and $6.50 for other drugs.

The following is an example of how Part D plan costs can vary, and why it’s so important to consider your total annual drug costs with each plan:*†

1. Plan with low premium and no extra coverage in the Coverage Gap
Monthly premium: $15.00 
Annual deductible: $320.00 
Monthly co-payments for drugs: $250.00 
Drug costs in the Coverage Gap: $450.00 
Total annual drug costs: $4,100

2. Plan with moderate premium and no extra coverage in the Coverage Gap 

Monthly premium: $25.00 
Annual deductible: $275.00
Monthly co-payments for drugs: $175.00
Drug costs in the Coverage Gap: $325.00
Total annual drug costs: $3,125.00

3. Plan with high premium and extra coverage in the Coverage Gap 

Monthly premium: $50.00 
Annual deductible: $150.00
Monthly co-payments for drugs:  $100.00 
Drug costs in the Coverage Gap: $100.00 
Total annual drug costs: $1,950

*Dollar amounts are samples for explanatory purpose only.
† Sample assumes 3 months in Coverage Gap stage.

The dollar amounts in the above examples are not taken from an actual plan; the example is meant only to demonstrate that it is possible for a plan with a high monthly premium to be less costly overall based on the deductible amount and drug costs.  If you are in a plan with a very low monthly premium right now, and you also take several medications on a regular basis, you may be missing a savings opportunity by not exercising your right to shop around for a plan that offers the best value for you.


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 14

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

 Day 14: Why Medicare star ratings are important to you

Chances are, you’re not going to choose a 2-star hotel or a restaurant that has only earned 3 out of 5 stars. You shouldn’t choose a Medicare Part D or Medicare Advantage plan with low star ratings, either. And for pretty much the same reason: Low star ratings mean lower quality.

Each year, the Centers for Medicare & Medicaid Services (CMS) rates how well health plans and prescription drug plans perform in different categories, such as customer service, prescription drug safety, and member satisfaction. The Medicare star ratings are important because they help you compare the overall quality of plans. Star ratings range from 1 star (poor) to 5 stars (excellent), so look for a plan with high ratings (4 or 5) to ensure you get the level of service and safety you deserve.

A plan can get ratings between one to five stars

★ ★ ★ ★ ★  is excellent

★ ★ ★ ★  is very good

★ ★ ★  is good

★ ★  is fair

★  is poor

The ratings for prescription drug plans are based on information from various sources, including:  

  • Results from Medicare’s regular plan-monitoring activities
  • Reviews of billing and other information that plans must submit to Medicare
  • Member surveys conducted by Medicare

 Starting December 8, 2011, you can switch to a 5-star Medicare Advantage or Part D Plan at any time during the year.

Although very few plans have earned a 5-star rating from CMS, if you’re fortunate enough to find one that serves your area, you can enroll in a 5-star plan any one time during the year, starting as early as December 8, 2011.

Why is this special enrollment period important for you? Let’s say you join a new plan during the 2012 Open Enrollment period, only to find out in January or February that the plan has lousy customer service. In past years, you were stuck with this plan until the following year. But now you can disenroll from the plan you’re not satisfied with and join a plan that has earned 5 stars.

The Special Enrollment Period for joining a 5-star plan runs from December 8, 2011, through November 30, 2012.

 Use the following resources to get plan ratings:

  • The overall plan star ratings are available at the Medicare Plan Finder.  Plan ratings will be available starting October 12.
  • You can call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
  • You can call your plan’s customer service number and ask for the plan’s Medicare star rating.
  • You can download the Medicare fact sheet, which has additional information about star ratings.

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