Posts tagged 'Medicare Part D'
When you need to have your drugs paid for by Medicare Part D to be able to make your finances work it can be incredibly frustrating when you are denied. This may seem like an impossibility as your doctor should know what drugs are not covered by Medicare Part D, but it does happen. However, you do have the right to appeal the decision and you have options if this does not work.
Once your drug is denied by Medicare Part D you will receive a “Notice of Denial of Medicare Prescription Drug Coverage” in the mail. This form will list what has been denied and why along with other useful information. This information will show you how to appeal the decision that was made not to pay for your Medicare Part D drugs.
If the appeal is not successful and it is finally decided that your drug is not covered you should return to your doctor. Ask your doctor if it is possible that you could take another drug to treat your condition that Medicare Part D does offer. If this works you are in the clear, if not, you should consider pushing the issue with Medicare a bit further.
The Medicare Part D open enrollment period is the final six weeks of each calendar year. This means the time you can start to choose a new Medicare prescription drug plan is on November 15th and the period will run through December 31st. Any changes you make during this time will go into affect on January 10th of the New Year.
Medicare recommends that you make changes to your plan as soon as possible during the Part D open enrollment cycle to prevent any confusion when the new plans take affect in January. You certainly do not want the pharmacy to have the wrong information when you need a prescription filled in January. Basically, the sooner you get your changes submitted, the less likelihood there will be that confusion will take place.
When it is time to choose a prescription drug plan, you will need to consider a number of factors to find the best Medicare Part D Plan to meet your needs.
The best way to begin your search is to go to the Medicare website (medicare.gov) and click on the "Compare Medicare Prescription Drug Plans" link which is under the "Search Tools" headline or choose the "Compare Drug Plans" link in the "Health and Drug Plans" box at the top of the page (see the graphic below for more details).
After you click the link, you will be taken to a page that will allow you to either view your current plan (if applicable) or "Find and Compare Plans". For this tutorial, we will click the "Find and Compare Plans" button.
The next page will allow you to to a "Personalized Plan Search" or a "General Plan Search". Medicare recommends the personal plan search. This option requires you provide information from your Medicare card and have your current plan information (if applicable). This option will help find the best fit for your needs in your local area.
The general search option allows you to input your zip code, your age, health status and other general information about your insurance needs and it will help you find the right plan. This option does not require you to enter any personal information or your Medicare card data.
Once you submit your answers, a confirmation page will be returned showing you the answers you provided and it will give you some options based on your answers. After you have read over the page, you will click the "Continue" button in the lower right hand corner of the page.
The next page will give you two options. The first is to enter your prescription information. You will simply add all of your prescription drugs to the listing or pull the data from your current Medicare account. Providing your current prescriptions will help the system provide more accurate pricing and choices.
The second option on this page lets you go on to the plan choice page.
After you click to continue with either option, you will get a detailed listing back of the number of plan choices available to you, the average cost per plan, the ratings of each plan from other recipients and the individual plans listed in lowest price order. You can also choose to rearrange the results by average rating, annual deductible and other headers.
At this point, you can carefully review all of your Medicare Part D Plans to choose from. As stated earlier, for the best comparison you should enter your prescription drug information. You may not find a plan that covers all your prescriptions, but try to find one that covers the most expensive prescriptions. You may also want to see if they cover generic versions of any of the drugs you are on (if applicable).
You will also want to enter the information for the pharmacy that you prefer to work with.
Right now we are in the middle of open enrollment for Medicare. Open Enrollment will last until December 31, 2008, and it is important that you know as much as possible about Medicare coverage so that you can make good choices for the next year.
Medicare and Medicare Supplements, also called Medigap, have a number of parts and they are not always easy to figure out. In fact, determining how all these parts fit together and what you need for your situation can be totally confusing. This brief overview will give you information on the basic parts of Medicare and what is covered by them.
Medicare Part A and B make up the original Medicare. Part A basically covers in-patient services including inpatient rehabilitation and inpatient psychiatric care. Many services are covered completely, but you will have to pay a co-payment for some of the others.
Part B covers your doctor visits and other outpatient services determined to be “medically necessary” for you. It also covers certain tests to determine if you have an illness. There is a deductible, which is $135 for the year 2008, and there are also some copayments with it.
Medicare Part C is also called Medicare Advantage. The Medicare Advantage Plans are not part of the actual Medicare system, but they work with it. Medicare Advantage is an alternative to Medicare and the plans are run by private companies. There are a variety of plans that all work differently. Some plans work as HMO’s others charge a Fee for Service allowing you to go to any doctor as long as the doctor will accept payment from Medicare as payment in full. It is very important to research and find out whether the Medicare Advantage Plan you are choosing will actually work with your medical needs.
Part D covers Prescriptions. These are covered by private insurance companies approved by Medicare. This coverage is important, and you must determine what type Part D coverage you need. You should figure out what you need in advance so that you can enroll immediately when you are eligible. If not, you will be charged a substantial late fee. If you enroll in a certain Part D plan and feel it isn’t right for you, every year you will have an opportunity to change between November 15th and December 31st which is where we are right now. If you need to change plans, now is the time to do it.
That was the easy part. Now for the Supplements – the Medigap policies. There are 12 policies that cover services that are not otherwise covered. Each supplement is different and covers different things. In addition, it is possible to purchase these supplements from private insurance companies, get them from you or your spouse’s employer or from various government programs.
All Medigap Policies are standardized and approved by Medicare. This means that for policies E on up the alphabet, each lettered plan offers the same coverage no matter what company you purchase it from. An insurance company can charge whatever they want to charge, so compare companies and rates carefully. That way you won’t buy from a company that charges much more as another company for the same coverage.
So, do your research and determine which Medicare Supplemental Insurance is the best for you and find the best price. If you need information, check the web at www.Medicare.gov.
Medicare used to be one basic program with very few – or no – variables. You got what you got, it paid what it paid, the doctors were pretty familiar with it and so were Medicare recipients. Sometimes the payment was slow getting to the doctors, but everyone knew that was how it was and simply lived with it.
Fast forward to today. There is still a basic Medicare program; however there are a total of 57 prescription drug programs (Part D) that a recipient could ask for. Any combination of them could work for a recipient; however, there is usually one combination that will work best. Supposedly, the way to find that combination is to go onto the Medicare website at www.medicare.gov and type in all of your prescriptions where asked. At that point, you should receive a plan recommendation that is best for you.
The problem is that there is no way to be sure. It is essential that you sign up for Medicare Part D when you are ready to turn 65. Do your research in advance, because you have only three months after your 65th birthday to sign up for Part D. In addition, you have the right to refuse Part B which covers , but experts say that it is not wise to do so. L Though it costs $96 per month and comes out of your Social Security check each month, it could cost much more if you had to pay the cost of the medical bills it covers out of your own pocket.
In some states and counties, such as in southern Oregon, there are meetings being held to discuss Medicare and unscramble what means what. There are organizations with volunteers in Oregon to help you understand – in plain, understandable English – exactly what is covered and exactly what you need.
Dick Heintz of Senior Health Insurance Benefits Assistance (SHIBA) will be facilitating workshops in Oregon. This is important information for you to know. If you are in areas other than southern Oregon and need information, go to www.medicare.gov.
