How to Choose and Join a Medicare Prescription Drug Plan
By: Source: AARP.org Date Posted: 2005-10-13 16:15:21
Choosing a Medicare Prescription Drug Plan
If you decide to get Medicare drug coverage, you’ll need to sign up for one of the drug plans approved by Medicare. You will have at least two different plans to choose from, and maybe many more, depending on where you live. In most cases, any plan you choose for 2006 will be the one you’ll have to stay in for the entire year. So it is very important to find the plan that best meets your needs.
How will I know what is being offered by the different drug plans?
In October 2005, you will begin receiving mail from the Medicare-approved private companies that will offer drug plans in your area during 2006. They may also contact you by phone. Remember that each company will promote only its own plans. To make a real choice, you need to compare them.
Beginning October 13, 2005, you can compare drug plans online at www.medicare.gov. Medicare’s website will allow you to compare the plans point by point, such as their premiums, copayments and which drugs they cover.
If you don’t have access to the Internet, you can get the same kind of information by calling Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. A customer representative will send you printed versions of details of all the plans that are available to you. This service, too, will be available after October 13, 2005.
Will a plan cover all the drugs I take?
Not necessarily. Each Medicare drug plan has a list of the prescription drugs it will cover. These lists are called formularies or preferred drug lists. When comparing plans, it’s important to find the plans that cover all or most of the drugs you take.
If the plan you are considering does not cover all your drugs, talk to your doctor to see if your medicine can be switched to one that is in the plan. If not, talk to the plan sponsor about whether your specific medical situation makes you eligible for an exception that pays for a drug not on the plan’s formulary. There are only a small number of prescription drugs, such as the anti-anxiety benzodiazepines and weightloss products, that Medicare plans cannot currently cover because they are not allowed to under the law.
All plans are required to have an appeals process. You may appeal your plan’s decision not to cover one of your drugs if your doctor can show that it is specifically necessary to your health.
It is possible for plans to change some of the drugs they cover during the year. Plans must provide you with information about these changes, if they apply to drugs you currently use, at least 60 days in advance.
Where can I get my prescriptions filled?
You must fill your prescriptions at a pharmacy that is in your drug plan’s network, except in special circumstances. So looking at which pharmacies are used by each plan available to you is important when comparing them. Many plans will also offer a mail order service that will deliver drugs to your door.
What if I live in different states during a year?
A plan that is available nationally will cover you throughout the United States. If a regional plan offers mail order services, your drugs can be sent to a different address. You should make sure the plan you choose will allow you that option.
Who can help me make these decisions?
By the fall of 2005, if you’re still uncertain whether Medicare prescription drug coverage is right for you, or confused by the drug plan choices you are offered, take your time. You don’t have to decide by November 15, 2005, the very first day the initial enrollment period begins. You still have six months after that to enroll.
- Your first resource is yourself.
Start by making a list of all your prescription drugs. Beside each one, write the price you now pay. You can use this list to figure out what you pay for your drugs over the course of a year and how much you will save with Medicare coverage. You can also use it to check which Medicare drug plan formulary most closely matches the list of drugs you take. - Your second resource is family or friends.
If you don’t have access to the Internet, or are not familiar with searching for information online, ask a family member or friend who can do it for you. - Published information and one-on-one help.
For different kinds of expert information and advice, see our Guide on the New Medicare Prescription Drug Coverage. - Local groups.
Churches, community centers, senior groups, and others in many places will hold information sessions in the fall. Watch for notices in local newspapers, newsletters, and bulletin boards.
Joining a Medicare Prescription Drug Plan
If you’ve thought things through and decided you want Medicare prescription drug coverage, and you’ve chosen a plan that suits your needs, it’s very easy to sign up.
- You can enroll on the phone by calling Medicare at 1-800-633-4227.
- You can enroll online by going to Medicare's website .
- Or you can call the plan of your choice directly by phoning the number provided on the plan sponsor’s marketing brochure or located through its details posted on Medicare's website.
You can enroll at any time from November 15, 2005 through May 15, 2006.
After May 15, 2006, most people who are already in Medicare will not have another opportunity to enroll until the following November and will be penalized for signing up late. There will be exceptions—for example, if you move out of your plan’s service area, or if you lose creditable drug coverage from another source through no fault of your own.
People who are not yet eligible for Medicare, but will become eligible in or after March 2006, will be able to enroll in a drug coverage plan during their initial enrollment period that extends for seven months—three months before and three months after the month they become eligible for Medicare. Younger individuals receiving disability insurance benefits may also enroll three months before and three months after they become initially entitled to Medicare.
Medicare will start covering your drugs at the beginning of the month after you have enrolled in a Medicare drug plan. If you sign up by December 31, 2005, your coverage will start January 1, 2006.
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