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Using Your Medicare Drug Plan

By: Source: AARP.org Date Posted: 2006-10-31 07:14:00-05:00

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Using your drug plan is easy. After you enroll, you will receive from your drug plan:

• A member handbook
• A membership card and enrollment letter
• A list of covered drugs
• A list of pharmacies that you can use (known as in-network pharmacies)
• Complaint and appeals procedures
• Other important information

You can take your drug plan’s card to any of the pharmacies in your plan’s network and purchase prescription drugs covered by your plan. Or you can follow your plan’s instructions for getting your prescriptions filled through mail order. If you use your drug plan card, you will always get the drug plan’s discounted prices and your plan will have a record of all your out-of pocket expenses. This will be important if you have enough expenses to qualify for catastrophic coverage.

If you haven’t received a letter or card from your drug plan sponsor and it is past the date your coverage starts, ask your pharmacist to call Medicare or your drug plan to confirm your enrollment.

If you discover that your plan does not cover a drug you are prescribed:

• Work with your doctor to find a similar drug your plan does cover, or
• Ask your plan for an exception to cover the cost of this drug.

Tips

1. Call your drug plan sponsor first with any questions or issues that may arise. If you have a medical emergency, call 911.
   
2. Read the monthly statement sent by your drug plan and keep your drug receipts so you can keep track of your expenses. If you do not receive a monthly statement, call your plan and ask for a copy. (However, if you are not now buying any drugs through your plan, you may not receive a statement.).
   
3. You cannot be charged a fee for enrolling in a plan or switching to another.
   
4. Beware of people who contact you about a drug plan. Don ’ t give out your Medicare ID number, bank account or credit card information, or send cash or check payments to people who contact you saying they represent a drug plan or Medicare. If you are interested in a plan, get the plan name and then call Medicare to see if it is an approved plan. Call them at the telephone number you get from Medicare. Drug plans are not allowed to be sold door-to-door. If you suspect fraud, report it to Medicare at: 1-877-7SAFERX (1-877-772-3379) or your state attorney general.
   
5. Over-the-counter drugs are not covered by a Medicare drug plan.
   
6. Consider having your premiums deducted directly from your bank account or Social Security check. If you do have your premiums withdrawn from your Social Security check, it will take at least two months to start the process.
   
7. During the enrollment year, your plan cannot:
   
   • increase your premiums, deductible, copays, or coinsurance percentages. (Your out-of-pocket costs may change depending on whether you reach and have coverage in the coverage gap or if the drug ’ s price rises and you pay a percent of the drug costs.)
   • move a drug to a higher cost tier unless there is a similar drug available at the lower tier.
8. During the enrollment year, your plan can:
   
   • drop a drug from its formulary or move a drug to a higher cost tier with 60-days notice. (These changes will not apply to you during the enrollment year if you are already taking the affected medication unless there are concerns over the drug ’ s safety or effectiveness.)
   • with 60 days notice, replace a brand name drug with a new generic drug.
   • add, with 60 days notice, to its list of available drugs throughout the year.