What You Need to Know: The New Medicare Prescription Drug Coverage
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?
Every October, you will receive mail from the Medicare-approved private companies that will offer drug plans in your area the following year. 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 in October of each year, you can also 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 in October.
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 weight-loss 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. These changes will not apply during the current enrollment year to people already taking the affected medication.
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?
- 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 Where to Go for More Help.
- 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.
