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)
• Information on 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, even when you fall in the coverage gap, you will always get the drug plan’s discounted prices and your plan will have a record of all your True Out-of-Pocket (TrOOP) 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, you can:

• work with your doctor to find a similar drug your plan does cover, or
• ask your plan about an exception to cover the cost of this drug.

How and when can I switch plans?

You are able to switch plans from November 15 to December 31 each year. If you want to switch plans, you simply enroll in the new plan and you will automatically be dropped from your old plan. Your old coverage ends on December 31, and your new coverage starts January 1.

If you are enrolled in a Medicare Advantage plan, you have additional time from January 1 through March 31 to switch plans, but you cannot use this time to add or drop drug coverage. For instance, if you are in a Medicare Advantage plan with prescription drug coverage, you could return to Original Medicare, but you would have to join a “stand alone” Medicare drug plan at the same time. You could also switch to another Advantage plan with drug coverage during this extra time.

Then again, if you are new to Medicare and aged 65 or older, you have 12 months from when you first signed up to switch from a Medicare Advantage plan with drug benefits to Original Medicare plus a “stand alone” drug plan.

Every October, drug plans will start advertising their plans for the coming year. Drug plans may change what drugs they cover, the price they charge for a drug, and your share of the cost. Read over the changes, if any, made to your plan and compare this coverage with other plans available in your area. Your drug plan sponsor should send you an “Annual Notice of Change” by October 31. You can get assistance with comparing plans from Medicare and your State Health Insurance Assistance Program or SHIP.

There are specific situations when you may be able to switch plans outside of the November 15 to December 31 time period. If you:

• are eligible for “Extra Help.” (In 2007, this exception applied to everyone with Extra Help.)
• lose your Medicaid coverage.
• move out of your plan’s service area to permanently reside elsewhere or as a result of your move you have new plan options available to you.
• are enrolled in a plan whose contract is terminated or stops service in your area.
• demonstrate to Medicare that your plan has not met the terms of its contract.

(There are time limits surrounding some of these events; call Medicare to learn more.)