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Medicare News
What to Do When You Realize Your Medicare Drug or
Health Plan Does Not Meet Your Need
Information on drug and health plans provided by Medicare
Rights Center – see links below article
 Jan.
4, 2008 – Sometimes, after you picked the Medicare private health or
drug plan that you thought best suited your needs, you discover in the
New Year that the plan you chose doesn’t work for you at all. Perhaps
you’ll find that your doctor or specialist isn’t part of the plan’s
network. Maybe you’ll discover that there are large copays for a
hospital stay or diagnostic procedures. Or maybe when you go to the
pharmacy, you’ll find out that your drug plan doesn’t cover your
medications.
Is there anything that you can do to remedy your
private health or drug plan choice after the clock strikes twelve on New
Year’s Eve?
The answer is, “it depends.”
Changing Medicare health plans:
Everyone with Medicare is allowed to change health
plans (not drug plans) one time between January 1 and March 31 during
the Open Enrollment Period. The new health plan coverage starts the
first of the month after you make the change. Note that you cannot
add or drop Medicare private plan drug coverage (Part D) during this
time.
So, for example, if you have a Medicare private
health plan without drug coverage, you can switch to another Medicare
private health plan without drug coverage or to Original Medicare alone.
You will not be allowed to purchase drug coverage until November 2008.
Changing Medicare private drug plans:
Most people can add, drop or change drug plans just
once a year, from November 15 through December 31, with coverage
effective January 1. However, you can change your drug coverage if it is
as a result of changing your health plan from January 1 to March 31 (for
example, if you switch from one Medicare private health plan with drug
coverage to another)..
Some notable exceptions:
People who have Extra Help - federal assistance
that helps pay for the costs of the Medicare drug benefit - or who live
in qualified institutional facilities (such as nursing homes) are
allowed to change health, as well as drug plans, once a month.
If your drug is not covered:
If you are a new member of a Medicare private drug
plan and discover that your new plan does not cover a medicine you’ve
been taking, you should make use of the plan’s transition policy.
All drug plans are required to provide new members
with at least a 30-day supply of a drug they were taking before they
joined the plan, and must override restrictions, such as prior
authorization or step therapy. (This policy does not apply to drugs that
are explicitly excluded by law from Medicare coverage).
You must take action during the transition period
to better ensure that you can continue to get the drug after the
transition period ends—have your doctor prescribe a drug that is covered
by your plan or make a special request to ask that your plan cover the
drug for your (ask your plan for an “exception”).
If a plan denies your exception request, you have
the right to appeal.
Drug plans can change drugs covered at any
time.
Keep in mind that a Medicare prescription drug plan
can change the drugs it covers (its formulary) at any time. If you are
already taking a drug through the plan, it should continue to be covered
until the end of the calendar year. However, if it doesn’t, you may need
to ask the plan for an exception.
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Medicare
Advantage Still Open for Enrollment |
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 Enrollment
is still open for Medicare Advantage plans only.
Beneficiaries can make one change in enrollment - enrolling in a
new plan, changing plans or canceling a plan - between January 1
and March 31, 2008. |
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Special Enrollment Periods:
Both Medicare private health plans and drug plans
have Special Enrollment Periods (SEP), which allow you to make changes
under certain circumstances.
For example, if you were enrolled into a Medicare
private health or drug plan by mistake or were misled into signing up,
you can request an SEP by calling 800-MEDICARE (you may be able to
disenroll retroactive to the date you first enrolled in the plan).
To learn more about changing health and drug plans,
drug transition and exception policies, Special Enrollment Periods, and
how to begin the appeals process, log on to Medicare Interactive
at the Medicare Rights Center’s website at
www.medicarerights.org/help.html.
Medicare Interactive (MI) Counselor makes all of MRC's knowledge and
experience available to you 24 hours a day, seven days a week. MI
Counselor uses easy-to-understand language and timely information to
help you learn the ins and outs of Medicare.
Through MI Counselor's straightforward Q&A format,
you will learn what Medicare covers, what it doesn’t, how to pick a
Medicare health plan, what you need to know about Medicare’s drug
coverage (Part D), how to appeal if coverage or care is denied, and much
more.
Medicare Interactive (MI) Counselor is free.
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links,
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