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My drug plan cost me too much this past year. What can I do?

What you should do is take advantage of the annual Open Enrollment Period. This is the time of year when you can make changes in your Medicare coverage. The period starts on October 15 and ends on December 7, 2013. Your new coverage will start January 1, 2014.

This enrollment period is very important. Why? Because unless you are new to Medicare, have Extra Help to pay your Medicare drug plan costs, or have a special circumstance, you will not be allowed to change your Medicare coverage for another year. So, if you need better coverage, now is the time to review your options.

During this time, you should review your plan options and consider joining a different Medicare drug plan. Remember, you only have until December 7 to switch to a plan that may better meet your needs in 2014, so don’t delay.

Find out how to explore your Part D options, what to consider in a plan, and how to enroll in a new plan.

Topic: Premiums and costs, Reviewing and changing plans

Keywords: drug, Part D, premiums

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I’ve just been prescribed a new drug and was told Medicare won’t cover it. What can I do?

Medicare covers most out-patient drugs through the Part D drug benefit. To get coverage, you must join a Medicare drug plan.

There a few reasons Medicare may not cover your drug:

  • The drug is excluded by law from coverage,
  • The drug is not on your plan’s list of covered drugs, also called the formulary, or
  • The plan may have special rules or set limits on how you get your drugs.

If your current plan does not cover a drug you are taking, there a few things you can do:

  • Ask your pharmacy: Your pharmacy should give you a notice that explains why your prescription could not be filled and how to contact your plan.
  • Ask your plan why the drug is not covered: Call your plan. Look at your plan membership card or other materials for the toll free number.
  • Talk with your doctor: See if your doctor (or other prescriber) can switch you to a similar drug on your plan’s formulary. If not, ask your doctor to give you free samples of the drug.
  • Request an “exception”: If the drug is covered by Medicare but not by your plan, ask your plan to cover it. This is called an “exception.” You will need your doctor who prescribed the drug to tell the plan why you need the specific drug. Contact your doctor and ask if he can help you request an “exception” from your drug plan.
  • Prescription Assistance Programs: See if any local prescription assistance programs in your area may offer this drug at a discount.
  • Review other drug plans: If you cannot get an exception from your plan and there is not an alternative drug, review other drug plans available in your area. Medicare’s coverage of prescription drugs varies from plan to plan. There may be another drug plan that does cover it. Use our QuickCheck tool to get help to compare plans.

Topic: Coverage of services and supplies, Premiums and costs

Keywords: drug, Part D, prescription

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I am not taking any medications right now. Does it ever make sense for someone like me to delay enrolling in Part D and accept the penalty?

Generally, we encourage anyone who is eligible for Part D (and who does not otherwise have creditable coverage, or coverage “as good as” Medicare) to enroll and get Part D coverage.

That said, Part D is a voluntary program, and you are right that one option is to delay enrollment and pay the penalty later on when you decide to enroll. However, it’s hard to say that you should delay enrolling now because you currently take no prescription drugs. That’s because no one can predict the future. And Part D is insurance to help you should you need help with your prescription drug costs.

Here are some important things to keep in mind when you are making this decision:

  • Your health may change: As you age and your health status changes, your need for prescription drugs may grow. The cost of those drugs may also increase over time. Consider signing up for one of the least expensive Part D plans in your area now (some areas even offer plans with $0 monthly premium), especially if you have a chronic health condition that could worsen with age.
  • Penalty costs may go up: The cost of the Medicare Part D penalty depends on how long you went without creditable prescription drug coverage. So, what may be a small penalty amount, say if you only delayed Part D for a year, could become costly if you waited 5 years. How so? For example, if you went without creditable coverage for one year, in 2012 you would roughly pay $3.70 in monthly penalty amount, plus any monthly Part D premium. If you had been without coverage for say 5 years, you would pay $18.60 every month in 2012, in addition to your monthly premium. You can see this penalty amount can become costly. And, this is a lifetime penalty — meaning as long as you have Part D you may have to pay the penalty, and it can increase every year.
  • You can enroll only at certain times: Keep in mind that you may have to wait until the next available Open Enrollment Period to get Part D coverage. There are only limited times of the year, and in only certain exceptional situations, in which you can enroll in a plan.For example, if your health suddenly changed, and you needed prescription coverage, you may have to wait to enroll during the annual enrollment period, which runs each year from Oct. 15 to Dec. 7, with coverage taking effect the following January 1. If you don’t enroll when you’re first eligible, you may end up in a situation where you need coverage, but you don’t have a special enrollment period and must wait until the next annual enrollment period to get it.

Topic: Medicare enrollment and cards

Keywords: drug, enrollment, Part D

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