Illustration by Christoph Niemann
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Still Tangled in Drug Plans?
By Karen Westerberg Reyes, May & June 2006
We gathered the toughest questions from people across the country—and our experts answered
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Q: Is there any grace period for Medicare Part D? I went with my mother to a Part D seminar at our senior center, and the presenter passed around papers and asked us to fill them out and sign them so we could take the seminar. We didn't know my mother was signing up for a specific plan, which it turned out she was. Is she stuck?
A: Maybe not. Your mother is permitted to change plans once between now and the deadline for enrollment, May 15, 2006. Call Medicare (800-633-4227) and explain the situation. Medicare will help your mother sign up for a drug plan she's more comfortable with. If she misses the May 15 date, she'll have to wait until the next open enrollment—November 15 through December 31, 2006—to change the plan. You also might consider reporting this incident to your state attorney general's office. It sounds as if you were deliberately misled—which might be fraud. Provide the name and address of the prescription-drug plan and the individual who conducted the "seminar." In addition, report this to MEDIC, which handles Medicare fraud and abuse cases. Call MEDIC at 877-772-3379, or write to Health Integrity, Attention: MEDIC, 9240 Centreville Road, Easton, MD 21601.
Q: I have been deluged with mail about Part D plans in my area. But when I recently went to my doctor for a routine exam, a salesperson in the waiting room tried to sell me his company's Part D plan. He really strong-armed me and the other older people there. Is there somewhere I can file a complaint?
A: Plans are prohibited from conducting sales presentations and distributing and accepting enrollment applications in areas where patients primarily intend to receive health care services. These restricted areas include waiting rooms, exam rooms, hospital patient rooms, and pharmacy counter areas (where patients wait for services or interact with pharmacy providers and get medications). Report this to MEDIC (see the previous answer for contact information).
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Q: I lost my wallet recently and found out later that someone had used my Medicare Part D card to fill a prescription for a painkiller. To whom do I report this, and how do I get a new card?
A: You should start by calling the police and reporting the illegal use of your Medicare prescription-drug card. Then inform MEDIC of the theft (see the first answer for contact information.) To get a new card, report the loss to the company that sponsors your Part D plan.
Q: I paid full price for my heart medication because I had run out of it. The pharmacist couldn't find my name on the computer even though I had signed up for a Part D plan. How can I get reimbursed?
A: First, call the Part D plan you signed up with to make sure you're enrolled with it. If the plan doesn't have you on record, call Medicare at 800-633-4227. (You can find out if you were mistakenly enrolled in another prescription-drug plan.) After verifying you are enrolled, take your Part D identification and your receipt for the heart medicine to the pharmacy where you purchased it. The pharmacist should be able to reprocess the claim and reimburse you. If you don't have the receipt, take the medication container back to the pharmacy and ask for a duplicate receipt. If you have any problems, the next step is for you to contact your Part D drug-plan sponsor and request that a claim form be sent to you. Fill it out, attach your receipt, and submit it directly to the drug plan for reimbursement.
Rx plans may seem like a maze, but there’s help.
Q: I live with my daughter and her husband. I signed up for a Medicare Part D plan in our area, but I just found out my son-in-law is being transferred across the country. I'm of course moving with him and my daughter. What do I do now?
A: The first thing to do is check with your drug plan to see if it offers coverage in your new location. If so, you can stay with your current plan. Otherwise, you're allowed to drop that plan and sign up with a new one because of your residence change. If your current plan has a mail-order service, use it until you get the new plan in place.
Q: I live in a small rural community. I've been getting all my prescriptions from the only pharmacy in town. The Medicare Part D plan this pharmacy honors does not cover several of the prescriptions I use, the nearest outlet for the plan that does is 120 miles away, and that plan doesn't have mail order. What should I do?
A: One of the requirements for Part D providers is that their plan's network include a sufficient number and range of retail pharmacies so enrollees can have convenient and emergency access. In rural areas, such as yours, the requirement is that 70 percent of the beneficiaries be within 15 miles of a pharmacy that services the plan. If you don't think your plan meets this requirement, call Medicare (800-633-4227) and explain your problem. Medicare will help you find a plan that covers your medications and is either closer to you or offers mail-order benefits. In the meantime, talk to your physician to see if you can substitute similar drugs that are covered by the local plan for the medications you're now taking. Otherwise, your next opportunity to choose another plan after initial open enrollment will be November 15 through December 31, 2006, and every year thereafter.
Q: I'm an expat living in Mexico. Am I eligible for any kind of Medicare Part D plan? And is there any way I can get my medicine here? Can I have someone in the States purchase my Part D prescriptions and send them here?
A: One of the eligibility requirements for Part D coverage is that you live in the service area of a Part D plan. The service areas are the prescription-drug plan (PDP) regions as defined by the Centers for Medicare and Medicaid Services (CMS). These encompass the 50 states and the territories. PDP regions do not extend beyond U.S. borders. So, unfortunately, the answer is no to all your questions.
Q: I need someone to help me sign up for a Part D plan. It's all too complicated. I don't know computers, and I'm also hard of hearing, so I can't use the phone very well. I live alone and don't have any relatives who live close to me.
A: Your State Health Insurance Assistance Program (SHIP) can help you. This organization trains volunteers to provide assistance with Medicare issues, and they can aid you through the process of signing up for a plan. See if you can get someone at your local senior center, place of worship, or library to call your local SHIP for you. For the number of your state SHIP, call Eldercare Locator at 800-677-1116.
Q: I've been getting my expensive heart medicine directly from the manufacturer through a program for qualified low-income people. Now that I've signed up for Medicare Part D, will I still be able to do that?
A: While there's nothing in the new Medicare law that prohibits a pharmaceutical company from continuing to offer these patient-assistance programs, some drug manufacturers are cutting back. The best thing to do is check with the company to see if it's going to continue its program. Since you qualified for low-income assistance with the drug manufacturer, you might also qualify for the Extra Help program available through the Medicare prescription-drug program. (To qualify, your annual income cannot exceed $14,700 for a single person, or $19,800 for a couple. Assets—not including your house, personal possessions, vehicles, or burial plots—can be no more than $11,500 for a single person or $23,000 for a couple.) It's worth checking to see if you qualify, because you'll receive substantial help paying for all your prescriptions. You'll also receive unlimited drug coverage with no coverage gap, help paying for your Part D premiums, a reduced (or even zero) annual deductible, and reduced copays based on your income and asset levels.
Q: I'm 72 years old, and my wife is 68. We are raising our three grandchildren, who are 12, 10, and 8. Although we are not considered below the poverty level, the extra cost of the Medicare Part D plan for both of us is going to put a real strain on our budget. Is there a program that might help us with our Part D costs?
A: There might be. Because you provide support for your grandchildren, your income level to qualify for Medicare Part D Extra Help can be much higher than it would be if you didn't have dependents. Apply for help by calling or visiting your local Social Security Administration office. (For details about benefits from Extra Help, see the previous answer.)
To see a comparison of Medicare Part D plans, to enroll in a plan, or to ask questions, either call 800-633-4227 or go to www.medicare.gov. Also, AARP offers three free publications explaining Medicare Part D: "The New Medicare Prescription Drug Coverage: What You Need to Know" (D18350, English; D18352, Spanish), "Extra Help for People With Limited Incomes" (D18351, English; D18353, Spanish), and "Using the Plan Finder" (D18490). To order copies of any or all these titles, call 888-687-2277 or log on to www.aarp.org/medicarerx.
Additional reporting by Pam Harkins.
Visit AARP Bulletin Online’s Medicare channel for more information.
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