Show #418 Airing Sunday, 1/27/08
You're signed up for a Medicare Part D plan. But the plan won't cover one or more of your most important, and most costly, medications. Is there anything you can do? Here with a money-saving prescription for prescription coverage is my law partner, Jennifer Peck.
Question: Why wouldn't Medicare Part D cover my medicines?
Answer: Each Part D plan covers its own list of medications, and none of the plans cover all medicines. So when you pick your plan, you try to find a plan that covers all or most of the prescriptions you need.
But chances are you might not cover all of them.
Even if all your prescriptions are covered when you sign up, the doctor might change your medications during the year. Or you might contract a new illness requiring new medicines that are not covered by your plan.
Question: How can we avoid getting socked with huge costs for uncovered medications?
Answer: Ask your doctor if he or she can prescribe an alternative that would work just as well and is covered by your plan. You'll have to provide to the doctor a list of drugs covered by your particular plan.
Question: What if no covered drug will work?
Answer: Ask the plan for an "exception" to cover your drug. Exceptions can be used to cover a medication not on the plan's covered list or to get a lower co-pay for a drug that is on the list.
To get an exception, you must have your doctor's help. The doctor must certify that the desired drug is the only one that will work for you or that the compatible drugs on the covered list may be harmful to you. The more details the doctor gives to the plan, in writing, the more likely the exception will be allowed.
Question: What if you've just joined a new plan that does not cover medications that were covered under your old plan?
Answer: You have a legal right to require your plan to continue to cover your medications for a minimum of 30 days, and some plans have policies that will cover your medications for more than 30 days.
So, if you began a new plan in January, and you now need to refill a prescription that was covered under your old plan, the new plan must cover the same drugs now, because you are within the 30-day transition period. But this rule only applies for the 30 days - after that time you will be subject to the new plans coverage.
Question: Where can we get more information about getting coverage for medicines not covered under a Part D plan?
Answer: There are two websites with lots of information: www.medicarerights.org and www.medicareadvocacy.org
You may still be able to save money on prescriptions, even if your Part D plan does not cover them. My thanks to Jennifer Peck for her helpful advice. To learn more, call her at the number that's next.
