Make the most of your Medicare Part D drug benefit
February 1, 2018
With the new year, many Medicare beneficiaries have enrolled in a Part D, prescription drug plan, possibly for the first time. There are several ways to make the most of your Part D benefit and we will examine them.
What you should expect from your Part D plan
Once you have enrolled in a plan you should receive, within two weeks, a letter letting you know your enrollment information has been received. Within five weeks you should receive a welcome packet that will include several items. You will receive a prescription drug card for you to present to your pharmacist when picking up your prescriptions and formulary, which is a list of every medication that your plan will cover. It is a good idea to take your formulary along with you when seeing your providers so that they know which prescriptions are covered by your plan. You will also receive a list of all of the pharmacies that will work with this plan and an Evidence of Coverage document which will explain to you the rules of the plan.
If you need to pick up prescriptions before your welcome packet arrives, you can use the letter that you received from the plan as proof of membership. You can also use the enrollment confirmation number you received when enrolling along with the plan name and the phone number You may be able to print a temporary card from your mymedicare.gov account. You can also call the Medicare Information Office at 1-800-478-6065 (toll-free in Alaska) for assistance.
Using generics vs brand name drugs
Many times a brand name medication may be substituted by a significantly less expensive generic alternative. You can ask your provider to examine your medications and notify your pharmacist that a generic alternative is okay.
Knowing your pharmacy’s status
Each of the 19 Part D plans available this year in Alaska has a pharmacy network. This is a group of pharmacies that have agreed to provide plan members with services and supplies at a discounted price. Some plans will only work with network pharmacies except in an emergency. Preferred pharmacies are pharmacies that are part of the plans’ network and offer the lowest out-of-pocket cost. As mentioned earlier, a list of pharmacies that will work with your plan will be provided in your welcome packet.
Getting a 90-day refill cycle
Often times Medicare beneficiaries can reduce their costs by refilling their prescriptions every 90 days rather than every 30. You can request that your provider write your prescription to allow for up to a 90 day refill. There are certain medications that cannot be given a 90 day refill such as controlled substances or certain expensive or specialty medications.
Get screened for the Extra help program
Medicare beneficiaries who meet the income and asset qualifications may be eligible for the Extra Help Program. This program offers numerous benefits that can significantly lower your costs. If you qualify, you can enroll in a Part D plan or change your Part D plan at any time throughout the year. This program also works with the plans to reduce your monthly premium. The premium is the amount you pay each month to belong to the plan. Seven of the 2018 plans will have a zero premium when working with the Extra Help Program.
Extra help will also reduce or eliminate any deductible required by the plan. The deductible is the amount you pay at the beginning before your plan begins to pay. And Extra Help lowers your co-pays or co-insurance. These are the costs you pay at the pharmacy when picking up your prescriptions.
If you are receiving Medicaid benefits, Medicare Savings Program benefits, or receiving SSI benefits, you are automatically eligible for the Extra Help Program. The current income limit for single individuals is $1,903 per month and for couples is $2,556 per month. The asset limits for single individuals is $13,820 and for couples is $27,600. The assets do not include the home that you live in, the car you drive or your personal possessions, but do include investments, other properties, and other resources.
If you want more information about the Extra Help program, would like to be screened or would like assistance with applying, you can contact the Medicare Information Office at 1-800-478-6065.
Take advantage of these avenues to maximize your Part D benefit and minimize your expenses in 2018.
Nila Morgan is a Certified Medicare Counselor and Medicare Fraud Education coordinator who works at the Anchorage Senior Activity Center.