Common Questions After Enrolling in a Medicare Part D Plan
By Amy Niles, Vice President of External Relations
Medicare Open Enrollment is in full swing. But if you’ve already enrolled in a part D prescription drug plan, you may still have a few questions. Understanding your plan is critical to making informed decisions about your prescription medications.
From billing errors to medications not covered by your new plan, we have answers for some of your frequently asked questions:
I enrolled in a Part D plan, but I haven’t heard anything. Is this normal?
No. You should have received a welcome letter and a prescription card from the plan. Contact the plan right away to confirm that you are enrolled.
I enrolled in a drug plan and got a letter welcoming me into the plan, but nothing else. I have nothing to show the pharmacist. How can I get prescriptions filled without a card?
Contact your plan immediately. If you need to get your prescription filled before your card arrives, bring the letter you received from the plan that confirms you have enrolled with you to the pharmacy. If you don’t have a letter, ask your pharmacist to call 1-800-MEDICARE (TTY: 1-877-486-2048).
The customer service representative should be able to tell the pharmacist in which plan you are enrolled. If you continue to have problems, you should contact your local SHIP office. You can locate your local SHIP office by visiting www.ShipTalk.org or by calling 1-800-MEDICARE (TTY: 1-877-486-2048).
Will my plan cover a drug that I need to take even if it is not on their formulary?
You, your authorized representative or your doctor can ask for a “coverage determination” (exception) to get your plan to cover a drug when it is not on the plan’s formulary.
The plan must decide within 72 hours (or 24 hours for an expedited review) if they will cover the drug. If they decide not to cover the drug, they must send you written notice. You also have a right to appeal their decision.
Note: If your drug is not on the formulary, but you are able to get it covered by the plan under the plan’s exceptions process, the money you spend on the drug is counted toward qualifying for catastrophic coverage.
What happens if my plan does not approve a drug that I need?
You must pay the full cost for any drug not on the formulary. The money you pay for these drugs does not count toward the total amount that you must spend to qualify for catastrophic coverage. That is why it is important to make sure that your drugs, especially the most expensive ones, are on the formulary of the plan you select.
I am having problems with my old Part D plan. I have enrolled in a new Part D plan, but my old plan still deducts a premium. What should I do?
Report billing errors to 1-800-MEDICARE (TTY: 1-877-486- 2048) as well as to the plan. Since your plan has not stopped billing you after you notified it of the error, you may wish to file a complaint. Ask the plan’s customer service representative to send you a complaint form or tell you how to find one on the plan’s website. You can also file a complaint (grievance) with Medicare by calling 1-800-MEDICARE.
Open Enrollment can be a confusing process. But with the right resources, you can make informed decisions. For more information on comparing your plan choices and finding the plan that best meets your prescription drug needs at the lowest cost, download the full Medicare Open Enrollment Guide.