Using Your Drug Plan for the First Time

For many people, getting enrolled in Medicare seems to be the hard part. But, it isn’t completely smooth sailing after enrollment. There are some things you need to know before using your coverage. It isn’t complicated, but you should be aware of these things.

What Do You Need To Take With You?

1. Your Medicare Card
2. A Photo ID
3. Your Plan Membership Card

Automatic Refill Plans (for mail-order service)

Many people who have Medicare benefits receive their prescriptions with an automatic refill option. This allowance delivers prescriptions to be refilled before they run out. In the past, some drug plans weren’t checking to make sure that customers wanted or needed the offered prescriptions, so they created waste and unnecessary additional costs for those with Medicare and its drug coverage (Part D).

Today, plans must receive a recipient’s approval to deliver a prescription, whether it is a new one or a refill, unless the request is made when the prescription is created. Some plans request this every year, others ask for this before delivery.

This policy doesn’t affect refill programs that the recipient picks up, and it doesn’t apply to long-term care pharmacies that give out and deliver prescription drugs. This new policy might be a change for anyone who has received their prescriptions via mail order and have not had the opportunity to confirm that they still need prescriptions.

Medicare recipients should always check if they receive any prescriptions that are unwanted via an automated delivery program. If you were, in fact, charged for a prescription that you did not request, you might be eligible for a refund. If you can’t resolve an issue with the plan or you wish to file a complaint, you are always welcome to call us for help.

When you apply to use your drug plan for the first time, you will need to provide your plan with certain documentation. These documents can include:

• A purple notice from Medicare that states you automatically qualify for Extra Help
• A green or yellow automatic enrollment notice from Medicare
• An Extra Help “Notice of Award” from Social Security
• An orange notice from Medicare that says your copayment amount will change next year
• If you have Supplemental Security Income (SSI), you can use your award letter from Social Security to confirm that you are receiving Social Security benefits.
• Proof of Medicaid coverage, living in an institution, or proof that you receive home- and community-based services:
• A bill from an institution such as a nursing home or a state document showing that Medicaid has paid for your stay for at least one month
• A printout from your state’s Medicaid system showing you have lived in an institution for at least one month
• A document from your state that shows you have Medicaid and are receiving home- and community-based services

Once you provide your plan with this information, your plan must:

• Make sure you pay no more than the LIS drug coverage cost limit. For example, in 2022, prescription costs cannot exceed $3.95 for each generic or $9.85 for each brand-name drug covered for the enrollment in the program
• Contact Medicare for confirmation if it’s available. Processing takes up to two weeks after application, depending on the circumstances.

Privacy and security of the health information of any applicant should be the primary concern of patients and their family members, health care providers, professionals, and the government. Federal law requires anyone who handles health information to protect such data regardless of its storage method. This is required by the Health Insurance Portability and Accountability Act of 1996 (HIPPA). You may have additional protections and rights under your state’s laws.

Using Network Pharmacies

Medicare prescription plans have contracts with other pharmacies that operate within their networks. These operate to provide you with better service. Medicare drug plans also work with these “network pharmacies” to offer lower prices to their enrollees.

Your plan’s network, along with retail pharmacies, might offer a mail order program or an option for retail pharmacies to supply an additional two- or three-month supply of your prescriptions.

• Preferred pharmacies: If your plan has preferred pharmacies, you could save money on out-of-pocket expenses
• Mail order programs: Some plans may offer mail order programs that will provide you with a three-month supply of your prescriptions. These will be sent directly to your home.
• Retail pharmacy programs: Some retail pharmacies offer a two- or three-month supply of any covered prescriptions.

Alicia's Insurance Services Boutique, LLC is Here to Help You

When you let us help you enroll, we are always here for you. Anytime you have questions about coverage, or are concerned about changes in your needs we are only a phone call away.

When it comes time to use your plan for the first time, don’t be embarrassed to call and clarify how to do so the right way. At the end of the day, we are here to help you.

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