Medicare: Protecting Your Loved One's Interests

Thus far, Medicare Part D has had its share of surprises and glitches. Following these tips may help you avoid pitfalls and resolve any problems that crop up.

Read the fine print. Sometimes hurdles exist even for covered drugs. A plan may request a statement from your loved one's doctor for particular covered drugs, or it may require a trial of a generic drug first before paying for a brand-name drug. Sometimes plans drop drugs from their list of approved medications (called a formulary), so it's best to double-check with a phone call before enrolling, even after doing an online search. Make sure any quantity limits on particular drugs fit your loved one's needs.

Cut costs. As many as one in three people on Medicare has sufficiently low income to qualify for assistance through Social Security, which may exempt him or her from paying premiums and deductibles and keeps copayments very low (call Social Security at 800-772-1213 to learn more). If the person you are caring for reaches the gap, you can stretch out coverage and cut costs by opting for generic drugs or less costly prescription drugs and by purchasing drugs through mail-order discount pharmacies and warehouse club stores that sell some generic drugs inexpensively. The Web site www.medicare.gov offers lists of state and national pharmaceutical assistance programs, which can also be a great help.

Keep records. Keep an annual file with copies of your family member's Medicare card and plan card, health plan phone number, and explanation of benefits. Save receipts for covered drugs, so you can request reimbursement, if necessary, and have a record of payments made after reaching the coverage gap. Plans automatically record this information when the subscriber buys covered drugs within their networks, but they usually require receipts for any bought elsewhere.

Getting Help
Plan comparisons, financial help, and other assistance are available through these sources:

www.medicare.gov or 800-633-4227 (TTY: 877-486-2048) for general information, a plan finder tool, prescription and generic drug lists, information on pharmaceutical assistance programs, financial aid information, and more

www.benefitscheckup.org for national and local charitable aid for drug costs (and many more benefit programs)

www.socialsecurity.gov or 800-772-1213 (TTY: 800-325-0778) for low-income aid called Extra Help

Your state health insurance program (call or check online at www.medicare.gov) for general information.

Source: from Caregiver’s Handbook, Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.  Use of Content | Medical Disclaimer