Medicare Part D help and tips for people with Medicaid Coverage. How to avoid confusion and get your medications you need on time. Help with the information about Medicare part D for low income.
   


New Medicare Part D prescription drug plan for people with Medicaid Coverage.

Starting January 2006 Medicaid is no longer pays for the prescription drugs for those who has both, Medicare and Medicaid. People how had Medicare Part a and/or Medicare Part D had to choose their own prescription drug insurance company, or Medicare ( or your local Department of Human Services) will sign you up with the Prescription drug insurance company and choose the prescription drug plan for you.

You suppose to get your new Medicare Part D prescription drug plan information and prescription drug card form your new insurance company by January 1st 2006.

Many people who used to have Medicaid to pay for their medications can get confused and frustrated with new plans. Trip to the pharmacy to re-fill their prescription or fill new prescription make turns to a shock. Pharmacy tell them, that have to pay a lot of money for their prescription drug that they use to get at no cost to them, or tell them that their insurance is no linger covers this medication. People spend endless hours and effort to contact their doctors to fill another prescription. High co-payment required by the pharmacy is no longer affordable. People end up without mediations for weeks.

This is a simple guide for people who still struggle with Medicare part D coverage and still fighting with the pharmacy to fill out their prescription.

What you should know about your new Medicare Part D coverage, if you still have Medicaid coverage.

As any other insurance, your new Medicare Part D plan has monthly premiums, deductibles and co-payments. The amount depends on what kind of plan you have. The MEDICARE.org websites has a list of all insurance companies they have contract with for a Medicare Part D. Usually, insurance plans for people with low income have low or no monthly premiums, low or no deductibles and low or no co-payment. MEDICARE pays all fees required by the plan for those with low income, and still covered by Medicaid. Medicare has set the limit on the amount of fees they are willing to pay to your new insurance company. Medicaid is no longer involved in any payment or fees to your Medicare Part D insurance company. If you are eligible for QMB, it will cover only your Medicare Part A and/or Medicare Part B fees.

So, if you are facing any kind of problems with your new prescription drug coverage, you need to deal with two people: Your new insurance company and MEDICARE.


Dealing with your new insurance company:

First of all, look at your new insurance card. It should be a toll free phone number for a Customer Service on the back of the card. If they will put you on hold for a long time, there are other options to get the information you need fast. If you can use the computer to go on their website (if not I am really encourage you to ask for help to do so). Normally, the website provides good information about the plan details. You can find a list of drugs covered by your plan. Look at your insurance card again - what kind of plan do you have - find this plan on the website - print the list of drugs covered by your plan - find your medication - check the co-pay amount for your drugs. YOU SHOULD NOT PAY more than $3 co-payment for generic drug and no more that $5 co-payment for brand name. This is very important to know. The insurance companies that are approved by MEDICARE agreed to these co-payment and should not charge your more. If your pharmacy tells you that your co-payment exceeds $5 - something is wrong.

Second of all, check your plan maximum coverage. Remember, when MEDICARE signed you up with the new prescription drug company, they choose the plan for you. MEDICARE has no idea of your health or the amount of medications you need. You may discover, that some medications are NOT COVERED by your plan, you have limit on how much your new plan covers per year.

You have an option to change the insurance company or upgrade your plan with the same insurance company to get better coverage. Upgraded plans will require greater fees. At this point you have to contact MEDICARE to ask if they will cover 100% fees for your upgraded plan. If you switched plans without MEDICARE confirming paying all fees, you will have to pay the difference between what insurance company charges and what MEDICARE is willing to pay.

If you have the medication, that is not covered by your current plan, contact your insurance company and ask for exception. Most insurance companies offer a procedure, called Benefits Approval. Basically, you have to contact your doctor to fill out the form for you asking the insurance company to add this medication in your plan as no other alternative medication is working for you. Insurance company will review the application and will contact you about their decision. In the mean time, your pharmacy has to give you 14 days supply of the medication. While your case is still under review, the insurance company may give you a 90 days temporary coverage for your medication. Again, you need to check with your insurance company and their policies.

Generally, dealing with your new prescription drug insurance company is a pure pleasure. The Customer Service is helpful, friendly and willing to solve your problem. If you cannot get a chance to contact your Customer Service rep fast, try calling insurance agent directly (people who sells the plans). You will have a better chance to talk to a real person fast. These people are usually very knowledgeable about the plans they sell and different options in each plan. They might help you better understand what kind of plan you currently have, how much it costs, who pays for what and all other questions you might have.