Medicare Rx Overview
Beginning this year, the annual election period for Medicare drug benefits will run from Oct. 15 - Dec. 7. This change from the traditional Nov. 15 - Dec. 31 time frame is good news for beneficiaries, particularly those who need to change their prescription coverage, because it will increase the likelihood of a smooth transition in benefits processing on Jan. 1. All Medicare beneficiaries are encouraged to examine their options each year, as policies and prices change – not to mention that the medication needs of an individual can change from year to year. In Durham County, Senior PharmAssist is glad to help any Medicare beneficiary – regardless of income or age – sort through the dozens of plans available to make the best selection for that person.
During the election period for Medicare drug benefits for 2011, Senior PharmAssist helped 711 individuals - a 41 percent increase over 2010. It's not unusual for our program to save a senior or younger Medicare beneficiary hundreds or even thousands of dollars per year. Senior PharmAssist has created a two-page overview regarding Medicare drug benefits - updated for 2012 - to help guide a beneficiary's decision-making.
If you miss the annual election period, you may still have the opportunity to sign up for or switch your Medicare-approved drug coverage during the year, depending upon your income and other factors. You can call Senior PharmAssist (919-688-4772) to learn more.
In Durham for 2012, there are 30 Medicare-approved Part D drug plans and 16 Medicare Advantage plans that include drug coverage. Most Medicare beneficiaries will add a Part D medication benefit to their traditional Medicare A (primarily hospital) and Medicare B coverage (primarily physician visits and outpatient services). You may opt, instead, to leave traditional Medicare and join a Medicare Advantage plan (Part C) to obtain your drug benefit. Click here to read a basic framework for understanding Medicare.
Medicare Advantage plans are approved by Medicare and administered by dozens of private insurance companies. These plans provide Medicare Part A and B benefits and MAY include extras such as prescription coverage. They come in many forms, including Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) that have provider networks, and also Private Fee-for-Service (PFFS) plans that do not have provider contracts.
While these plans can be appropriate medical coverage for many seniors, a number of these plans are not widely accepted by healthcare providers (physicians, hospitals, home health agencies, rehabilitation facilities, etc.) in North Carolina. Selecting the wrong Medicare Advantage plan can mean denial of services or more costly medical care. Also, the payment structure for policyholders is very different than traditional Medicare.
Frequently, we see people who have enrolled in these health plans without truly understanding the pros and cons. In addition, Medicare Advantage plans do not work with Medicare supplemental coverage (Medigap). Senior PharmAssist is the coordinating site in Durham County for the Seniors' Health Insurance Information Program, and our staff works closely with the state SHIIP office (1-800-443-9354) to furnish individuals with the information they need to make informed judgments about Medicare Advantage plans, employer-sponsored retiree coverage, basic Medicare A & B, and supplemental coverage, in addition to Medicare Part D.
Special Information for Pharmacists
Senior PharmAssist and the state SHIIP office have created a two-page document to help North Carolina pharmacists deal more easily with Medicare Part D for 2012. Pharmacists may also reference a guide from the Centers for Medicare and Medicaid Services on closing the coverage gap. We hope you find this information helpful.