Medicare Rx Overview
The annual enrollment period for Medicare drug benefits is Nov. 15th through Dec. 31st, with coverage beginning Jan. 1st. 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 most recent enrollment period (for 2010), our staff and trained volunteers helped 503 individuals with this important decision. It’s not unusual for our program to save a senior or younger Medicare beneficiary hundreds or even thousands of dollars per year.
If you miss the annual enrollment 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 North Carolina, there are 45 Medicare Part D or “stand-alone” drug plans to choose from for 2010, with monthly premiums ranging from $17.10 to $103.80. Most Medicare beneficiaries will add this 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.
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. 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, i.e., Medigap policies. Senior PharmAssist is the only 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 help individuals obtain the information they need to make informed judgments about Medicare Advantage plans.
You may click here to read a basic framework for understanding Medicare.
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 2010. We hope you find this information helpful.