Avoiding Common Medicare Mistakes – Part 3

In this final blog about Medicare, we will discuss some highlights regarding prescription drug coverage. 

  • Check your plan for Part D as to covered prescription drugs and which are formulary and non-formulary.  Each plan has lists of drugs fitting into each category.  If your drugs are not on the approved list, you may have to process an exception, pay a higher cost or file an appeal. 
  • Also consider whether you can visit a local pharmacy or if you are required to use mail order.  There are also preferred and non-preferred pharmacies to be considered. 
  • Finally, know your options with regard to name brand vs. generic drugs.

If you have a very limited income, there is assistance which may be available to you to help with your health costs.  These programs include:

Medicare Savings Programs (MSPs) help pay the monthly Part B premium and may help with Medicare cost sharing, depending on the program (there are three types of MSPs). Contact your SHIP at www.shiptacenter.org to learn if you are eligible for an MSP.

Extra Help is a federal program that helps pay for some to most of the costs of Medicare Part D prescription drug coverage. Contact the Social Security Administration at 800-772-1213 or visit www.ssa.gov to learn if you are eligible for Extra Help and to start an application. 

State Pharmaceutical Assistance Programs (SPAPs) are offered in some states to help eligible individuals pay for prescriptions. Contact your SHIP at www.shiptacenter.org to learn if there is an SPAP in your state.

Do your homework before turning 65 to know your options with regard to Medicare.  Avoid costly mistakes.  Healthcare coverage can be overwhelming and very confusing.



About the Author

Kay Sowa is a paralegal in the Trusts and Estates Group at Capehart & Scatchard, P.A. She is an IRS Enrolled Agent, an Accredited Estate Planner®, and a Certified Trust and Fiduciary Advisor. She oversees the trust and estate administration practice for the firm. She is an accomplished author and lecturer who has frequently spoken on behalf of a number of organizations including the National Business Institute and the Institute of Paralegal Education.

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