How can I avoid problems with Medicare Part D plans?

Anne Fabiny
Geriatric Medicine
Following these tips may help you avoid pitfalls and resolve any problems that crop up in a Medicare Part D prescription drug plan:
  • 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 cost. 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. 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 stores that sell some generic drugs inexpensively. The Website 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.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.