Medicare Part D Notification: Fill & Download for Free

It is not normally a health insurance company who is administering your prescription drug coverage. It’s more likely to be a Pharmacy Benefit Manager (PBM).If you have health insurance/pharmacy coverage through a large employer, it is likely a self funded plan. This means the employer is underwriting the expenses, and hires plan managers (administrators) and PBMs to run their programs. Employers can decide a lot about what they will and will not cover in their plan.The answer to your question is: unless you are a Medicare Part D beneficiary, it depends on what state you live in. Health insurance and pharmacy benefits are regulated by the states. Most states have guidelines or requirements for the company to notify patients a certain number of days in advance of a formulary change.Many states have adopted language resembling the Medicare Part D regulations. As an example, Maine adjusted their language in a law that went into effect July 1,2018.Medicare Part D guidelines are as follows:if a plan puts access restrictions on a medication (such as step therapy), starts to require preauthorizion, moves a drug to a higher cost tier so it costs more, or limits the quantity you can get, they must notify you at least 60 days in advance.Plans are allowed to make changes at any time during the year. For Medicare plans, the written notification must be in 12 point font or larger. Many plans will make formulary changes for January 1, and notify the Medicare beneficiaries in the “Annual Notice of Change” document that is sent to arrive by October 1. Plans must also send out formularies with the coverage documents (plan summaries or evidence of coverage).Plans are required to provide an appeal or “exception request” process.If you have a concern or issue, contact your plan’s Membership Services department and ask them if you were notified - and ask what your rights are to request an exception or how to appeal the change. Your provider will likely have to complete paperwork to document that the drug is medically necessary. You might also ask your provider’s office if they were notified and/or if they can help you start an appeal.

In my experience many people are confused about Medicare partsA,B, C & D, Medicare Advantage Plans and Medicare Supplement plans so I feel the need to give some basic explanations:Medicare Part A: Covers hospitalization costs. At age 65 we are all eligible and there is no monthly premium.Medicare Part B: Covers outpatient services at about 80%. The balance is paid by the patient. There is a monthly premium of about $110–120 for Part B that is deducted from your Social Security check. You do not have to subscribe to Part B but you will not have any outpatient coverage.Medicare Part C: Under Part C the patient may choose a Medicare Advantage Plan offered by a commercial insurance company (AARP Medicare Advantage is an example). These plans MUST include the minimum coverage of Part A and Part B Medicare. If the patient chooses to go with a Medicare Advantage Plan then all their healthcare claims are paid by this commercial insurance company and NOT by Medicare. Medicare pays the premium to the Medicare Advantage Plan for the basic coverage. However most Medicare Advantage Plans offer other “add-ons” for an additional premium that is paid by the patient. The “add-ons” May include additional medical coverage, lower co-pays or some drug coverage. Essentially you may be able to roll your supplement into your Medicare Advantage Plan by paying an additional premium.Medicare Part D: This is the coverage for drugs. It does not involve any commercial insurance company. Your current prescription usage is evaluated and a premium is set. The premium is deducted from your Social Security check.Whew!Now to the question of supplements. Medicare Advantage Plans are essentially a combo of Medicare type coverage plus a supplement so they are not part of this discussion. So let’s assume you have Medicare Parts A & B (hospital and outpatient coverage). Now you are interested in a supplement that may offer additional coverage and may pay for some of the 20% outpatient co-pays not covered by Medicare Part B. You can also get supplements that cover prescription drugs.Your task is to decide what additional coverage you want based on your medical history and prescription drug usage. Both of these can be addressed in the same policy or they could be purchased separately. Personally I am covered by Medicare A & B plus a supplemental from my former employer (retired) plus a separate drug policy. That works for me because of my particular life circumstances. What is most advantageous for you may be different. For those who love research please go ahead and check out many policy options. For those who are horrified by that thought of such research I suggest you look for an insurance broker who can assist you. Be sure that this broker represents many different companies - not just one. You’ll get lower premiums with more choices. You are not obligated to purchase policies from the broker so you could speak with other brokers if you’re not happy with the first one.If I’ve made any factual errors I would appreciate notification.Best of luck with your search.Susan

No you do not need to notify the old company that you are dropping them. When you sign up for a new plan the old plan is notified that you are cancelling them January 1. You will get a letter from your old company notifying you that will not be their client as of January 1. If you are deducting your premium from your Social Security check each month the possibility exists that your old premium may come out of the January check. However they will get notification from Medicare as to your new plan. Once that happens they will take the new premium out of your check and then they will reimburse you the amount they took out for the old plan.