Tag Archives: b. medicare

Your Questions About Medicare Part D

William asks…


What is the deal with Medicare part D? Is it right for most everybody?

Medicare Insurance AZ staff answers:

If you have drug coverage from Tricare,the VA, employee or retiree coverage (check with the benefits administrator to see if it’s creditable) then you usually are better off keeping that coverage. Medicare accepts creditable coverage, which means if you have a prescription drug benefit that is at least as good as Medicare coverage, you can keep it.

Ken asks…

I have part D medicare, yet their is one of my meds they will not pay for. I have contacted various places for?

contacted the drug company and they will not help because we make too much money, of course they don’t take into consideration that the difference between income and bills. I have also contacted various agencies for help and no way…do any of you have any suggestions for me?

Medicare Insurance AZ staff answers:

You should go through the appeal process, according to the Medicare website. It says:

“What can I do if my Medicare drug plan says it won’t cover or pay for a drug that my doctor prescribed for me?
If your Medicare drug plan decides that it won’t cover or pay for a prescription drug, it must tell you in writing why the drug isn’t covered. This written decision is called a coverage determination or “Notice of Denial of Medicare Prescription Drug Coverage.” You should read this decision carefully because it will explain how to ask for an appeal. You have the right to ask for an appeal if your Medicare drug plan says it won’t cover or pay for a prescription drug. You should also talk to your doctor about whether you can take another drug that your Medicare drug plan covers.”

As part of your appeal, I suggest you have the doctor include a letter of exactly why you need it.

(My insurance company once refused to pay for my bone density scan. My dr. Wrote them a letter, calling then “dunderheads” and then saying if it were not paid, he would refer it to the state insurance commissioner. The insurance company then paid for it upon appeal).

John asks…

Why isn’t Medicare part D refered to as BushCare since Bush signed it to law? Why is ObamaCare so special?

Medicare Insurance AZ staff answers:

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Susan asks…

Need Help with medicare part D?

Questions about Medicare Part D For NewJersey?
Question #1. If you are on disability that is SSDI and under the age of 65 and on medicare part A and B, do you have to sign up for Medicare Part D?

Question #2. If you are on medicare part A and B no matter what age no matter what reason, is it voluntary to sign up for medicare part D, or is it a choice? does one have the freedom of choice? Or does medicare automatically sign you up?

Question #3. If you are a patient that was on hospice for 5 years and then discharged because you outlived the doctors prognosis does medicare automatically sign you up for medicare part D? and would a patient have to pay a penalty for something that was out of their control? This patient has medicare part A and B.

Medicare Insurance AZ staff answers:

NOTE: This is a better option versus trying to find a Medigap policy that includes Part D. They are called Medicare Complete policies and they even show Medicare Health Insurance Plans by States.

Http://www.medicaresolutions.com/

When you click on New Jersey, this is just one paragraph of what it says–New Jersey’s Pharmaceutical Assistance to the Aged and Disabled (or PAAD) program is a state funded prescription program which helps income eligible New Jersey residents with the costs of prescription medication. Drugs purchased outside the state of New Jersey are not covered and neither are pharmaceutical products whose manufacturer has not signed a rebate agreement with the state of New Jersey. Individuals looking to obtain Medicare insurance and specifically Medicare Prescription Drug coverage often have questions about the relationship between Medicare Part D and PAAD

NOTE: You should consider getting a Medigap policy that includes Medicare Part D. There are many plans out there that offer this option.

Here is a link concering Medicare Part D–http://mypartdusa.com/

NOTE: The answer below addresses all three of your questions above.

You always have to take the initiative to sign up and it is voluntary, even though there may be a penalty if you don’t sign up when eligible.

I believe (although I’m not positive on this so call up your local Social Security Office) that while under hospice, if medicines were included, you can still enroll in Medicare part D without penalty.

Of course, it’s always best to call your local Social Security Office or you can call the national 800 number at 1-800-772-1213.

If you have limited income and resources, and you qualify for extra help, you may not have to pay a premium or deductible–This is under the section (click on the first link below)–How does Medicare prescription drug coverage work?


When can I get Medicare prescription drug coverage?

You may sign up when you first become eligible for Medicare (three months before the month you turn age 65 until three months after you turn age 65). If you get Medicare due to a disability, you can join from three months before to three months after your 25th month of cash disability payments. If you don’t sign up when you are first eligible, you may pay a penalty. If you didn’t join when you were first eligible, your next opportunity to join will be from November 15, 2009 to December 31, 2009.

Http://www.medicare.gov/pdp-basic-information.asp#whympdc

There are also prescription cards you can get through private companies that might be just as good though.

RxAssist provides medicines to people who can’t afford to buy medicines.–http://www.rxassist.org/

There’s Partnership for Prescription Assistance–http://www.pparx.org/

Special Reduced and Free Prescription Drug Programs

http://www.peoples-law.org/health/charity-care/special_drug.htm

There are discount drug cards–http://www.needymeds.org/indices/discountcards.shtml

Daniel asks…

Medicare part D?

what is medicare part D?

Medicare Insurance AZ staff answers:

This is a very large subject.Medicare Part D is the Medicare prescription drug program that goes

into effect on January 1, 2006.

“Explaining Medicare‘s New Drug Plan—Not An Easy Task,” by Betsy White

Booz (July 21, 2005)

Town Times

http://www.towntimes.com/articles/2005/07/21/news/local_news/news11.txt

An official page concerning this program is:

“Your Medicare Prescription Drug Coverage Options”

Medicare.gov

http://www.medicare.gov/MPCO/Home.asp

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Your Questions About Medicare Part A Enrollment

Thomas asks…

Where do I find info re the part d changes for BCBS medicare rx plan?

I received info from BCBS of Texas via their publication of Life Times about a change in Part D. The enrollment period is Nov 15 to Dec 31. Since I am already enrolled in part D with BCBS, I want to obtain more info on these changes.
Thank you, Elroy T.

Medicare Insurance AZ staff answers:

Medicare Part D plans–and the prescription drugs each plan covers–can be confusing. Yes, you can and should check out the Medicare. Gov web site.

If you would like some help in answering this question from real people–and how it will work if you need to change the BCBS Part D plan you have to another one to get the drugs you need–I would recommend that you contact the Area Agency on Aging where you live. You would want to have the listing of all the prescriptions you are taking, the dosages prescribed and also the pharmacy that you prefer to do business with. Professionals at the Area Agency on Aging can provide guidance in helping seniors and their caregivers deal with the peculiarities of the different Medicare Part D plans. You will most likely find the professional staff there friendly and helpful–and they are not selling any particular plan or product. They also know the latest “scoop” on changes that are still happening with Medicare Part D in your state. (Yes, even now more changes are happening within plans!)

If you live in the United States or one of the territories, there is an Area Agency on Aging serving where you live. You can call toll-free 1-800-677-1116 to find how to contact the one serving you.

If you do contact your local Area Agency on Aging and like the help that they give you, let your local county officials and your folks in Congress know. Area Agencies on Aging are funded under the Older Americans Act and they don’t have big budgets for advertising. Your contribution to help provide this important information and assistance to your older friends and neighbors would be appreciated–but is not necessary to get the help you are seeking.

Good luck and best wishes!

Maria asks…

Who should we call to resolve this problem signing up for Medicare?

My father just retired and with that his health insurance coverage from work ended. My mother was also covered by his health insurance plan. Both enrolled for social security benefits as well as Medicare Part A and Part B. Since my father was a few months past his 65th birthday when he retired, they are enrolling for Medicare under the “Special Enrollment Period.” The problem is that the Social Security office gave them forms for my father’s employer to fill out to certify that they had been covered by the company’s health insurance plan, with the dates of coverage, etc. The form has lines for “Employee” and “Claimant”. In my father’s case he is both, in my mother’s case, she is the claimant and my father is the “Employee” under whose plan she was covered. The employer refused to sign my mother’s form, however, saying that she was never an employee. Because of this, my father was able to enroll for Medicare Part B but my mother’s application was denied. The social security office says that without the signature from my father’s employer, they can’t approve her claim and they are not willing to call the employer to explain what the form is asking for.

Medicare Insurance AZ staff answers:

I would call the Social Security Administration and explain it to them. That is correct in the way it was filled out. They should call your father’s employer and explain to him what that means, and maybe he will sign it.

David asks…

Question about OPEN ENROLLMENT/ changing plan to UNITED HEALTHCARE?

Older member of my family has local health care insurance with Medicare. Will be moving very soon and will not have that insurance (or plan, whichever it’s called) over there.

Will like to get back to UNITED HEALTHCARE (preferably MEDICARE COMPLETE) which she had for many years.

Does OPEN ENROLLMENT apply here? What is OPEN ENROLLMENT?

Will she be able to change to any plan right now? She’ll be moving by end of the month!!!

If unable to be accepted by UNITED or other plan now, would MEDICARE alone be enough when seeing a doctor or going to area hospital in the meantime? She does have MEDICARE part A and B.

Medicare Insurance AZ staff answers:

A move out of the service area is considered as a special election period, not open enrollment.

She can keep her current insurance (for ER & urgent care) while she is moving. After she moves she’ll be able to get on another plan in her new location. She’ll want to do this as soon as possible even though she officially has 6 months to make a change. She should visit a local independent agent that works with the senior market and with all the major plans to find the best plan for her situation. Medicare Complete is a good plan but it may not be the best for her. The agent can help her and there is no extra charge for the services.

Jenny asks…

Best medigap policy for my Mom? (see details)?

This is Texas.

I want to get her a medigap plan that covers A-J. I missed the open enrollment period (she is 66 now.) I need to know which company to buy from.

Mom has original medicare and medicare part b.

She was born November, 1941, so she is 66 years old.
She is 5’2″, 135 lbs, never been a smoker, never been a drinker.

No osteoporosis.

*She had a total knee replacement surgery 2 years ago, and arthroscopic on the old knee 12 years ago. *

*Only pre-existing conditions are: mild hypertension controlled with medication, worn cartilage in knee, and some arthritis.*
I want to get her a policy with a decent company with affordable premiums.
Okay, I geuss I should have said that I want to get her a medigap ‘J’ policy.
:

Medicare Insurance AZ staff answers:

Each State has it’s own Medigap Insurance Providers. I know that here in Florida we have dozens of them. My parents and inlaws all used a service available through our State to help them select a plan. My parents did this by phone and my inlaws had someone come by their house. They reviewed their health history, list of doctors, and medications and then matched them up with the policy with the lowest premiums and the medications and services they need most.

If you are in Texas; check out this website to see if you can get the same type of advice:
State of Texas
Medicare Prescription and Medigap plans

http://www.dads.state.tx.us/medicare/index.cfm

I’m eager to see the other answers; I think the process for selecting coverage is cumbersome and would love to have additional pointers to share.

Robert asks…

My husband is on Social Security Disability. He needs to change his Medicare Advantage plan pronto!?

He presently is on a Medicare Advantage plan that (supposedly)helps pay for what Medicare doesn’t pay for Part B and D.His premiums are increasing in 2009 almost 120%! We can’t afford that premium on fixed incomes! And,yes,he gets Federal and State help with premiums.The premium amounts that HE has to pay (combined) is above the premium help amount of $187.We have essential shelter costs (not including grocery bills,we don’t get foodstamps, or automotive and auto ins costs!)of $1300 and we do not have any credit cards and only one other credit account and that is for a new ‘fridge. We are in S. GA.His copay for his PCP is $20, copays for specialists are$35-50.Prescription co pays are $5-30.Does this sound like this Advantage plan is really worth the cost of the premiums?He has over 10 meds he takes every day and 3 are in the $20-30 copay range.He on average has around 3-8 appointments each mo. for his PCP and specialists.We are not freeloaders! We have worked 42-39 yrs respectively. Both of us are disabled due to on-job severe injuries and chronic genetic diseases.Anybody know of a good ins agency in S GA? Already tried Medicare.gov. We’ve been going over every ins agency we can since the open enrollment started. It ends Dec 31. HELP!
We’ve looked at AARP’s and Humana.He is currently on Georgia Improvement platinum plus,but they have his coverage as “Silver plus” but he is charged as getting “Platinum”!We’re sick of being on hold 45 mins to an hour or more, just to talk to one of those ‘clueless’ they use as customer service reps that couldn’t find their OWN butt with both hands and a roadmap!Seriously folks,do you think we haven’t already tried all of that?In S.GA,to become eligible under the ‘Medically needy program’,you have to pay out a certain amount to qualify for any medicaid help.The meds I’m talking about are: heart,hypertension (high blood pressure),pulmonary,PAD, COPD,and depression medications.He’s had a quad heart bypass,has therapy for claudication in his legs,sleeps with a C-PAP,and has an implanted defibrillator – NOT a pacemaker,but one of those things that knocks the H*** out of you if it detects any arythymias.He takes 2 types of antidepressives.The best so far is a newbie,GAMedi-Cares Advantage.

Medicare Insurance AZ staff answers:

Care improvement Plus is a great plan. This plan allows you to not go into the gap with many life needing drugs.The cost of this plan for 2009 is 189 a month.In Macon you can call Georgia Cares at 1-800–669-8387 they will help you find a plan that best works for you. The person who sent you those links is stupid.The first link is a scam wanting to take your money.There are free medications out there one that I would suggest is PPA,they have a toll free number 1-888-477-2669 and will not take any money for helping you.You really can not trust some of the people on here giving you answers. I was shocked at that one. Call that number for Georgia cares they will go through all the programs with you.It is a state paid agency and there help is also free.

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