Medicare Corner 1

June 30, 2017

Dear Medicare Counselor,

Q: I have a Medicare drug plan and they have stopped covering one of my medications. What are my options?

A: You have several options:

  1. You may switch Medicare drug plans every year during the Open Enrollment Period (OEP) between October 15 and December 7. A SHIP Medicare Counselor can help you search and identify which plans cover your medications for least cost for the coming year starting Jan 1. Some drugs may not be covered.
  2. If you have certain chronic conditions, you may be eligible to switch to a Special Needs Plan HMO or PPO that covers your drug, without waiting to end of the year.
  3. You and your doctor can apply to your drug plan to request a “Formulary Exception” review.
  4. There may be a pharmaceutical assistance program or foundation or discount card that will cover some or all of your drug’s costs.
  5. Your doctor’s office may have free samples. Or your doctor may be able to prescribe a comparable medication that is covered by your plan.
  6. If your gross income is up to 150% of the Federal Poverty Level and you do not exceed the resource limit, you may change Medicare plans any month with the Extra Help benefit through Social Security. You can apply online at SSA.gov or ask a Medicare Counselor for help.

Your local State Health Insurance Assistance Program (SHIP) office can help you determine the best way to maximize access to your health care and Medicare benefits.

For more information, assistance or in-depth explanation of your Medicare coverage, call the State Health Insurance Assistance Program (SHIP) office for free advice from a trained Medicare Counselor. SHIP is a national network, local community service that is available to every county in the U.S. There is no insurance company affiliation or sales.

In Maricopa County, call the Benefits Assistance Program at the Area Agency on Aging: (602) 280-1059
BAP SHIP PROGRAM Video 2 mins 

One-on-one free Medicare counseling is available through the SHIP Program by phone or in person from a Benefits counselor at the Area Agency on Aging: (602) 280-1059

You may submit a question to Medicare Corner through “Submit a Comment” below for a reply in the next issue. All questions are not certain to be posted and answered in the magazine.

Related Websites and Articles

 Website: Benefits Assistance Program – Medicare

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Author: Cindy Lee

Cindy Lee is the vice president and a member of GPPA’s Board of Directors and a member of Scottsdale’s Historic Preservation Commission. Her profession is TV Commercial Film Production. Cindy is a North Scottsdale resident since her 2009 move from New York. She volunteers free health insurance counseling and advocacy for Medicare beneficiaries through the Area Agency on Aging, a non-profit organization serving Maricopa County.

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