January 16, 2015 in Insurance

Medicare open enrollment ended in December, and if you changed your Medicare Advantage or Medicare Part D plan, your new coverage took effect on Jan. 1. But your job isn’t quite done — it’s still important to take a look at your plan materials. In fact, even if you didn’t switch plans you still may face changes, so reading through your coverage information is top priority.

Unfortunately, those materials can be overwhelming and difficult to get through, says Ross Blair, senior vice president of eHealthMedicare.com. So I asked him and Leslie Fried, the senior director of the Center for Benefits Access at the National Council on Aging, to break down the important points. Consider this your Medicare Cliffs Notes.

Make sure your drugs are on the formulary, the list of covered drugs. This is something you should have checked when weighing your Medicare Part D or drug coverage plan, but many people don’t, says Fried. “Unfortunately, a lot of Medicare beneficiaries don’t look at the formulary, and the first time they find out their drug isn’t covered is when they go to the pharmacy and their plan denies the prescription. Sadly, a large number of people just walk away and don’t get the drugs or pay out of pocket and that can (represent) a significant cost.”

Instead, check any drugs you’re taking against the list of drugs covered by your plan, then speak to your doctor about alternatives to any drugs that aren’t covered. If an alternative isn’t available, Fried says you can submit for an exception to the drug plan, and if that’s denied, you can appeal.

Choose your pharmacy wisely. There are two types of pharmacies that would be considered in network by your Medicare Part D provider, but your costs will differ between them. Some pharmacies are simply in network, which means the drugs will be covered there. Others are preferred pharmacies, which means the drugs will be covered at a lower out-of-pocket expense to you. You want to visit the latter if possible, says Fried. She notes, too, that drug costs are often higher under a plan’s mail order drug system, so be sure to compare costs with your local pharmacy before ordering.

Use preventive services. “Medicare Part B covers many preventive benefits that help you protect your health,” Blair says. “Some, like flu shots, are available to you free of charge, so it’s a good idea to know what these benefits are so you can maximize your Medicare coverage.” You may be eligible to receive cardiovascular disease screenings, shots, depression screenings, annual wellness visits, breast cancer screenings and other services at no additional cost.

Stay in network. With Medicare Advantage, coverage rules can vary. You may need a referral to see a specialist, and certain hospitals and doctors may be considered out of network. Be sure to check with your plan to make sure all of your care providers are in network before scheduling appointments or services. This is true even if you have continued on the same plan from last year; the rules and the provider network can change, Fried says.

Get help. There are several services available to qualified applicants who can’t afford premiums or other out-of-pocket costs. The first is the Medicare Savings Program, and it’s administered through Medicaid. To see if you qualify, visit your local office. That program may provide help with Part B premiums and other costs. Another program is Extra Help, which is administered through the Social Security Administration (and you can apply online at SSA.gov). That program may offer assistance with prescription drug costs and out-of-pocket expenses, Fried says.

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