Trending
Question: I have a Medicare Part D prescription drug plan, and get notices from them each month. What are they for and should I keep them?
Answer: The last two weeks this article has reviewed the EOB's and MSN's for your healthcare. This week is about the Part D monthly reports.
Centers for Medicare (CMS) sets a standard of practice that the Medicare Part D Insurance companies have to abide while providing Prescription Drug coverage to those enrolled in their plans. The monthly claim report you are asking about is one of those standards of practice. Each insurance carrier must send each individual enrolled in their plan a monthly listing of the medications filed under their ID number.
This information can be very useful to you. It includes the medications you filled, how much you should have paid, and where you are in the different phases of coverage.
These monthly mailings usually arrive around the 15th of the month. Watch for them and review them.
You want to look over these mailings. I also recommend saving these notices for at least a year. I regularly have clients come to me to talk about their medication co-pays, but they don't understand why they pay what they pay. This monthly mailing is the company's monthly coverage explanation and how it works for you.
First, look to see if the medications filled were medications you actually filled. There may be billing errors. Someone could be filling medications under your claim number.
You also want to confirm that the amount you were supposed to pay was the amount the pharmacy charged you. There are sometimes errors and you may find that your pharmacy receipts do not match the amount the insurance company indicates. If this happens, you need to take your print out to the pharmacy to see if they can resolve the problem. If not, call your insurance carrier to talk about this discrepancy. You may be able to file a claim to receive any overpayment back from the pharmacy or the insurance carrier.
You may have EPIC, and with EPIC (New York State Pharmacy Assistance Program) there are times when EPIC may be paying part of your costs for your medications. In this case, the statement from your Part D plan may not include that information, or may list it as 'payment from another source."
This monthly notice also tells you where you are in the phase of coverage for your medications. Remember that the Medicare Part D plans have phases of coverage. The first phase is the deductible (at most $615). The deductible, if you have one, is where you usually pay full price for your medication. Some plans give you Tier 1 and Tier 2 medications at a lower price even during the deductible phase. Once you have met your deductible, you begin to save money on all your medications, called Initial Coverage.
This savings lasts until your total cost of Medications reaches $2100. (In other words, what you have paid for your medications.) Many people don't reach this phase of coverage. If you are taking expensive medication, you may move through the deductible phase quickly, and possibly spend that $2100, which moves you into the Catastrophic
Coverage phase. During the Catastrophic Coverage phase your costs are $0 for ALL covered medications.
All this was said to remind you to review those monthly notices from your Prescription Drug Coverage Carrier. These monthly notices provide valuable information to you.
Save these notices, if there is an error you have proof to fight that error. If you switch insurance companies, you can check to be sure your coverage has transferred properly.
The money you spend under one carrier at the pharmacy carries over to your new plan during the same calendar year. You don't start all over with your coverage if you switch plans in the middle of the year.
If you have questions about what your medications cost you and why it changes throughout the year, these monthly statements help us to understand and explain that coverage to you.
Janell Sluga is a Geriatric Care Manager helping seniors in our community access services and insurance. To reach her, please email editorial@post-journal.com.