Medicare Prescription Drug Coverage For Dummies E-Book

Patricia Barry

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 699

Veröffentlichungsjahr: 2008

Beschreibung

Confused about Medicare's drug coverage? You're not alone. Medicare Prescription Drug Coverage For Dummies explains Part D in plain English and shows you how to find the best deal among numerous drug-coverage plan options. Whether you're new to Medicare or already in the program, you'll navigate the system with more ease and confidence, avoid pitfalls and scams, and have plenty of help choosing the plan that's right for you. This easy-to-understand, consumer-friendly guide helps you find out whether Part D affects any drug coverage you already have and weigh the consequences of going without coverage. You'll find ways to compare plans, identify the one that covers your drugs at the least cost, and make sure you sign up at the right time. And you'll learn how to minimize your expenses, use the "right" pharmacies, and troubleshoot any problems with your coverage. Discover how to: * Decide whether you need Part D * Understand how Part D works, from costs to coverage * Choose and enroll in the best plan for you * Get up and running with Part D * Handle the coverage gap * Lower your drug costs * Join and switch plans * Comply with long-term-care rules and rights * Challenge plan decisions * Avoid scams and hard-sell marketing Now, more than ever, you need clear, reliable information that helps you understand Part D and make smart, cost-saving healthcare decisions. You need Medicare Prescription Drug Coverage For Dummies.

Leseprobe

Medicare Prescription Drug Coverage For Dummies®

Table of Contents

Introduction

About This Book

Conventions Used in This Book

What You’re Not to Read

Foolish Assumptions

How This Book Is Organized

Part I: The Nuts and Bolts of Medicare Prescription Drug Coverage

Part II: Deciding Whether to Sign Up for Part D

Part III: Choosing and Enrolling in the Right Part D Plan for You

Part IV: You’re In! Navigating Part D from the Inside

Part V: The Part of Tens

Part VI: Appendixes

Icons Used in This Book

Where to Go from Here

Part I: The Nuts and Bolts of Medicare Prescription Drug Coverage

Chapter 1: The ABCs (And D) of Medicare

Knowing Your Place in the Wide World of Medicare

Examining Costs and Coverage in Medicare’s Four Parts

Part A

Part B

Part C

Part D

Comparing different types of Medicare insurance

Getting with the Program: When and How to Sign Up for Parts A and B

It’s all in the timing: When to sign up

Taking the plunge: How to sign up

Lowering Costs and Adding Benefits

Medicare supplementary insurance (also known as Medigap)

Medicare Advantage plans (Part C)

Veterans benefits

Medicaid

State Medicare savings programs

Chapter 2: The Rules of the Game: How Part D Works

Qualifying for Medicare Prescription Drug Coverage

Voluntary Enrollment and All the Strings Attached

Picking a Plan, Any Plan — but Only One

Making Sense of Drug Coverage That Can Vary throughout the Year

Getting Coverage for the Drugs You Take

Paying for Your Drugs and Filling Your Prescriptions

Being Locked into One Plan for a Year

Chapter 3: The Big Question: What Will Part D Cost (And Save) You?

Decoding the Jargon of Medicare Drug Payments

Making a commitment: Monthly premium

Forking over the first financial slice: Annual deductible

Sharing the pain: Co-payments and coinsurance

Leveling on costs: Tiers of charges

Getting out your wallet: Full price

Counting the cost: True out-of-pocket costs

Grasping How Costs Fit Together and Add Up

The importance of the drugs you take

The importance of the plan you choose

Putting together drug costs and plan designs: Three common examples

Knowing the Costs That Plans Can (And Can’t) Change during a Calendar Year

The costs your plan can’t change

The costs your plan can change

Being aware of your rights

Understanding How Costs May Change from Year to Year

Chapter 4: Delving into Drug Coverage under Part D

Finding Out about Formularies

The drugs that Part D plans must cover

The drugs that Medicare doesn’t pay for

The off-label uses for some drugs

The rules of formulary changes

Making Sense of Special Restrictions on Some Covered Drugs

Getting the Drugs You Need When They’re Restricted or Not Covered

Sidestepping the hoops

Understanding the 30-day rule

Trying another drug

Requesting an exception with your doctor’s help

Obtaining excluded drugs

Getting drugs for off-label uses

Knowing When Drugs Are Covered by Part D, Part A, or Part B

Chapter 5: Extra Help: A Better Deal if Your Income Is Low

Understanding the Value of Extra Help

Applying for Extra Help

Obtaining an application form

Helpful tips for filling out the application

Getting a hand with applying

Signing and sending in your application

Knowing what happens next

Figuring Out Whether Extra Help Affects Other Assistance

Choosing a Drug Plan, Signing Up, and Switching Plans

/div>Before you choose: Realizing that some plans may cost you more than others

Finding a plan with the premium you want and the drugs you need

Joining and switching plans

An option to consider: Participating in a State Pharmacy Assistance Program

Determining Whether You’ll Qualify for Extra Help All Year and Next Year

How you could lose Extra Help

Finding out where you stand

Taking Action if You’re Denied or Lose Your Eligibility for Extra Help

Appealing a “no” decision

Getting Extra Help another way

Seeking other help to pay for drugs

Looking for help to pay other expenses

Part II: Deciding Whether to Sign Up for Part D

Chapter 6: Taking Other Drug Coverage and Sources into Account

Finding Out Whether Your Current Drug Coverage Is Creditable

Drug coverage from a current or former (nonfederal) employer

Drug coverage for federal employees and retirees

Veterans drug benefits

Medicaid drug coverage

Drug coverage from a State Pharmacy Assistance Program

Drug coverage for Native Americans

Drug coverage from Medigap insurance

Drug coverage from individual insurance

Deciding Whether to Stay with the Coverage You Have or Switch to Part D

/div>Considering the other factor: Medical benefits

Determining whether Extra Help can help

Understanding the Medigap dilemma

Having It Both Ways: Using Part D as Well as Your Own Drug Insurance

Employer or union coverage

Federal drug benefits

Veterans drug benefits

Coverage from State Pharmacy Assistance Programs

Individual health insurance

Factoring in Drugs from Other Sources

Chapter 7: Considering Coverage if You Take Few or No Drugs Right Now

Balancing Today’s Good Health against Tomorrow’s Risks

The odds of getting sick

The cost of going without drug coverage

Compromising on Coverage at the Lowest Cost

Chapter 8: Confronting the Late Penalty

/div>Avoiding a Late Penalty by Signing Up for Part D at the Right Time

When you join Medicare and don’t have creditable drug coverage

When you lose or drop your current creditable drug coverage

When you return to the United States after living abroad

When you’re released from prison

What the 63-day rule really means

The Price of Missing Your Personal Enrollment Deadline

Looking at how the late penalty is calculated

Understanding how the late penalty can add up over time

Deciding whether to risk ignoring the late penalty

Part III: Choosing and Enrolling in the Right Part D Plan for You

Chapter 9: The First Cut: Deciding How You Want to Receive Your Medical Benefits

The Features of Traditional Medicare and Medicare’s Private Health Plans

Traditional Medicare

Medicare Advantage plans

Three other types of Medicare health plans

Deciding between Traditional Medicare and a Private Medicare Health Plan

Weighing the systems

Recognizing when you may not have a choice

Comparing Medicare’s Private Health Plans and Making Your Pick

Determining how many plan choices you have

Finding a list of plans online

Digging for plan details

Getting personal help to compare plans

Watching out for hard-sell marketing pressures and scams

Asking questions before you make your final choice

Knowing if you can make a change

Chapter 10: Making a Smart Choice among Medicare Prescription Drug Plans

Understanding the Need to Compare Plans Carefully

What’s the best plan, anyway?

Is comparing plans worth the effort?

Will you avoid Part D buyer’s remorse?

Getting Organized with Two Crucial Lists

Creating an accurate list of your meds

Drawing up a list of your plan preferences

Introducing the Medicare Prescription Drug Plan Finder

Moving Step by Step through the Medicare Plan Finder — The Fast Way

Drilling Down to Drug Plan Details

Making Additional Worthwhile Searches to Help Pick a Plan

Looking at the nuances of drug coverage details

Lowering costs with alternative drugs

Considering mail order

Examining retail pharmacy choices

Assessing customer service

Searching for pharmacies if you travel or live away from home for part of the year

Finding Personal Help to Compare Plans

Asking family or friends for assistance

Seeking help from professionals

Taking advice from other sources

Chapter 11: Buyer Beware: Avoiding Scams and Hard-Sell Marketing

Steering Clear of Outright Scams

Red flags to watch out for

A few lies already reported to Medicare

Who to contact to report a scam

Actions you can take if you’re ripped off

Resisting Hard-Sell Marketing Tactics

Assessing different kinds of salesmanship

Understanding the various types of Medicare insurance

Getting familiar with Medicare marketing rules

Thinking and checking before you sign

Knowing what to do if you’re misled into joining a plan you don’t want

Chapter 12: Signing Up for a Part D Plan for the First Time

Stay Informed: Knowing the Right Time to Enroll

Distinguishing among different enrollment periods

Recognizing why you shouldn’t sign up at the last minute

Play It Safe: Making a Few Final Checks before You Sign Up

Take the Plunge: Enrolling in a Plan

Grasping the importance of your address

Deciding how to pay the premiums

Disclosing other drug coverage you have

Don’t Give Up: Understanding Why Your Enrollment May Be Delayed or Denied

If your enrollment is delayed

If your enrollment is denied

Part IV: You’re In! Navigating Part D from the Inside

Chapter 13: You’ve Just Signed Up — What Happens Now?

Knowing When Your Coverage Will Start

Receiving Your Plan’s Card and Other Important Stuff You Need to Read

The membership ID card: Your key to coverage

Information about your plan: Your new bedtime reading material

A form for disclosing other coverage: Your chance to put it all out there

A late penalty assessment: Your price for missing your enrollment deadline

Nice ’n’ Neat: Starting and Keeping Careful Records

Keeping hard-copy records you can rely on

Tracking information online

Chapter 14: Filling Your Prescriptions

Choosing How to Fill Your Prescriptions

Retail pharmacies

Mail-order pharmacies

Specialty pharmacies

Going to the Right Pharmacies and Avoiding the Wrong Ones

Using in-network pharmacies

Avoiding out-of-network pharmacies

Knowing when going out of network may be okay

Unlocking the Information in Your Membership Card

Understanding what your membership card says about you

Making sure your benefits are correct and coordinated

Putting Your Plan to the Test: Filling Your Prescriptions on Day One

Dodging possible snags and delays by verifying your coverage

Chapter 15: In and Out of the Coverage Gap

Understanding the Basics of the Coverage Gap

The yawning gap in the middle of coverage

What drops you into the doughnut hole

What lifts you out of the doughnut hole

Rules for buying your drugs in the doughnut hole

The consequences of stopping premium payments in the doughnut hole

Determining Whether You’ll Fall into the Coverage Gap

Reviewing statements from your plan

Using charts on the Medicare Web site

Avoiding or Narrowing the Coverage Gap with Other Benefits

Leaning on employer benefits

Filling in with veterans benefits

Seeking additional coverage from a State Pharmacy Assistance Program

Getting lucky with a Medicare drug plan that covers your drugs in the gap

Chapter 16: Bringing Down Your Drug Costs

Stretching Your Coverage

Taking a hard look at your meds

Switching to less expensive drugs

Buying drugs by mail order

Shopping around for the best prices at local pharmacies

Lowering Drug Costs in the Coverage Gap

Low-cost drugs from manufacturers

Low-cost drugs from abroad

Other options

Chapter 17: Switching to Another Plan

Switching Part D Plans at Standard Enrollment Times

Enrolling in a new plan

Figuring out how many times you can change your mind

Switching Plans during a Special Enrollment Period

Knowing when you can use SEPs to change plans

Applying for an SEP

Making sure your records are transferred

Dropping a Plan without Joining Another (Or Being Dropped)

Being a plan dropout

Being dropped by your plan

A special case: Knowing what can happen when you don’t pay your premiums

Taking action if you’ve been disenrolled unfairly

Conducting a Yearly Plan Review to Decide Whether to Stay or Switch

Reading your Annual Notice of Change to understand plan alterations

Comparing plans — yes, all over again!

Making your decision

Chapter 18: Staying in Long-Term Care (Or Helping Someone Who Is)

Reviewing Your Drug Coverage When You Enter a Nursing Home

Understanding how your drugs will be covered

Asking important coverage questions on Day One

Switching to Another Plan

Knowing your rights for changing plans

Choosing and enrolling in a new Part D plan

Checking out two alternative plan options

Getting Help for Yourself or Your Loved One

Chapter 19: You Have Rights: How to Holler and (If Necessary) Holler Louder

Having a Game Plan in Mind

Filing a Grievance

What is a grievance?

How do you file a grievance?

Requesting a Coverage Determination

Filing for a coverage determination when it comes to your meds

Filing for a coverage determination when it comes to your hard-earned cash

Dealing with your plan’s response

Filing an Appeal against a Decision You Disagree With

Understanding the five levels of appeal

Coping with delays

Getting Help in Making an Appeal

Part V: The Part of Tens

Chapter 20: Ten Ways Boomers Can Help Loved Ones with Part D

Helping with Tact

Identifying the Insurance Your Loved One Has Now

Doing Your Homework

Offering Your Skills

Helping to Pick a Plan

Following Up

Making Part D an Annual Event

Looking to Your Loved One’s Future

Remembering That Your Time Will Come

Being a Bona Fide Boomer by Making Part D Better

Chapter 21: Ten Proposed Changes to Part D You Should Know About

Simplifying Plan Choices

Abolishing the Asset Test for Extra Help

Allowing Medicare to Negotiate Prices

Eliminating the Doughnut Hole

Improving Access to Needed Drugs

Cutting Medicare Advantage Subsidies

Legalizing Drug Imports from Abroad

Creating a Government-Run Plan

Throwing Out Part D and Starting Over

Bringing in Universal Health Insurance

Part VI: Appendixes

Appendix A: Worksheets

Appendix B: Sources of Help

The Centers for Medicare & Medicaid Services

The Social Security Administration

State Health Insurance Assistance Programs

The Eldercare Locator

The Medicare Rights Center

The National Alliance for Hispanic Health

The National Asian Pacific Center on Aging

Appendix C: Buying Prescription Drugs Safely from Abroad

Assessing safe and ethical service

Avoiding scams and dubious sellers

Using state links to Canadian pharmacies

Looking online for seals of approval

Medicare Prescription Drug Coverage For Dummies

by Patricia Barry

Medicare Prescription Drug Coverage For Dummies®

Published byWiley Publishing, Inc.111 River St.Hoboken, NJ 07030-5774www.wiley.com

Copyright © 2008 by Eric Tyson and Ray Brown

Published by Wiley Publishing, Inc., Indianapolis, Indiana

Published simultaneously in Canada

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About the Author

Patricia Barry is a recognized expert on Medicare and its Part D prescription drug coverage. As a senior editor of the AARP Bulletin — the newspaper and Web site that serve AARP’s 40 million members — she’s written extensively about Medicare from the consumer’s point of view since 1999. That year, she went to a press conference at the White House to hear President Bill Clinton announce his proposal to add outpatient prescription drugs to Medicare and came away thinking: “This story has legs — it’ll run and run.” For the next four years, she covered the bitter political battles in Washington that finally led to President George W. Bush signing Part D into law in December 2003.

Ever since, Patricia’s mission has been to explain the controversial and complicated benefit to consumers. She’s written numerous articles and guides on navigating Part D for AARP publications and books. Before and after the drug benefit went into effect in 2006, she invited readers’ questions and personally answered hundreds of them. She continues to do so through the Bulletin’s Web site (bulletin.aarp.org). Patricia has directly helped many, many people — readers, friends, neighbors, and colleagues’ parents — find the Part D plan that suits them best. Those questions and experiences are the foundation of Medicare Prescription Drug Coverage For Dummies.

In her long journalism career in Europe and America, Patricia has written thousands of newspaper and magazine articles and three books. A native of Great Britain, she’s lived since 1985 in Maryland, where she and her husband raised three adventurous children — Katerina (currently living in Russia), Jessica (in France), and Oliver (in Egypt). In 2006, not without a sense of mutinous disbelief, Patricia became a Medicare beneficiary herself.

Dedication

This book is dedicated to the hundreds of older or disabled Americans who so generously shared their personal Part D stories with me since Medicare prescription drug coverage began. You told me what it was like on the front lines — experiences that were good, bad, and occasionally downright ugly. You prompted me to find answers to questions I hadn’t thought of asking. You gave me the motivation to write this book, and I couldn’t have done it without your insights. You were the consumer pioneers of Part D. To each and every one — a huge thank you!

Author’s Acknowledgments

Writing this book has been a roller coaster grounded by the expertise and wisdom of many people who kept me on track. My thanks go to experts at two key federal agencies, the Centers for Medicare & Medicaid Services and the Social Security Administration, who helped me through the labyrinth of regulations that govern the Part D program and patiently answered hundreds of questions I threw at them. I’m also indebted to experts at the consumer help organizations who daily assist Medicare beneficiaries with Part D issues: the Medicare Rights Center, the Center for Medicare Advocacy, California Healthcare Advocates, and the State Health Insurance Assistance Programs.

I’m especially grateful for the advice and generously shared knowledge of many colleagues at AARP: David Gross, Gerry Smolka, Paul Cotton, Ed Dale, Lee Rucker, Elinor Ginzler, and, above all, Joyce Dubow, a national expert who for many years has been my guru on all things Medicare. I thank my editors at the AARP Bulletin, Jim Toedtman and Susan Crowley, for their encouragement and forbearance when I needed to take time out — and my former editors, Elliot Carlson and Bob Hey, who first twisted my arm to take on the Bulletin’s Medicare beat.

I’m enormously grateful to my project editor on this book, Georgette Beatty, and copy editors Vicki Adang and Jen Tucci at John Wiley & Sons, who have been a pleasure to work with. Also to Vicki Gottlich, of the Center for Medicare Advocacy, for her profound knowledge of Part D and vigilant eye while acting as technical adviser during the book’s draft stages. And to my superb agent, Maureen Watts, who got this ball rolling.

Finally, to my children (who urged me on when I felt daunted by the task) and to my husband (whose devotion ran to cooking dinner every night for months), I can only say: What would I do without you?

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Introduction

If you’re reading this book, chances are you’re baffled. That’s okay — you’re not alone. Since Medicare prescription drug coverage began in 2006, I’ve heard from multitudes of people trying to get their minds around Medicare Part D — the program’s official name — and most often they call it “confusing.” In fact, the crispest verdict came from an exceptionally on-the-ball 93-year-old who’d spent the afternoon swing dancing at a Wisconsin senior center. He asked, simply: “Why did they come up with a program I couldn’t figure out myself?”

That’s why I’ve written this book. There’s no doubt about it — the Medicare drug program is complicated, largely because it comes with a lot of choices. Sure, choice is a good thing, but having many options also forces you to make more decisions. And to make good decisions — instead of just guessing and hoping for the best — you have to know the angles. That’s where Medicare Prescription Drug Coverage For Dummies comes in. It takes you step by step through the choices you face and gives you the practical knowledge you need to make informeddecisions. Consider it a road map for navigating the twists and turns in the system so you can figure it out for yourself — and with confidence.

Part D is a real benefit. Yes, it could be simpler and better, but it has still saved money for millions of people and allowed many to get the meds they need for the first time. For 40 years, Medicare didn’t pay for outpatient prescription drugs at all, and during that time, these meds became increasingly expensive and more necessary as a medical treatment. But now there’s Part D, and the problems are different. Typical questions I hear include:

“There are 52 Medicare drug plans in my area, so how the heck am I supposed to choose one?”

“I’ll be getting my meds through my retiree health plan. How will Part D affect it?”

“I was tricked into a plan I didn’t want. How do I get out of it?”

“This benefit has saved me a lot of money, but now my plan has stopped paying for my drugs entirely. Why?”

This book answers those questions and many more. Yes, taking a whole book to explain Part D says a lot about the program’s complexities. But in these pages, I try to consider everybody’s circumstances by covering the widest possible spectrum of issues. In doing so, I draw on the frontline experiences of people like you who’ve grappled with Medicare drug coverage, my own experience in helping them, and the knowledge of many experts I’ve badgered for answers to the trickiest questions.

So whatever your situation, Medicare Prescription Drug Coverage For Dummies offers strategies to cut through the confusions of Part D, either for yourself or for someone you’re helping. It explains the program’s ins and outs in plain words. It shows you how to avoid or cope with pitfalls and suggests how you can lower your costs or find a better deal. Best of all, it convinces you that you can — yes, you can — handle Medicare Part D!

About This Book

Medicare Prescription Drug Coverage For Dummies gives you a lot to chew on, but don’t worry — you can take small bites. What you personally want to read depends on your situation — and on whether you’re using this book to help yourself or someone else. But one matter’s certain: If you recognize yourself in any of the following scenarios, you can find help in these pages:

You have no insurance for prescription drugs right now (or it’s coming to an end), but you’ll soon be going into Medicare and know zip about Part D coverage or how to get it.

You do have drug insurance now (from an employer or elsewhere) but will soon be eligible for Medicare and need to know whether Part D will affect you and whether you should sign up for it.

You’re already in Medicare but haven’t signed up for Part D and are wondering whether you should.

You’re already enrolled in a Medicare Part D plan but can use some help troubleshooting problems, finding a better deal, or cutting your expenses.

You need to know about Part D because you’re helping parents, relatives, or friends find the best Medicare drug plan for them.

In your job (or as a volunteer) working with seniors or people with disabilities, you can use a plain-language reference to Part D.

Conventions Used in This Book

As you may expect from a program run by a federal bureaucracy, you’re going to meet certain unavoidable jargon in this book. This Part D–speak is worth getting to know, because notices you receive from Medicare or your drug plan — or any to-and-fros you have with either — will be easier to understand. So I use the following conventions:

New terms in Part D–speak are explained the first time they appear.

When you see the word “Medicare” used on its own, it usually means the whole Medicare program. (As in: “When you join Medicare . . .”) Sometimes it means the federal agency that runs Medicare. (As in: “Medicare may send you a notice . . .”) The agency’s official name, the Centers for Medicare & Medicaid Services (CMS), is used as the source of information in some tables.

The Medicare prescription drug program is referred to interchangeably as Part D or Medicare drug coverage. The private plans that provide this coverage are referred to as Part D plans or Medicare drug plans.

I also include a few standard conventions to help you navigate this book:

Italics indicate definitions and emphasize certain words.

Boldface text highlights key words in bulleted lists and actions to take in numbered steps.

Monofont points out Web and e-mail addresses.

“Quotation marks” generally indicate specific buttons or links you are to click on a given Web site.

What You’re Not to Read

Guess what? You can skip the sidebars — chunks of text that appear in nifty gray-shaded boxes. They’re not necessary to understanding how to find your way through Part D. Still, you may find them interesting. Ever wonder how on earth Congress dreamed up some of the more oddball bits of this program? You’ll find answers in the sidebars scattered throughout this book.

Foolish Assumptions

This book assumes that you don’t have any working knowledge of the Medicare prescription drug program — none, zip, nada. But even if you do, you can still find practical insights and useful tips to help you navigate the system more quickly, easily, and confidently.

Another point: This book assumes no political standpoints. Part D has always been controversial, coming under fire from conservatives and liberals alike. If you hold strong opinions, fine — that’s your privilege. But in these pages, the only “us versus them” undertone is a bias toward consumers (us) rather than government bureaucracies and insurance companies (them). The aim of this book is to help you understand and deal with the system as it is now. If you want it changed, please tell your members of Congress, not me!

How This Book Is Organized

Medicare Prescription Drug Coverage For Dummies has six main parts with 21 chapters and three appendixes. Just dive into whatever you need to know — whether you’re thinking about Medicare drug coverage for the first time, you’re already in a Part D plan, or you’re in a special situation, such as having a limited income or living in long-term care. You don’t need to read stuff you already know, and you don’t have to wade through stuff you don’t need to know right now. The following summaries of each part include guidance on what you may want to read, according to your own situation.

Part I: The Nuts and Bolts of Medicare Prescription Drug Coverage

This first part begins with a quick run through the essentials of Medicare as a whole. This spot’s your first port of call if you’ll soon be going into Medicare and need to know if you qualify and how to sign up. Next, I get into the nitty-gritty of Part D itself by first looking broadly at the main rules of the prescription drug program and how it works. Then I take a closer look at the big questions that matter most to your pocketbook and health — costs and coverage. These chapters are essential reading if you’re considering Part D for the first time.

In this part, too, I provide detailed information about the program-within-a-program known as Extra Help, which offers much more generous drug benefits to people with limited incomes. Head to this chapter if you think you can’t afford the premiums and co-payments required in the regular Part D program, or if you currently get your meds from Medicaid.

Part II: Deciding Whether to Sign Up for Part D

For many people, this crucial question — “Do I really need Part D?” — can cause everything from head-scratching to panic attacks. Read this part if you already have prescription drug insurance, rely on free or low-cost drugs from some other source, or take no or very few meds right now. Here you discover how to find out if your current drug coverage is considered better or worse than Part D coverage and why this distinction matters. You also find help in weighing the consequences of continuing to have no drug coverage when you’re eligible for Part D — including hard facts about the late penalty if you don’t sign up for Part D at the right time.

Part III: Choosing and Enrolling in the Right Part D Plan for You

Having to pick just one Medicare drug plan — out of more than 50 that are available to you, wherever you live — can bring on an acute form of paralysis, especially because each plan has different charges and covers a different range of drugs than the next one. So this part shows you the best ways to pick the plum — meaning the best plan for you — out of a whole lot of apples, oranges, and pears. It explains how to compare plans properly in the quickest way and why doing so is worth the effort. It also suggests ways to avoid scams and hard-sell marketing tactics. Finally, I show you how to enroll in the plan of your choice. Check out this part if you’re joining Part D for the first time and if you’re already in a Part D plan in November or December and want to know if it’ll still be the best one for you next year.

Part IV: You’re In! Navigating Part D from the Inside

This part covers a ton of ground — from first receiving your plan’s card right through to the end of the year when you’re deciding whether to stay with this plan or switch to another. Want to know how to navigate the dreaded doughnut hole (formally known as the coverage gap)? Need a drug that your plan won’t pay for? Want to cut down your out-of-pocket expenses? Wondering how going into a nursing home affects your Part D coverage? Need help in challenging a decision your plan has made that you don’t agree with? You can find the answers to these questions and many more right here. Consider reading much of this part if you’re joining a Medicare drug plan for the first time. But if you’ve been in a plan for a while, you may just want to jump into the chapter that directly speaks to your particular concern.

Part V: The Part of Tens

From the Ten Commandments to David Letterman’s Top Ten Lists, ten has long been the magic number for snappy lists. This part has two ten-point lists. Check them out for information you can take in at a glance on two key areas — ten ways for boomers to ride to the rescue of loved ones grappling with Part D and ten proposed changes to Part D that you should know about.

Part VI: Appendixes

Appendix A offers sample worksheets you can use when comparing Part D plans — whether stand-alone drug plans or Medicare Advantage plans. Appendix B is your go-to resource for when you need personal help with Part D. Look here for the names and contact info of organizations and agencies mentioned in this book. Appendix C is your guide to safely buying prescription drugs by mail order from abroad. It explains steps you can take to ensure you receive genuine products from reputable pharmacies instead of falling prey to counterfeit medicines and dubious sellers.

Icons Used in This Book

Icons are those cute drawings you see in the page margins now and again. Here’s what they mean:

This icon indicates a situation in which you need your doctor’s help — for example, when asking your Part D plan to pay for a medicine it doesn’t usually cover, or when finding out whether a lower-cost drug would work just as well as the expensive one you’re taking now.

This icon signals important info. If you take anything away from this book, it should be information highlighted with this icon.

This icon draws your attention to on-target advice and practical insights that will save you time, effort, and maybe even money.

This icon raises a red flag to alert you to a Part D rule or potential pitfall that may trip you up if you remain blithely unaware of it.

Where to Go from Here

Nobody expects you to read this book cover to cover. Harry Potter it’s not! But you can jump in anywhere to the bit you need, at whatever point you happen to be in when grappling with Medicare prescription drug coverage. I’m going to whip off the cloak of invisibility to reveal . . . not the Sorcerer’s Stone, not the Chamber of Secrets . . . but the practicalities of a system that isn’t very mysterious at all — after you know how to navigate it.

Part I

The Nuts and Bolts of Medicare Prescription Drug Coverage

In this part . . .

Before you can choose a prescription drug plan, you should understand the basics of Medicare Part D prescription drug coverage — how it fits into the wider Medicare program and, broadly, how it works.

First, for those of you who are just about to join Medicare, I give a quick primer on the different parts of the Medicare program — Part A (hospital coverage), Part B (doctors and outpatient services), Part C (private health plans), and Part D (drug coverage) — as well as how to be sure you’re eligible for Medicare and how to enroll. Then I give an overview of the main rules of Part D so you can get a general idea of how Medicare drug coverage works if you’re not yet enrolled in the program.

In the remaining chapters of this part, I explain in more detail the two topics that probably most concern you at this stage — how much you’re likely to spend and save in Part D (whether you’re in the regular program or you qualify for extra financial help in paying for meds) and how your prescription drugs will be covered.

Chapter 1

The ABCs (And D) of Medicare

In This Chapter

Getting a grip on Medicare and how to qualify

Checking out Medicare’s benefits and costs

Figuring out when and how to enroll in Medicare

Discovering how to decrease your costs and increase your benefits

Medicare helps pay for your prescription drugs only if you’re in the wider Medicare health program. You don’t necessarily have to be using its medical services at this time to be eligible for drug coverage; you just need to have your very own numbered file in the vast Medicare system.

So with this info in mind, why not begin at the beginning with a quick tour through the essentials of Medicare as a whole? If you’re already well acquainted with Medicare, you can skip to other chapters for the scoop on Medicare prescription drug coverage. But stick around if you’re facing the mysteries of Medicare for the first time and need to know whether you qualify, how to sign up, and how the different parts of the program — each with its own benefits and costs — fit together.