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Starting the Dialogue with your Aging Parents: Medicare Part D

September 9, 2013

During the month of September and through the end of November those over age 62 will receive multiple letters from providers of the Medicare Part D program. This can be very confusing for some and may also create unnecessary stress.

Medicare Part D is the prescription medication portion of Medicare benefits and is not to be confused with Medicare Parts A & B.  I will discuss those benefits in a separate post at another time.

Back to the letters anyone over age 62 will be receiving: these are to encourage people to enroll in one of the various Medicare Part D drug programs and they will come from many different providers, not just the provider currently in use. This is where it can get a little bit tricky.

The letters have an aura of urgency and indicate that the time frame for enrollment ends on December 7th. This is true; the enrollment period is from October 15th through December 7th every year.

What is missing in most of these communiques is a clear statement indicating that the individual does not have to do anything if they are happy with their current Medicare Part D provider.

If, on the other hand, your parents are not happy with their current Medicare Part D provider here are some things to help them consider whether they want to change providers, and if so, to which one:

  • First they should decide what it is that they are not happy about. Have them write it down.
  • Second they should put together a list of all medications they are taking and what the current co-pays are for those medications under their current provider.  You may want to speak with the pharmacist or spend time online looking up the trade name and the generic because some formularies only identify the medication one way.
  • Then it’s time to compare what other providers have to offer.
  • This can be time consuming and a bit confusing so keep lists.
  • Be sure that the medications prescribed by the doctor for your parents are on the formulary for any provider your parents might be considering changing over to.
  • Then look at what tier the medication is catgorized in. The tier determines what the co-pay will be, if any.
  • Finally look to see if there is a deductible. How does it compare to their current deductible.
  • Other things to look at might be whether the provider will send the medications via mail order, fill 90-day prescriptions, who’s responsibility it is to monitor for refills, and whether they charge for shipping.
  • One final thing to bear in mind is that not all prescriptions can be filled via fax, telephone, or electronically. An example of this would be narcotic pain medications which require the doctor to write a specialized script for the medication and it must be hand delivered to the pharmacy.

The perfect scenario is that you and your aging parents are satisfied with the current Part D provider and no changes need to be made. Those letters from other providers seeking their business can be put in the burn barrel or shredded and recycled.

If there is a desire to change my advice is to start the process of investigation early during the enrollment window. Don’t wait until a few days before the time frame ends to start your search. If change is desired it is possible to inform the current provider so they don’t send new ID cards and create additional confusion and possible delay in claims being paid.

If you have additional questions about this subject feel free to leave a comment and I will reply.  Additional resources can be found in the annual publication Medicare and You or on the http://www.cms.gov website

Thank you for reading my blog and sharing it with those who might benefit from the content.

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