My Part D USA

We get letters everyday from people who are having trouble with getting a drug covered under their drug plan.  We also get letters from people who have been billed incorrectly, but the drug plan will not change it or help them.  There are many issues that come up and many people do not know where to go for help.

Remember to contact the MEDICARE RIGHTS CENTER! 

NEW YORK OFFICE - 212-869-3850

WASHINGTON D.C. OFFICE - 202-544-5561

They have lawyers there that can help you resolve your problems.  You can also contact Medicare directly, but many times they are very busy and you may need an alternate resource.

PLEASE JOIN US AT MY PART D USA!

We would love to hear from you! Do you have a particular question about your Medicare Part D drug plan? Do you need information about Medicare health coverage? Do you have a story or experience you have had that you would share with our readers?

We hear everyday of situations where our Senior Citizens have been taken advantage of and outright lied to concerning their Medicare Benefits. It is such a shame that some unscrupulous agents make it so much harder on the rest of us that truly care about people! You have heard that saying “ONE BAD APPLE DOESN’T SPOIL THE WHOLE BUNCH”, however, in this case there may be more than one bad apple, just don’t throw out the babies with the bath water!!!

There are many state SHIP offices(State Health Insurance, I have all those numbers listed on this blog in each state) that are non-profit, and you can call them for help and, of course, people can call Medicare directly to enroll on drug plans. These people work very hard to keep you informed and do so with only your best interests in mind.

At My Part D USA we specialize in helping seniors and people on disability understand their choices of Medicare Drug Plans and health care coverage policies. We work for the PEOPLE NOT THE INSURANCE AND DRUG COMPANIES! We take into consideration what your circumstances are and how you can best be served by Medicare. We do not sell any particular plans based on commissions as all our Senior Consultants are paid the same NO MATTER WHICH PLAN THEY RECOMMEND FOR YOU!!! They have no reason to mislead you because of being paid more for this plan or that plan. We designed it that way to make sure the Senior Citizens needs come FIRST!!!

This may be an unusual way to do business for insurance, but I can assure you, when you put the needs of people before money, you make life long connections that insure TRUST!

We cannot claim to be totally non-profit because it does cost money to keep these websites going and Senior Consultants paid. However, all our free drug comparisons and our advice and helping you enroll on Federal Drug Assistance Programs is at no charge and for the benefit of anyone on Medicare or anyone helping their parents or friends or family members. We do have some advantage over non-profits in that we know the ins and outs of these insurance and drug companies because we work with them everyday. We can advise you on which ones pay their claims promptly and which ones are harder to deal with, such as their customer service depts, and also which ones will charge you the least amount of money for the exact same benefits!

A Non-Profit Care Manager writes: “I work with low-income elderly and disabled clients. They are subjected to fraudulent marketing practices by virtually all the insurance companies. They get mail and calls to their homes repeatedly with very pushy sales people trying to make a commission. People feel angry, betrayed and embarrassed when they realize they have been victimized by an insurance company. Many times their doctors will not accept the plans they were tricked into joining.”

There are many issues about the drug plans and Medicare Advantage Plans marketing tactics that need to be addressed. We hope in the next election we get someone in the White House that will be more aggressive in making these changes. Seniors are so confused and WHO WOULDN’T BE?? We have been doing this for years and we have to keep on top of it daily to make sure we are giving you the right information.

Our best advice to you as consumers in this very confusing time, and with many different sales people telling you things you may not be able to believe about Medicare Advantage Plans, PLEASE, PLEASE, make sure you know what you are getting yourself into before you join anything. DO NOT GIVE OUT YOUR MEDICARE CLAIM NUMBER OR SIGN ANYTHING BEFORE YOU TRIPLE CHECK TO SEE WHO YOU ARE TALKING TO AND WHAT PLANS THEY ARE TRYING TO SELL YOU. THEY MAY ASK YOU TO SIGN SOMETHING THAT DOES NOT EVEN LOOK LIKE AN ENROLLMENT FORM AND TELL YOU THIS IS TO GET YOUR PERMISSION FOR HEALTH INFORMATION. DON’T SIGN ANYTHING UNTIL YOU ARE ABSOLUTELY SURE YOU WANT TO JOIN A PLAN!!

We get calls all day long with people saying they were enrolled on Medicare Advantage Plans and did not even know it was happening!

IMPORTANT INFORMATION YOU MAY NOT YET KNOW ABOUT:

GOOD NEWS!! YOU ARE NOT STUCK WITH THE PLAN YOU HAVE IF YOU DO NOT LIKE IT. YOU HAVE 12 MONTHS FROM THE TIME YOU JOIN AN ADVANTAGE PLAN TO GET BACK ON ORIGINAL MEDICARE AND A TRADITIONAL MEDICARE SUPPLEMENT WITH NO UNDERWRITING, NO HEALTH QUESTIONS. YOU DO NOT HAVE TO WAIT UNTIL ANY OPEN ENROLLMENT PERIOD OR SPECIAL TIME TO DISENROLL.

You can call us to find out about your choices. We will explain exactly how the Advantage Plans, Traditional Supplements and Drug Plans work and discover which ones will be the best plans for you. As I have said before, if you can afford the premium on a Traditional Supplement, you will save yourself many headaches by KEEPING IT!!

OUR TOLL FREE NUMBER IS: 866-752-1795

Just yesterday the Governor of Illinois, Rod R. Blagojevich, announced the new state drug assistance program called “Illinois Cares RX”. This is for low-income seniors, but the income thresholds are higher than the Federal levels.

If you have applied for extra help programs through Social Security and were turned down, don’t forget to try your State programs. Many State assistance programs are becoming available and could help you. I have listed the State SHIP offices below.

Please find the SHIP toll free numbers below:

Alabama - 1-800-243-5463

Alaska - 1-800-478-6065

Arizona - 1-800-432-4040

Arkansas - 1-800-224-6330

California - 1-800-434-0222

Colorado - 1-8888-696-7213

Connecticut - 1-800-994-9422

Delaware - 1-800-336-9500

Florida - 1-800-963-5337

Georgia - 1-800-669-8387

Hawaii - 1-888-875-9229

Idaho - 1-800-247-4422

Illinois - 1-800-548-9034

Indiana - 1-800-452-4800

Iowa - 1-800-351-4664

Continue reading ‘Don’t Forget Your State Office When Applying for “EXTRA HELP” To Pay for Prescriptions’

What is a Medicare Part D appeal?
Have you ever been denied coverage for a certain drug on your Part D drug plan?

Did you think there was nothing you could do about it? Think again.

The only way to succeed with a Part D appeal is to make sure that the prescribing doctor submits a clear statement of medical necessity that only the prescribed medication will work for you. Many times the Part D drug plan will require that you take a generic form of the medication, or a simular medication that is on their formulary. This may not be best for you and only your doctor can submit that request to the Part D Plan.

The first thing you need to get from your Part D Drug Plan is a request of written coverage determination. You need this written coverage determination before you can start the appeals process. Getting a “no” at the pharmacy is not considered a coverage determination. You must call or write to the Part D drug plan company and ask for this written document. You must also submit a doctor’s statement of medical necessity to the Part D plan. The more documentation your doctor submits, the stronger your case will be. If your doctor is too busy or unwilling to help, you might also try contacting the nurse or physician’s assistant for help.

If your Plan still continues not to approve coverage for you, you may need legal assistance. The Medicare Rights Center has volunteer lawyers ready to assist you. You can call their Appeals Hotline at 888-466-9050.

There is a very valuable website available to you with in-depth instructions on this matter and many others. www.medicarerights.org

We hope this information will be helpful to you.

For months and months I had been trying to help someone with getting their Medicare Part D Drug Plan enrollment to be approved. She had a SEP, or special enrollment period qualification that allowed her to enroll in a Part D plan even though it was in the lock-out period. As you know you can only enroll or change plans during the AEP or Nov. 15th thru Dec. 31st.

We sent her application to a certain drug plan company and NOTHING happened. She called and they said they had no record of her application. We then sent it to them a 2nd time. Again, it got hung up in their system. Meanwhile they miraculously FOUND her first application. We waited and STILL nothing. Finally, we called 1-800 Medicare and had a 3 way converstaion with them and submitted her application to them directly for a 3rd time. She did get a call from the Drug Plan and was sent a Welcome letter that said she could use her letter to get her drugs until her official drug card came to her by mail. When she went to the pharmacy, her letter was denied.

Fortunately, she thought of contacting her REGIONAL MEDICARE OFFICE. She submitted a formal compaint against the Drug Plan and got the CONTRACT NUMBER used by Medicare for her drug plan. She said that the contract number is very imporant information to have because they can identify them very quickly. This was on a Monday. On Wednesday morning she recieved a call from her Drug Plan that her plan was now in force and they even CALLED her pharmacy to tell them to process her prescriptions through her new drug plan.

If you are in a simular situation with any issues that pertain to Medicare Part D or any Medicare issues that you cannot seem to get resolved, please contact your REGIONAL MEDICARE OFFICE.

We thank you, Judy, for sharing your story with us and actually helping someone else that may be in this predicament!!

I have a list of the Medicare Regional Offices and their numbers:

1. Boston - 617-565-1188

10. Seattle - 206-615-2306