The Medicare Part D Drug Program: Making the Most of the Benefit Making the Most of the Benefit

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ISBN: 9780763749675 | 0763749672
Cover: Paperback
Copyright: 3/21/2007

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What is the Medicare Part D Drug Benefit? How does it work? Am I eligible? How can I apply? The only book of its kind, this practical guidebook offers the answers to these questions and much more! Whether you're a senior, caregiver, or practicing healthcare professional, The Medicare Part D Drug Program: Making the Most of the Benefit clearly and concisely explains how the Medicare Part D Drug Benefit works, where to obtain clarification and further information about the Program, how and when to apply, and how to use the Benefit to help seniors. In an easy-to-use format featuring simple terminology, this book explains how the Medicare Part D Drug Program meshes with other insurance programs and offers essential information on the Benefit and its components.

Foreword	p. xiii
Introduction	p. xv
The Part D Program of Medicare	p. 1
What is Medicare	p. 1
Medicare Part A	p. 1
Medicare Part B	p. 2
New Program in Medicare	p. 2
Caution About Scam Artists	p. 3
Complaints About Medicare Part D	p. 3
So How Can I Benefit from Medicare Part D?	p. 4
When Did Medicare Part D Start?	p. 4
What Pharmacies Can I Use to Obtain My Prescriptions?	p. 5
Are Your Drugs Covered?	p. 7
What About Other Assistance Programs?	p. 7
Signing Up for Medicare Part D	p. 8
So What Do I Need to Know to Get Started?	p. 8
How Will This Program Work and How Can I Determine What Is Best for Me?	p. 11
Private Prescription Drug Plans (PDPS)	p. 11
The Name of the Organization	p. 12
The Actual Plan Name	p. 12
Cost	p. 12
Coverage	p. 12
Type of Additional Coverage Offered in Drug Coverage Gap (the "Donut Hole")	p. 13
Most Commonly Used Drugs	p. 14
Convenience	p. 14
Network Pharmacy	p. 14
Medicare Advantage Plans	p. 15
Location by County	p. 15
Organization Name	p. 15
Plan Name: The Name of the Medicare Drug Plan	p. 15
Type of Medicare Advantage Plan	p. 16
Cost	p. 17
Coverage	p. 17
Number of Top 100 Drugs on Formulary	p. 18
Convenience	p. 18
Network Pharmacy	p. 18
General Issues Across Both Prescription Drug Plans and Medicare Advantage Plans	p. 18
Maintaining Drug Coverage for Major Diseases	p. 18
Extra Help for Those with Extra Needs	p. 18
What Do I Do Now?	p. 20
Learning About Different Plans	p. 20
Know When You Need to Sign Up for Coverage	p. 20
Are You Eligible for Extra Help with the Medicare Part D Program?	p. 23
Extra Help is Available for Many	p. 23
You Will Need to Do Several Things to Make Sure You Get the Help You Deserve	p. 23
The Social Security Administration Will Mail Applications to Many Eligible People	p. 25
Extra Help in Addition to Regular Assistance	p. 26
How to Find Out If I Qualify?	p. 26
Persons with Medicaid Coverage	p. 28
What If You Previously Were on Medicaid and Medicaid Paid for Your Medications?	p. 28
Do You Have a Limited Income but Do Not Qualify for Medicaid Coverage for Your Prescription Drugs?	p. 29
Pharmaceutical Assistance Programs	p. 29
Chapter Figures	p. 31
Choosing a Medicare Part D Insurance Drug Plan	p. 43
Different Plans and Options	p. 43
Decisions to Sign Up for Medicare Part D	p. 43
The Medicare Prescription Drug Plans	p. 45
Medicare Advantage Plans	p. 45
New Members in Drug Plans and What They Can Expect with Their Drug Coverage	p. 47
Starting Your Coverage, But You Do Not Have Your Prescription Drug Plan Card	p. 47
Creditable Coverage	p. 48
There Are Consequences If You Do Not Sign Up when You Are Eligible	p. 49
Penalty Fees	p. 49
Initial Enrollment Periods	p. 49
What Happens When People First Become Eligible to Enroll in a Medicare Drug Plan?	p. 50
What Happens If I Go into a Nursing Home?	p. 50
Refunds for Overcharges	p. 51
How Can I Pay for My Premiums?	p. 52
Medicare Errors in Billing	p. 53
Maintaining Coverage for Your Drugs	p. 53
Challenging a Prescription Drug Plan Action	p. 53
Appealing Plan Decisions that Are Not in Your Favor	p. 54
Other Considerations	p. 55
You Can Apply for Extra Help at Any Time	p. 56
How Does CMS Know About All of This?	p. 56
Special Enrollment Periods	p. 57
Coordinated Election Period	p. 57
Medicare Advantage Special Plans for Special Needs Individuals	p. 59
Changes in the Standard Benefit for 2007 (6)	p. 60
True Out Of Pocket (TrOOP) Costs	p. 61
What Else Might I Do to See What Is Available for Me?	p. 62
What Drugs Are Covered?	p. 65
Drugs for All Diseases and Ailments-But Not All Drugs	p. 65
Drugs Covered in the Model Formulary Guidelines	p. 66
How to Find Out What Drugs the Prescription Drug Plans Will Pay For	p. 68
Formulary Finder	p. 68
Coverage for Drugs Under Medicare Part B	p. 70
Non-Covered Drugs in Any Formulary	p. 72
Over-the-Counter Drugs (OTC)	p. 75
Barbiturates	p. 75
Benzodiazepines	p. 75
Vitamins	p. 75
How to Choose a Pharmacist	p. 77
The Importance of Your Pharmacist	p. 77
Referrals from Friends	p. 77
Is the Pharmacist Accessible?	p. 78
Can I Call for More Information and Speak to the Pharmacist Every Time?	p. 79
General Concerns About Drugs and Drug Use	p. 79
Concerns About Certain Medications if You Are Caring for an Elderly Individual	p. 79
Counseling when Obtaining New Prescriptions	p. 80
Brand and Generic Drugs	p. 81
Charging for Services	p. 82
Refusal to Fill Your Prescription	p. 82
Furnishing You the Best Price Available	p. 83
Drugs and Expiration (Freshness) Dating	p. 84
Transfer of Prescriptions from One Pharmacy to Another	p. 84
Who Owns Your Prescription?	p. 85
Privacy and Respect	p. 85
Who Are Those People Back There (Filling Your Prescription)? 86 What to Do if You Suspect Something Is Not Right with How You Receive Your Prescriptions	p. 87
What if You Cannot Choose Your Pharmacy?	p. 87
Other Services	p. 88
The Formularies In This Program, and How They Work	p. 91
Formularies-Definitions and Considerations	p. 91
Formulary Definition	p. 91
Formulary Finder	p. 92
Uncovered Drugs	p. 92
Formularies Used to Lower Costs	p. 96
Specific Other Formulary Issues	p. 97
Step Therapy	p. 97
Prior Authorization	p. 97
Preferred Drug Lists	p. 97
Tiered Co-payments	p. 98
Pharmacy Networks	p. 98
Dispensing Limits	p. 99
Summary of Formulary Issues	p. 99
The Medication Management Programs and How to Use Them to Your Advantage	p. 101
Medication Therapy Management Services	p. 101
The Goal Is to Help You with Your Medicine Taking	p. 101
Who Is Eligible?	p. 102
Your Rights	p. 102
An Example to Show How it Would Work	p. 103
How This Service Might Work for You	p. 104
Specialized Contacts to You by Phone or in Person	p. 107
Reducing the Number of Drugs That You Take	p. 108
Use These Services if You Can	p. 108
Coverage for Preventive Services in the Medicare Program	p. 109
Disease Prevention and Health Promotion	p. 109
Disease Prevention	p. 109
Seniors Not Aware of Services Available	p. 110
Medicare Will Pay for Screening Tests and Other Services for Beneficiaries	p. 110
My.Medicare.Gov	p. 111
Health Promotion Screenings and Tests	p. 112
Physical Examination (Women and Men)	p. 112
Cardiovascular Tests (Women and Men)	p. 112
Diabetes Screening, Supplies, and Self-Management Training (Women and Men)	p. 112
Breast Cancer Screenings-Mammograms (Women)	p. 113
Bone Mass Measurement	p. 114
Glaucoma Tests	p. 114
Cervical and Vaginal Cancer Screening (Women)	p. 114
Colorectal Cancer Screening (Women and Men)	p. 115
Fecal Occult Blood Test	p. 116
Flexible Sigmoidoscopy	p. 116
Screening Colonoscopy	p. 116
Barium Enema	p. 116
Prostate Cancer Screening (Men)	p. 116
Digital Rectal Examination	p. 117
Prostate Specific Antigen (PSA) Test	p. 117
Various Shots (Vaccinations) for Flu, Pneumococcal Pneumonia, Hepatitis B	p. 117
Flu Shot	p. 117
Pneumococcal Shot	p. 117
Hepatitis B Shots	p. 118
Smoking Cessation Counseling	p. 118
Coverage of Smoking Cessation Counseling	p. 119
Drugs Do Not Work as Well when You Smoke	p. 120
What Specific Services Are Provided to Help You Stop Smoking	p. 121
Counseling	p. 121
Medicare Part D Coverage for Smoking Cessation Drug Therapies	p. 121
New Health Promotion and Disease Prevention Services for 2007	p. 121
Use These Services to Help Yourself to Better Health	p. 122
Getting Your Drugs and Drug Taking in Order	p. 123
Tips to Improve Your Drug Taking	p. 123
Take as Few Drugs as Possible	p. 123
Routine Check-Ups	p. 124
What is Patient Compliance?	p. 125
Various Forms of Patient Compliance	p. 126
The Importance of Patient Compliance Being the Best it Can Be	p. 126
Difficulties Seniors Face with Medication Compliance	p. 121
Social Isolation	p. 127
Chronic Disease	p. 127
Severity of Disease	p. 127
Multiple Drug Regimens	p. 127
Complex Drug Regimens	p. 127
Advice on Medication Taking	p. 128
Answers to Know About Your Medications	p. 129
Summary	p. 131
Summary and Next Steps	p. 133
So Where Do You Go from Here?	p. 133
Several Changes for 2007 and Beyond	p. 133
Premium and Deductible Increases	p. 134
Pilot Programs for Persons with Chronic Diseases	p. 135
Miscellaneous Medicare Provisions That Are New	p. 136
Income-Related Increase in Part D Premium	p. 136
Health Savings Accounts	p. 137
Ombudsman	p. 139
Proof of Citizenship	p. 140
Qualifying for Extra Help	p. 140
The Coverage Gap-"Donut Hole"	p. 141
Best Price	p. 142
Generic Drugs	p. 142
State Assistance Plans and Medicare Part D	p. 143
TrOOP	p. 143
Changes in Formulary Coverage	p. 144
Removing Drugs from the Market	p. 145
Protection for You	p. 145
Coverage Determination	p. 145
Approvals by You or Your Authorized Representative	p. 146
You or Your Doctor and the Forms Required	p. 147
Yearly Notification	p. 147
Plans Must Respond Promptly	p. 147
Level of Appeals	p. 148
Your Personal Health Information and Privacy	p. 149
Initial Enrollment Periods	p. 150
Where Else Might You Obtain Help in Enrolling?	p. 150
Enrollment Materials	p. 151
Annual Coordinated Election Period (AEP)	p. 151
Extra Help	p. 152
Automatic Enrolling	p. 152
Notification	p. 152
Changes Affecting Your Extra Help Situation	p. 154
Special Enrollment Periods (SEPs)	p. 154
Losing Coverage Through No Fault of Your Own	p. 155
Special Enrollment Periods	p. 156
Notice of Plan Change Requirements	p. 157
Options During Enrollment Periods	p. 158
Special Circumstances	p. 159
Penalty or Not	p. 159
Changes in the Prescription Plan Finder for 2007	p. 160
Summary of Considerations and Next Steps	p. 160
Cost	p. 160
Formulary Coverage	p. 160
Coverage Gap	p. 161
Convenience	p. 161
Peace of Mind	p. 161
Creditable Coverage	p. 161
What Happens if You Move During the Year to Another State?	p. 161
What If I Am Not Happy with My Plan?	p. 162
State Resources That Can Help You	p. 162
Types of Problems That Have Occurred	p. 162
Incorrect Premium Deduction	p. 162
Overcharging at the Pharmacy	p. 162
Prior Authorization Hassles	p. 163
Doctors Not Being Willing to Fill Out the Prior Authorization Paperwork	p. 163
Medicare Advantage Plans	p. 163
Deceitful Marketing Practices	p. 163
Spouses of Individuals in Nursing Homes	p. 163
Nursing Home Residents	p. 164
General Summary of the Issues Related to Medicare Part D Prescription Drug Benefit Information	p. 165
Web Sites for Senior Citizen Information	p. 173
Individual States With Medication Assistance Programs for Seniors with Certain Income Restrictions	p. 177
Petition Process for Formulary Addition and Notification of Noncoverage	p. 179
Web Sites for More Information About Drugs	p. 183
Privacy and Health Information Pamphlet Provided by the U.S. Department of Health and Human Services Office of Civil Rights	p. 187
Glossary	p. 191
Index	p. 203
Table of Contents provided by Ingram. All Rights Reserved.

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The Medicare Part D Drug Program: Making the Most of the Benefit Making the Most of the Benefit

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Table of Contents

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