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April 3, 2006:
:: Medicare Part D enrollment extension for victims of Hurricane Katrina!
:: Niaspan (r) / Niacor (r) (prescription Niacin) excluded from Part D.
:: When is the effective or starting date of my Medicare Part D plan?
:: Why does everything seem to take so long?
:: I still have not received a Medicare Part D ID card -- Now what?
:: I have not yet been billed for my Medicare Part D Plan -- Now what?
:: Having trouble receiving the proper "Extra Help" or "Duel- Eligible" co-payments?
:: Please give us your opinion on the Medicare Part D program.
:: Where can I find more answers? Browse our Frequently Asked Questions (FAQs).
Medicare Part D enrollment extension for victims of Hurricane Katrina!
The Centers for Medicare and Medicaid (CMS) announced a Special Enrollment Period (SEP) for people affected by Hurricane Katrina (the memo was entitled: "Additional opportunities for individuals affected by Hurricane Katrina have to join and switch Medicare Plans, including Medicare prescription drug plans in 2006".
In this memo, CMS granted hurricane evacuees the right to switch between Medicare Part D prescription drug plans at any time through December 31, 2006. This SEP applied to people who resided within certain Zip Codes (listed in the link below) during the time of the hurricane. Read more about the Katrina Extension:
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:: Here is the link to eligible Alabama, Louisiana, and Mississippi Zip Codes list:
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Niaspan (r) / Niacor (r) (prescription Niacin) excluded from Part D.
We have been contacted by a number of people about whether prescription Niacin products such as Niaspan (r) or Niacor (r) are covered under their Medicare Part D plans. In a letter from February 3, 2006, CMS noted that prescription Niacin would not be covered by Medicare Part D plans. The document notes:
"CMS has determined that prescription Niacin products (e.g. Niaspan (r), Niacor (r)) are prescription vitamins and, therefore, excluded from the definition of a Part D drug in accordance with statutory requirements. The effective date of this decision is June 1, 2006 due to the ambiguity and unique circumstances surrounding prescription Niacin products, and the previously authorized delay in issuance of EOB notices [see note, below]. Prior to this effective date, Part D plans may treat prescription Niacin products as either excluded prescription vitamins or as Part D drugs. After May 31, 2006, prescription Niacin products will be universally excluded [emphasis added] from the definition of a Part D drug."
[note:] "On January 27, 2006, CMS notified Part D plans that they could wait until March to send the first Explanation of Benefits (EOB) document to members. A plan choosing to send the first EOB to members during the month of March must ensure that the EOB reflects any activity for the months of January and February. In addition, plans must send an EOB extension notice during the month of February for all members who utilized the prescription drug benefit during the month of January."
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:: For more on about the prescription Niacin determination, please click on:
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When is the effective or starting date of my Medicare Part D plan?
Your Medicare Part D plan becomes effective the first day of the month after the month in which you enrolled. If you enrolled at the end of the month (for instance, March 30), your plan becomes effective on the first of April -- this is true no matter what you requested as your starting or effective date.
We have heard from a number of people who enrolled in late 2005 or early 2006 and requested a starting or effective date of May 2006. These people were surprised to see that their coverage began the first day of the month after their enrollment, not in May.
If you turn 65 or become eligible for Medicare outside of the first Open Enrollment Period, you have a seven (7) month window in which to enroll and avoid any possible penalties. The seven month period includes three (3) months before the month of your eligibility - the month of your eligibility (e.g. you turn 65) -- and the three (3) months after the month you become eligible for Medicare. If you enroll before the month when you are eligible, your coverage begins or is effective the month that you actually become eligible for Medicare. (So if you become eligible for Medicare in August 2006 - you can enroll as early as May 2006 - but Medicare Part D coverage does not begin until August. If you enroll in August 2006, coverage begins the first day of the next month or September 2006).
Please note: No matter when you enroll, it takes up to 2 weeks to receive the Welcome Packages from some of the insurance carriers.
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Why does everything seem to take so long?
The process of recording/verifying enrollment is relatively complex, especially given the millions of people enrolling in the Medicare Part D programs. After submission of enrollment information, each person's Medicare eligibility is checked with Medicare and the "extra-help" status of enrollees is checked with the Social Security Administration. In short, a great deal of information is being passed from your insurance carrier to the US Government and back again -- and this takes a bit of time.
What does this all mean? If someone has enrolled late in a given month, the person may be entered into one computer system for purposes of coverage, but that person may not be found in other computer systems for several weeks or until their eligibility has been verified -- this may be especially true for the national computer systems used by the Pharmacies.
Another situation is where people have enrolled more than once, sometimes with the same company and plan. The enrollment/re-enrollment process adds another step to this great data-exchange as the previous plan must be notified of the change of enrollment -- again, this all slows down the system and adds to the time necessary to process / receive Member information.
Bottom Line -- If you need Medicare Part D coverage beginning the first day of next month, do not wait until the end of this month before enrolling.
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I still have not received a Medicare Part D ID card -- Now what?
As many of you already know, due the incredible volume of enrollments, many new members of Medicare Part D programs have not received their Medicare Part D membership information. This problem is especially true for those of you who have enrolled relatively late in any given month. As could be expected, each company has a slightly different procedure for obtaining your Membership information within the first few days after the plan becomes effective or starts.
In general, those Medicare Part D beneficiaries who have not received any Medicare Part D card should contact the insurance company's Customer Service Center or New Member Services to determine how to use their prescription drug benefits before receiving a Membership card or Welcome Packet. Some plans that we have spoken with will provide the caller with their ID number which they can then use when purchasing medications. Other plans will enter the person's information into the system directly so that the caller could immediately have use of their prescription drug coverage. Several plans have online systems that allow enrollees to receive their Membership information through the internet. Alternatively, Medicare Part D beneficiaries may also be able to purchase the medications without a discount and seek reimbursement from their Medicare Part D plan once the person's enrollment information is on file.
Again, the key is to contact your plan (or the agent who sold you your plan) to determine the proper procedure for purchasing prescription medications while awaiting the arrival of a Welcome Packet or Medicare Part D card.
We have more information on how to obtain Membership information for specific plans in our online FAQs:
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:: Frequently Asked Questions, (including brief instructions of how to use several of the internet-based online systems):
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I have not yet been billed for my Medicare Part D Plan -- Now what?
Many people have still not made a monthly premium payment for their Medicare Part D plans, although their plans have been effective or started several months ago. Also, after signing up for a Medicare Part D plan, some people received a Coupon-payment book, although they had asked that premiums be automatically deducted from their Social Security checks. Later, some of these same people were telephoned and told not to pay with the coupons and that the monthly premium payments would be deducted from their Social Security check as requested. However, the payments were still not deducted.
From our information, it appears that the coordination of Social Security payment deductions may take a few months and some companies provided Coupon Books so that new Members could make payments before the beginning of their Social Security deductions. The rationale seems to be that, because of the time needed to transfer data between computer systems, some people may have a rather large sum of three monthly premium payment deducted at one time when the process finally begins.
What if I pay too much? If a person over-pays (sends in payment coupon and then has the monthly premiums taken from their Social Security check), the insurance companies would either reimburse or refund the additional over-payment.
For those people who still have not made a monthly payment -- be aware / plan ahead, you may receive a much smaller Social Security check when three or more months of premium payments are deducted at one time!
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Having trouble receiving the proper "Extra Help" or "Duel- Eligible" co-payments?
As noted, the Medicare Part D system requires the verification of a great deal of information before enrollment is complete. The coordination of data may cause additional difficulties for those people who are Duel-Eligible (that is, eligible for both Medicare and Medicaid) or involved with the "Extra-Help" programs. As noted by Medicare, when first using the new prescription coverage it may be wise to bring proof of Medicare/Medicaid eligibility or "Extra-Help" status. If there is a problem and the status of the plan member is not recognized, Pharmacists can contact the particular Medicare Part D plan in order to charge the appropriate co-payments.
Specifically, Medicare instructs:
"If the person has both Medicare and Medicaid or has been approved for the low-income subsidy (extra help paying for prescriptions), they should bring a copy of the yellow automatic enrollment letter from Medicare, a Medicaid card, an approval letter from the Social Security Administration, or other proof that they qualify for extra help."
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Please give us your opinion on the Medicare Part D program.
Satisfied with your Medicare Part D plan? -- Would you recommend your plan to another person?
What do you think others would say? Take a look at the online survey.
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:: To cast your vote:
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Last updated on: 07/18/2008
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