Resources
- The National MS Society is available to answer your questions about Medicare Part D, and address problems that might come up. Call 1.800.344.4867.
- For comprehensive answers about your most pressing Medicare Part D questions please reference this page from Medicare Interactive, part of the Medicare Rights Center. www.medicareinteractive.org
- www.medicare.gov/ is the official website of Medicare. The site allows users to identify and compare all prescription drug plans (PDPs) and Medicare Health plans (Medicare Advantage) serving their area, enroll in a plan, and check on their enrollment status. To speak to a Medicare representative, call 1-800-MEDICARE to ask questions or for help enrolling in a Part D plan over the phone.
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Every state has a State Health Insurance Program, or SHIP. SHIPS are staffed by people knowledgeable about Medicare, including Part D and Extra Help, and are available to speak to you over the phone. Click here to find the number of your state's SHIP.
• The Medicare Rights Center (MRC) is the largest independent source of health care information and assistance in the United States for people with Medicare. MRC provides education and counseling to individuals who need answers to Medicare-related questions or help getting care through their hotlines, website, and unique interactive web-based tool Medicare Interactive (click on the compass on the top for Medicare Interactive). Hotline counselors are available Monday through Friday, 9AM - 1PM (Eastern Time) at (800.333.4114). MRC can assist with applications to the Extra Help program and other programs for beneficiaries with lower incomes as well as Part D enrollment, appeals, and more.
Glossary of Terms
Annual Coordinated Election Period
The period of time between November 15 and December 31 of every year when you can change your Medicare private drug plan and/or your Medicare health plan choice for the following year. This is also the time you can enroll in the Medicare prescription drug benefit (Part D) if you do not enroll during your Initial Enrollment Period (you may have to pay a premium penalty if you enroll during this time unless you had drug coverage from another source that was at least as good as Medicare's and you were not without that coverage for more than 63 days). Your new coverage will begin January 1.
Annual deductible
An initial amount of drug costs the Part D enrollees must pay first before the Part D coverage pays each year.
Catastrophic Coverage
In general, catastrophic coverage is a protection against very high out-of-pocket costs for people with expensive health care needs. All Medicare Part D plans include catastrophic coverage, although the amount you must pay out-of-pocket each year before the catastrophic coverage kicks in goes up each year.
Coverage Gap
Also called a “Doughnut Hole.” A gap in insurance coverage during which you must pay all drug costs in full; followed by “catastrophic coverage” from the insurance plan.
Creditable Coverage
Creditable Coverage drug coverage that is “just as good as” coverage provided by Medicare prescription drug plans. Your current insurer must tell you if the drug coverage you now have qualifies as ‘creditable coverage'.
Formulary
The list of prescription drugs that your private health plan, like a Medicare HMO, will pay for either in part or in full. Drugs not on the formulary are generally not covered by private health plans.
Lifetime Penalty
Medicare prescription drug plans are allowed to penalize you for enrolling late by adding 1% to your monthly premium for every month you failed to enroll if you were eligible to enroll and did not, and you did not have creditable coverage.
Prior-authorization (also known as pre-authorization or pre-approval)
This common practice among health plans requires that a beneficiary must get a prescription for a drug OK'd by the plan before the pharmacy can fill it.
Tier Formularies
Tier Formularies that includes drugs that are similar, such as the MS disease-modifying therapies, may be tiered, with higher costs for the beneficiary the higher the tier. Generally, the more specialized a drug is, such as injectible drugs and others requiring refrigeration, are placed on Tiers 3 or 4.