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With Final Rule, Seniors Are Protected, But Threats to Part D Remain

In early February, the Centers for Medicare & Medicaid Services (CMS) released a final rule to make changes to Medicare Advantage and Part D. Among other things, the rule aimed to finalize remaining changes included in a proposed rule from January 2014 but that were not finalized last summer. Importantly, this final rule not only leaves out the harmful proposed changes that Medicare Today and hundreds of other organizations spoke out against last year, the rule actually listed some of the most controversial provisions that were purposefully left out.

As noted in CMS’ final rule summary:

“The rule does not finalize any of the following provisions: 

  • Lifting the protected class designation on three drug classes – antidepressants, antipsychotics and immunosuppressants for transplant rejection;
  • Requiring Medicare Part D sponsors to include any pharmacy willing to accept the terms and conditions to participate in narrower pharmacy networks that offer preferred cost sharing to beneficiaries;
  • Reducing the number of Part D plans a sponsor may offer; and
  • Codifying CMS interpretation of the Part D non-interference provision.”

This is a critical victory for seniors and would not have been possible without the collaboration and hard work of hundreds of organizations and individuals like you that opposed these changes, which would have undermined the Part D program and jeopardized seniors’ access to critical medications. We applaud the effort advocates have made since the very beginning of this debate to ensure seniors are heard and protected.

It is critical for seniors and advocates alike to remain vigilant against new, potentially harmful policy changes to Part D. As legislators and regulators continue to assess the program, we urge them to reach out to patient and health advocates to discuss any proposed changes, to ensure their efforts do not endanger a successful program that helps keep seniors healthy.

We are pleased that CMS has heeded the concerns of advocates, and we look forward to working together to continue to safeguard Part D against changes that would negatively impact access to affordable prescription drug coverage for seniors and disabled beneficiaries.

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Exploring Your Part D Coverage

During open enrollment, you may have signed up for a new Part D plan, or maybe you stuck with the same drug coverage you’ve had for years. Either way, making sure you know some basic information about your plan will help guarantee that you are getting your medications at the lowest possible cost. So at the beginning of this year, take some time to sit down and review the elements of your Part D coverage.

The first thing you want to look at when reviewing your Medicare Part D plan is its formulary, or the list of medications it covers. You can look up your plans formulary by going to your insurance provider’s website or search plans in your area through Medicare’s website at

The next thing you’ll want to think about is how much you will be paying for your medications. There are a number of different factors that can influence the total amount you will need to pay out of pocket for your prescriptions. Below is a list of some of the basic elements that can impact your costs and what each term means:

Premium– This is the amount you pay for your insurance coverage plan. You usually pay this amount on a monthly basis, but can sometimes pay quarterly or annually.

Deductible- The deductible is the amount you are required to pay annually before your plan will begin to cover your expenses. The deductible you have to meet does not include the payments you made towards your premium. Once you meet your deductible, your plan will begin to cover your expenses but you may still need to pay cost-sharing in the form of a copay or coinsurance (more on that below). A high deductible can make your out of pocket costs each year much more significant, so make sure you factor that into your cost calculations.

Copay– A copay is the fixed amount you’ll have to pay towards your medications each time you get them filled.

Coinsurance– Coinsurance means that rather than play a flat rate for your medications, you will pay a percentage of the medication costs. If one or more of your medications requires coinsurance that could significantly impact your costs.

After you have figured out what drugs your Medicare Part D plan covers and what costs you will be expected to pay, the next thing you want to look at is what pharmacies are covered under your plan. Some plans have a preferred relationship with certain pharmacies, which may make obtaining your medications less expensive.

Take some time this month to look over your coverage and explore the additional resources on this site to further understand your Part D plan. If you are not on a 5 star rated plan and find for any reason your plan is not working for you, you can change to a 5 star plan at any time and not have to wait until the next open enrollment season.

If you have any questions contact your Medicare SHIIP Counselor at your local Area Agency on Aging. You can also call Medicare all day, any day except Federal holidays at 1-800-633-4227.

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Keeping Part D Strong: Standing Against Harmful Changes

If you’re like me, your Part D coverage is a critically important part of your health plan and allows you to access the medications you need every month. It’s not something I take for granted, and I know you don’t either. Every time I go to the pharmacy, I’m thankful that I have coverage I can rely on and that helps me afford my medications.

For years, I have been advocating for policies that protect Part D and safeguard it against changes that might negatively impact the affordability of the prescription drug coverage that helps to keep them healthy.

Luckily, I’m not alone. In fact, recently almost 400 advocacy organizations wrote to Congress asking them to oppose changes to Medicare Part D that could cause an increase in premiums and cost-sharing for many seniors.

As comforting as it is to know so many dedicated lawmakers are fighting to protect our Part D coverage, we know that seniors and individuals with disabilities also have a powerful voice, and it’s critical that you use it. Get involved in the fight and make sure you are heard. The easiest way to stay updated is to join our Facebook page to keep up to date on breaking news and developments. And be sure to let us know what’s on your mind in the comments!!

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Seniors Sound Off: Learn About Part D and Get Involved

In the last 3 weeks, two of my friends have been diagnosed with very serious illnesses. One is enrolled in Medicare and has Part D coverage and one is not yet old enough to be eligible. Their experiences in accessing the medicines they need have been quite different and have led me to once again appreciate the security and strength that Medicare Part D coverage provides.

Of course the examples of two people cannot tell a whole story but I believe their situations do illustrate two points that all Medicare beneficiaries need to consider:

  1. How do we best learn about and utilize all of the benefits Medicare Part D provides?
  2. How do we support efforts to protect the Medicare coverage we have?

Over the next few weeks I have invited several people with great expertise in Medicare to help answer these questions. I also hope you will send in your questions, ideas, and concerns. I promise we will respond!!

Together we can work to protect against any threats to our Medicare Part D coverage.

Remember — your voice makes all the difference!!!

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Keeping Part D Strong: Protect a Program that Works

Have you used your Medicare Part D plan this year? I have, I changed pharmacies and refilled two prescriptions that I take regularly.  It took only a minute or two and I was on my way–just another errand in the course of a busy day.

But as one who worked for many, many years to advocate for prescription drug coverage in Medicare, I cannot help but reflect on how much Part D has changed the lives of older Americans and individuals with disabilities–providing peace of mind, enabling them to remain active, and, most importantly, restoring and maintaining their health! It’s almost inconceivable to think that just a decade ago, Medicare did not provide beneficiaries with coverage for prescription drugs. What a different world that was!

We have made much progress, but we also must safeguard it. This year is going to be a difficult one for Congress and, indeed, the entire government. There are lots of issues, lots of pressure to act, and enormous demands on our national budget, and, of course, lots of politics. As we have seen over the years, this kind of situation can lead to misguided actions that negatively impact Medicare.

From beneficiary satisfaction ratings nearly 90% or higher, to the steady premium costs, to the broad choice among plan options, Medicare Part D has been and remains a program that works — truly works– for almost 40 million seniors and disabled individuals who depend upon it.  Let’s be on guard and be ready to defend our benefit and redirect lawmakers and regulators to the many programs that don’t work and desperately need their attention. Part D should be off the table!

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Protect and Preserve the Medicare Part D LIS Program

Sometimes there is a double meaning to the term “Medicare reform.” “Reform” can mean improve and strengthen or it can mean change and weaken.  One example is a proposed reform of the Medicare Part D Low-Income Subsidy (LIS) Program, also known as Extra Help. This program saves low-income beneficiaries close to $4000 per year in prescription drug costs according to the Centers for Medicare and Medicaid Services (CMS).

The proposed reform would change and weaken the program by requiring low-income Medicare beneficiaries to pay higher copays for brand name drugs while lowering copays for generic drugs. The reform, first proposed by the Medicare Payment Advisory Commission (MedPAC), aims to drive more seniors and individuals with disabilities to use generic drugs, which in theory could lower costs to Medicare.

However, this proposed reform is flawed for a number of reasons. It fails to take into account that many patients, including those at or below the poverty level, require access to brand name drugs because their doctor has determined these medications will produce more positive health outcomes than generic medications would provide. In these instances, patients must have affordable access to brand name drugs or their health and well-being could suffer as a result.

Unfortunately, the proposal would increase cost sharing for these patients.  According to analysis by the Leadership Council on Aging Organizations (LCAO), this would deter access to needed medicines which could in turn lead to much higher Medicare costs on other types of health care services.

Further, even if this change provided some exclusion for certain therapeutic classes of drugs, the exclusion may not be broad enough to address the treatment of chronic diseases for which there are often no generic substitutes.

The LIS program must be protected and preserved. This program works to keep cost sharing low for the most vulnerable beneficiaries to ensure patients can access the treatments they need. Adding to those costs could make health care unaffordable for them. The most inappropriate way to celebrate Medicare’s 50th anniversary in 2015 would be to adopt an LIS reform proposal that increases costs for low-income people instead of maintaining its commitment to improve their quality of life.

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Stand Alone or Take Advantage?

A very important question you should ask regarding Medicare prescription drug coverage is what type of plan you want.  There are two very different choices.

The first is to enroll in Medicare Part D. This is a stand-alone plan that covers just your medications. You use this coverage in conjunction with the medical coverage you receive with Medicare Parts A and B (hospitalization, provider visits, testing, etc.).

The other option is to opt for a Medicare Advantage Plan that provides all of the health care services under Part A and B as well as coverage for your medicines in one plan. Examples of Medicare Advantage Plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Medicare Medical Savings Account Plans, and Special Needs Plans.

Both types of plans have advantages, the right choice for you depends on many factors including where you live and your preferences regarding provider choice. Also, be sure to examine more than just the bottom line on premium costs when evaluating any program.

Some beneficiaries choose to enroll in traditional Medicare health coverage as wells as a stand-alone drug plan (Part D) because it gives them freedom to choose providers without having to coordinate within a network or get referrals. The Part D plans cover your medicines but do not include extra services or provide care. (Note: Some beneficiaries who have regular Medicare and Part D plans also purchase Medicare Supplemental Insurance to assist in copayments and deductibles for medical services.) Part D plans are available throughout the United States, so you have this option no matter where you live.

On the other hand, Medicare Advantage Plans provide health coverage through specific provider networks and facilities. Once you enroll, you are required to seek care within your network. In some cases, these plans also offer additional services not available to beneficiaries who aren’t in their program. Medicare Advantage Plans contract with Medicare to provide Medicare Parts A and B services as well as coverage for your medicines. If you choose to enroll in a Medicare Advantage Plan you do not need to purchase Medicare Supplemental Insurance. These plans are not available everywhere, so it’s important to check what is available in the region or area in which you live. You can check online using the plan finder at or use our tools to find a local office to assist you in your search.

Here are a few questions to consider when determining what is right for you:

  • Does my current doctor or other care provider participate in the Medicare Advantage Plan?
  • If not, am I willing to change doctors/providers?
  • Are the care providers and other facilities in Medicare Advantage Plans convenient to me?
  • Are my medicines covered?

One last thing: Medicare provides a rating of 1 to 5 stars for Medicare prescription stand-alone plans and Medicare Advantage Plans. These ratings are based on both Medicare quality standards and beneficiary experience. For a full explanation of the star rating system, go to and don’t forget to look for and consider the rating as you select a plan.

Remember that a Medicare is open 24/7 at 1-800-633-4227.

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Thanksgiving Plans???

Thanksgiving weekend has been a traditional time for discussion and consideration of Medicare Part D plans. This year, as families gather, both Medicare beneficiaries and younger family members may be considering their various healthcare coverage options. It’s a great thing to do because plans and coverage needs can and do change from year to year!

The tools Medicare has provided on its website,, have become even more streamlined and user friendly over the years, and surveys consistently show that those of us who use them appreciate that convenience as well as the coverage we receive.

Happy Thanksgiving!

So, if you haven’t already done so, take a break from that post-turkey-dinner nap, non-stop football, or Black Friday shopping and go over your Part D coverage!   Don’t forget to also check out all of the resources that are available at!  They will get you prepared for the tasks at hand.

Remember, is ready and waiting all the time, and though Medicare’s call center is closed of Thanksgiving Day, you call them bright and early Friday morning or any other time including the weekend at 1-800-633-4227.

Have a safe and wonderful Thanksgiving!

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Shopping for Plans In-Person or Via the Phone

Earlier this week on the blog, we laid out the simple steps you can take to compare plans and shop for coverage using the online tools, such as the Plan Finder, available at Of course, there are people of all ages who are not comfortable putting all their information into a computer – or at least trying to do it without help. Fortunately, Medicare understands this. If you would rather have an in-person discussion or talk to a specialist on the phone, those resources are available as well.

The initial steps to shopping for coverage are the same whether with a representative or online. Begin by making a list of the medicines you take and the dosage. Next, decide whether you want to get most of your medicines, especially the ones you take regularly, by mail or at a local pharmacy. You’ll also need your Medicare card available which will have key information like your Medicare number and the date you became enrolled in Medicare.

If you don’t use a computer or have one available, you can call your local Area Agency on Aging and make an appointment to meet with the SHIIP Counselor who can help you compare available plans. You can find information on local agencies using our online mapping tool. When you go, remember to bring your medication information and your Medicare card with you when you go.

Additionally, you can speak to a Medicare counselor over the phone any day of the week by calling 1-800-MEDICARE or 1-800-633-4227. A live person will walk you through any questions or concerns you have along the way. They are available 7 days a week excluding federal holidays.

How long will this process take? Probably about an hour or so.  Not long, but enough time to maybe save you money or at least confirm that you are getting the best coverage you can for the medicines you take.

Finally, you can always get information directly from the plan you are interested in. To do this, go to the Plan Finder on the Medicare website, follow the directions, and you will get a list of plans in your area. Click on the name of the plan in order to obtain the contact information. You can also call a local SHIIP Counselor to get plan contact information.

Have you gone through the paper enrollment process? Any guidance you would share with fellow seniors? We’d love for you to sound off in the comment section or through our Facebook page to let us know about your personal experience.

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Online Tools to Shop for Part D Coverage

It is interesting to hear younger people talk about how hard it is to choose health insurance plans. They’re right. Evaluating all the intricacies of multiple plans can at times be a significant challenge. That’s why Medicare beneficiaries are incredibly fortunate. We have easy-to-use tools and real people to help us compare choices and select the Part D plan that’s right for us.

A quick visit to the Medicare Plan Finder website is all you need to get started using the tools that are available to compare plans. So, if you are thinking about reviewing your Medicare Part D plan options now that it is open season – and you really should be thinking about it – here are some easy steps to follow.

Begin by making a list of the medicines you take and the dosage. Next, decide whether you want to get most of your medicines, especially the ones you take regularly, by mail or at a local pharmacy. With that information, a laptop or tablet computer, a phone, and your Medicare card, you are ready to go.

Once on the Medicare Plan Finder website, you will be asked if you want to look broadly at all of the plans available in your area or do a more personalized search which requires providing your name, Zip Code, Medicare Number, date of birth, and the year your Medicare coverage became effective. All of that information can be found on your Medicare card. If you or someone searching for you has never put in your information before, you should use the General Search option.

Continuing with the General Search, you next have to provide some information about yourself and your income and Medicare status as well as the list medicines you take and their dosage. All of this is necessary to help narrow down the list to plans that are right for you.

If you have searched for coverage before, it’s even easier. Simply choose the Personalized Search option and it will automatically reflect the information you provided the last time you compared plans. It will also give you the chance to update the information with any changes or additions.

From that point on, just follow the directions on the screen until you have a number of choices that you are comfortable working with, or in some cases, a single choice that best meets your needs. You can always go back and change the search data to get more or fewer choices.

But the best news is that if you need help or have questions, — day or night, weekday or weekends — you can call 1-800-MEDICARE or 1-800-633-4227 and speak to a live person. They’re available anytime except federal holidays.

Watch the blog for more information this week about the resources available to you if you’d rather not search for a plan online. In the meantime, let me know what your experience has been like with the online tools – both good and bad.