Ringing in the New Year

The calendar’s page has now turned to January.  You are probably receiving less calls and mail about new Medicare plans or changes.  You’ve got new ID cards and a new year has begun.  Should you assume that you’re done?

Whether you switched your plan or not, it’s likely your plan has changed in some way.  It is critical to understand how.  One of the most common things we see this time of year is the Pharmacy Scramble.  I’m sure you’ve seen it before – you’re at the pharmacy counter and the cashier totals your order, then they ask you for $400.

What happened to my $10 copay?  I can’t owe that much!

The first thing to brush up on is your benefits.  Does your plan have a deductible? Are these drugs still covered by the formulary? Are there any restrictions?

Regardless if you’ve changed your plan during AEP, there are three things we recommend to our clients before going to the pharmacy for the first time in January.

1. Call your doctor’s office to inform them of your plan for that year. They may be familiar with the necessary authorizations to get the drugs covered.
2. Place a call to your insurance company’s member service department. You can find this number on the back of your insurance card.  They’ll be able to tell you what steps will need to be taken before showing up at the pharmacy.
3. Review your formulary (list of drugs covered by your plan). You may notice your prescription has letters next to it.  What do those letters mean? If you see the letters QL (Quantity Limit) or ST (Step Therapy), the plan may require you to take other alternatives before they cover your medicine.  There is also PA (Prior Authorization), which means your doctor may need to send an explanation to the plan as to why a particular medicine is medically necessary.

These three key steps will position you for a stress free visit to the pharmacy this January.  No one likes surprises when it comes to their drug coverage.

One last tip – Always Ask Questions!  I am continually telling our clients that if you don’t understand something about your plan, it’s important to call our office to get a clear and understandable answer.  That’s our mission at Focus Senior Benefits.