February 9, 2006
Q: My grandmother has both Medicare and Medicaid and was assigned to a Medicare drug plan for this year. Turns out, the Medicare plan doesn't cover three of her six drugs. Can she change plans? -- Esther
Dear Esther:
Yes, your grandmother can switch plans if she is not satisfied with her current Medicare plan. Your grandmother is one of more than six million Medicare beneficiaries with Medicaid who were randomly assigned to a Medicare drug plan for 2006. These beneficiaries – known as dual eligibles – are able to switch plans throughout the year.
If your grandmother chooses to stay in her current Medicare drug plan, she will not be responsible for paying the monthly premium or any deductible but will be required to pay a copayment for each of her medications. However, she will have to pay the full cost of medications that are not covered by her plan.
Before your grandmother switches plans, she might want to talk with her doctor to find out if there are other drugs that are covered by her plan that would be appropriate to take instead. If, however, her physician feels that she should not make a change, she has two options. Her first option is to ask the plan for an exception to cover this drug for her, which would allow her to receive the drug for her usual copayment. Another option is to search for a new Medicare drug plan that covers all of her prescriptions.
One word of warning about switching plans: In general, Medicare pays the full monthly premium for dual eligibles but only up to a certain amount. Your grandmother should check to make sure the plan she wants does not charge a premium above the amount that Medicare will pay. If she enrolls in a higher premium plan, she would have to pay a share of the monthly premium for the more expensive plan.
This column was prepared by the Kaiser Family Foundation, an independent, non-profit private foundation based in Menlo Park, Calif., that is not affiliated with the Kaiser Permanente health plan. Do you have questions about the new Medicare drug benefit? Send your questions to Medicare Q and A. The Kaiser Family Foundation. 1330 G St., NW. Washington, DC 20005 or MedicareQ@kff.org.
(c) 2006, Knight Ridder/Tribune News Service.
Distributed by Knight Ridder/Tribune Information Services.
