April 20, 2006
Q: My grandpa lives in a nursing home. We signed him up for a Medicare drug plan earlier this year. We just learned that the nursing home uses a pharmacy that is not covered by his Medicare drug plan. What should we do? -- Alex
Dear Alex,
Many nursing homes contract with one pharmacy to provide medications for all residents of the facility. This means that an important consideration for nursing home residents is finding a Medicare drug plan that includes the pharmacy in its network. If your grandfather’s Medicare drug plan does not contract with the pharmacy used by his nursing home, it would probably be a good idea to switch to another plan. Otherwise, your grandfather will likely have to pay more for using an out-of-network pharmacy to fill his prescriptions. And, this could be quite costly.
Your grandfather might want to enroll in a plan that includes the pharmacy used by his nursing home to avoid these extra costs. You may want to ask the nursing home staff for a list of Medicare drug plans in the area that work with the pharmacy the facility uses.
Once you have identified other Medicare drug plans that include the pharmacy used by his nursing home, it would be a good idea to compare the benefits offered by these plans before making a switch. Look for a plan that covers most or all of the medications your grandfather takes. Also consider the drug plan’s premium, deductible, copayments for filling each prescription, and any restrictions the plan may have on your grandfather’s medications.
The good news is that nursing home residents, like your grandfather, are able to switch plans at any time during the year if they have a problem with their Medicare drug plan. Other people on Medicare are typically more limited; they can switch plans only once before May 15 and are then locked into their plan for the remainder of the year.
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.
