Changing Prescription Drug Coverage

Wayne Goodwin is North Carolina Insurance Commissioner

The details, options and deadlines surrounding Medicare Part D Prescription Drug Plans still confuse many people.

Some Medicare beneficiaries may have kept their PDP simply so you wouldn’t have to worry about the six-week annual election period. However, they may have now discovered that some of the drugs that were covered last year are not covered this year.

You might feel stuck, but here’s the good news. If you fall into one of two categories, you might not be stuck with your plan after all.

Two Exceptions:  If you currently have Medicare and Medicaid or if you have Original Medicare and have been approved for the federal Extra Help Low Income Subsidy (LIS) program through the Social Security Administration, you have a continuous special election period to change your Medicare Part D PDP. This means that you may change your Medicare PDP at any time!

Extra Help assists eligible Medicare beneficiaries in paying for their prescription drugs. To qualify for Extra Help, your annual income must be at or below $16,335 for an individual or $22,065 for a married couple living together. Your total resources must be limited to $13,300 for an individual or $26,580 for a married couple living together.

The resources do not include a primary residence or a vehicle. If you have not applied for the Extra Help program and think you might be eligible, call SHIIP, the Seniors’ Health Insurance Information Program (800-443-9354), the Social Security Administration (800-772-1213) or the SHIIP Coordinator listed below.

Medicare is a confusing topic for most people, but SHIIP is available to help you work through your options. SHIIP, the Seniors’ Health Insurance Information Program, is a division of the North Carolina Department of Insurance that provides free and unbiased information about Medicare to beneficiaries and their caregivers.