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Privacy and Medicare Rights

Joining a Medicare Drug Plan is simple. The enrollment dates are November 15-December 31. Once you have selected a drug plan, you may complete a paper application, call the plan for over the phone enrollment or enroll online. You should not, however receive any phone calls asking you to enroll in a plan (unless CMS has authorized demonstrations and pilot programs in your area-more about this later).

Make sure you protect yourself from fraud and identity theft. Identity theft is a crime. This happens when your personal information is used by someone who doesn’t have your permission. No one from a Medicare plan should be asking you for a credit card or your bank information unless you are already a member of that plan. If you are being asked for credit card or bank information and you are not already a member, contact 1-800-MEDICARE to report.

The Medicare Drug Plan you join will release your personal information to Medicare and other plans as necessary for treatment, payment and health care operations. In addition, Medicare reserves the right to release your personal information for research and other purposes.

A center for Medicare and Medicaid Services (CMS) has authorized demonstrations and pilot programs. Theses programs are sometimes called research studies. They are special projects that test improvements in Medicare coverage, payment and quality of care. Typically these programs are limited in that they are for a specific group and only specific areas. Please contact your state department of insurance or 1-800-MEDICARE for questions regarding demonstrations and pilot programs.

You have the right to ask your Medicare Drug Plan for a written explanation (which is called a coverage determination). This is the first decision that your drug plan will make about your drug coverage. This may include whether a particular drug is covered, have you met all of the requirements for a particular drug, or how much you’ll have to pay for a particular drug.

You have the right to ask your Medicare Drug Plan for an exception if you and your doctor believe you need a drug that is not on your approved drug list. You may ask for an exception if your doctor believes a coverage rule (like prior authorization) should be waived. You may ask for an exception if you believe you should pay less for a non-preferred drug because you and your doctor have determined that you can not take any of the preferred drugs for your condition.

An exception must be filed in writing unless your plan accepts exceptions by phone. To expedite the process you or doctor can call or write the drug plan. In addition, if your doctor tells the plan that your life or health is in danger; your request will be expedited automatically.

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Content copyright © 2015 by Denise M. Castille. All rights reserved.
This content was written by Denise M. Castille. If you wish to use this content in any manner, you need written permission. Contact Denise M. Castille for details.


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