Medicare Prescription Drug Coverage (Part D)
The Medicare prescription drug plan allows private health insurers to offer limited insurance coverage of prescription drugs...
Read moreIf your Medicare drug plan denies coverage for a drug you need, you don't have to simply accept it. There are several steps you can take to fight the decision.
The insurers offering Medicare drug plans choose the medicines -- both brand-name and generic -- that they will include in a plan's "formulary," the roster of drugs the plan covers and will pay for that changes year-to-year. If a drug you need is not in the plan's formulary or has been dropped from the formulary, the plan can deny coverage. Plans may also charge more for a drug than you think you should have to pay or deny you coverage for a drug in the formulary because it doesn't believe you need the drug. If any of these things happens, you can appeal the decision.
Local Elder Law Attorneys in Your City
Before you can start the formal appeals process, you need to file an exception request with your plan. The plan should provide instructions on how to request an exception. The plan must respond within 72 hours or 24 hours if your doctor explains that waiting 72 hours would be detrimental to your health. If your exception is denied, the plan should send you a written denial-of-coverage notice and a five-step appeals process can begin.
For information about other Medicare appeals, click here.
The Medicare prescription drug plan allows private health insurers to offer limited insurance coverage of prescription drugs...
Read moreMedicare prescription drug coverage affects Medigap coverage of prescription drugs.
Read moreA low-income subsidy (called Extra Help) is available to help pay the premiums, deductibles, and co-payments of the Medicare...
Read moreMedicaid Rules, etc