What to Do When Medicare Denies Coverage
If Medicare refuses to cover your care, do not assume this means you will have to take on the financial burden.Read more
Medicare prescription drug plans can change which drugs they cover, leaving you without coverage for a drug you need. Or you may switch plans into a plan that doesn't cover your medication. In these circumstances, Medicare drug plans are required to offer you a 30-day transition supply of the drug you were taking.
All Medicare drug plans, including Medicare Advantage plans with prescription drug coverage and stand-alone drug plans, must offer these transition refills. Plans must provide a 30-day supply (unless a lesser amount is prescribed) of an ongoing medication within the first 90 days of plan membership or within the first 90 days of the new contract year. The plans are also required to provide written notice that you are using your transition supply and explaining what your rights are.
You are entitled to a transition refill when you first enroll in a Part D plan, if you move to a new plan that does not cover your current medication, when your current plan drops your medication or imposes new restrictions on the drug, or when you experience a change in your level of care (e.g., a move from a hospital to a nursing home). The 30-day supply is designed to give you time to either talk to your doctor and find a substitute medication or to request a coverage exception from your current plan. If you ask for a coverage exception, your plan must provide temporary refills until the request has been processed.
Residents in long-term care facilities get additional protections. If you are in a long-term care facility, the plan must cover all the 31-day refill requests you submit in the first 90 days on the plan. After the first 90 days, the plan must offer an emergency 31-day supply if your request for an exception has not been processed.
For more information about transition refills, click here.
For more information about Medicare prescription drug coverage, click here.