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December 8, 2009, Online Chat



Margaret Beardsworth
PHA's Insurance Program Manager

Chat Transcript

Moderator_Margaret_Beardsworth: Welcome, everybody! Thanks for joining us. We are going to be starting in just a few more minutes.

Moderator_Margaret_Beardsworth: Good afternoon and welcome to the Medicare Part D and Enrollment: Choosing a Plan that Works for You chat!

Moderator_Margaret_Beardsworth: Thank you for joining us today as we talk about steps you can take to help you maneuver through Medicare Part D. We will begin with some basic Medicare questions and then begin answering questions you have emailed to me already and questions that you submit today.


Panelist_Kristin_Brown: This is Kristin Brown, Scarlet Watts and Sue Batkin from the Medicare Rights Center. Sue is the Director of Casework, Scarlet is the Director of Marketing and Outreach and Kristin is an AmeriCorps VISTA in the Marketing and Outreach Department.

Panelist_Doug_Taylor: Hi, I'm Doug Taylor. I lead a support Group in the Midlands of SC.

Panelist_Doyle_Hull: Good afternoon! My name is Doyle Hull. I'm a Director of Patient Services for Caring Voice Coalition. I supervise part of CVC's financial assistance program as well as its insurance education program.

doccharli: Hi everyone. It's Charlotte from the Puyallup SG in WA

Moderator_Katie_Kroner: Hi Charlotte!

Panelist_Kristin_Brown: Medicare Part D is Medicare's prescription drug coverage. It covers drugs that you would purchase at the pharmacy. You can only get Part D through a private plan. If you want or need part d, now is the time to research the plans that will best meet your needs. Medicare Part B is the part of Medicare that covers outpatient doctors and providers as well as durable medical equipment like walkers and wheelchairs. Medicare Part B has a monthly premium. Medicare Part A is the part of Medicare that covers inpatient hospitalization and skilled nursing facilities as well as some type of home health care. Most people get Part A for free, if they have worked a certain number of quarters.

Dan: (Q) There is no audio. Should I be hearing sound?

Moderator_Katie_Kroner: (A) Hi Dan and all--no audio today. Just share your questions in the chat area and we'll pass them on to the panelists to answer.

JT: (Q) What are the best Medicare advantage products in Texas?

Panelist_Kristin_Brown: (A) We can't really answer this question outright. So much depends upon your own personal healthcare needs. There are different types of Medicare Advantage Plans: HMO's, PPOs, PFFS. Each has its own set of rules. For example, HMO's require that you go to doctors and hospitals within a very prescribed network. PPO's allow you to go out of network. You really need to ask your doctors what plans they take and then choose a plan that will allow you to go to your favorite doctors and providers. This is Sue and Kristin from the Medicare Rights Center.

Peatlog: (Q) How can I find out which drugs, Medicare D requires a company to cover. My company has dropped 600+ name brands from coverage effective 1/1/10.

Panelist_Kristin_Brown: (A) There are only about 7 categories of drugs that Medicare Part D does not cover -- by law. Most D covers most categories of drugs. We will give you a link to the excluded categories momentarily. But generally speaking, every part D plan must cover a few drugs within each category. So if you can't get the brand that you want, you may be able to get a generic in that same category, if the doctor thinks that would work for you. If you can ONLY take a certain brand and the plan doesn’t' cover the drug, then you can ask the plan to make an exception. You will need your doctor's support in order to get an exception. We have lots of information about how to "appeal" a drug denial on Medicare Interactive. Here is a link to Medicare Interactive.

carol_d: (Q) What do you think about the AARP's donut hole calculator?

Panelist_Doug_Taylor: (A) I don't have any experience using it myself.
Doccharli: I've used it for 2 years Doug and it has been off by more than $50.00 a month each time. My non generics seem to cost much more out here on the west coast than they are quoted as costing on AARP's donut hole calculator. The Calculator on the Medicare interactive site is better...IMHO.

Panelist_Doug_Taylor: RE: AARP's calculator. Anytime you have something for 'everyone' to use, it isn't going to be as accurate as a tool or calculation specifically for you, for instance asking your local pharmacist for help.

MaureenFH: (Q) Have you ever heard of a Medicare "Carve-Out" policy? Through a mix-up, my secondary company (Anthem) was saying they couldn't cover Flolan because of the "carve out" policy. I just wanted to know had anyone heard of such a thing?

Panelist_Doyle_Hull: (A) Yes! Another name for a "carve out" is "non-duplication coordination of benefits." Whenever more than one insurance is in effect on a person, the plans have to coordinate which one pays what. It sounds as if your Anthem plan has rules saying that, when it is secondary to Medicare, it will not pay for something that Medicare has already paid for if the Medicare payment is as much as or more than what Anthem would have paid.

Robert: (Q) Is there a quick way to know how many prescriptions are included in a carrier's formulary?

Panelist_Doyle_Hull: (A) I'm not sure what you're asking. Do you mean how many different drugs are included in the plan's formulary?

Merle: (Q) Hi Kristin, Scarlet and Sue -- the big question I got from my support group members is what happens while in the donut hole...

Panelist_Kristin_Brown: (A) When you are in the donut hole, you must pay 100% out of pocket for drugs. However, there are some plans that will cover generics through the donut hole. If you are researching drug plans, this may be something to consider. In addition, if one is of limited income, then he/she may be eligible for Extra Help -- the federal program that help pay for the cost of prescription drug coverage. If you are in Extra Help, this program will cover your covered drugs through the donut hole. IN addition, many states have State Pharmaceutical Assistance Programs. For example, In New York State we have EPIC. These programs can be helpful through the donut hole. Not all states have these programs. Finally, pharmaceutical programs have Patient Assistance Programs. These programs allow you to apply for assistance through the company. If you qualify, they will help subsidize the drug. You can find out about these programs through []

Panelist_Doug_Taylor: I want to put a plug in for Caring Voice Coalition. They were incredible in helping me find the right plan specifically for me. And also, the SC 'SHIP' who have totally up to date info on the plans available in your state and can help you with the cost you will have under the plans.

Panelist_Doug_Taylor: Having the right plan is the first step to take in reducing your out of pocket costs.

Jody_C: (Q) We have a consumer who is newly dual eligible and on an Advantage plan. On, it is showing that in January she will have a PDP. Does this mean she was automatically disenrolled from Advantage plan and put back on Original MC with a PDP?

Panelist_Doyle_Hull: (A) It may. It could be that the premium for the Medicare Advantage plan increased past the level where it would be covered in full under Low Income Subsidy guidelines. To ensure that the consumer remained covered, this may have been what occurred. It would be best to call Medicare to check.

Tashi: (Q) Where can i find info on part D plans available?

Panelist_Kristin_Brown: (A) You can find information and compare drug plans on Medicare's website.

Rich_Vandiver: (Q) The Medicare booklet has a list of available plans. What you don't see is whether certain medications are excluded. For example, a patient on blood thinners may be required to go to Lovenox (very expensive) in advance of a heart cath or other surgical procedure. Is there a way to know whether certain medications are excluded from respective programs?

Panelist_Doyle_Hull: (A) The best and quickest resource, I believe, is the Medicare website. It allows you to look at plans that are available in your area and to look at whether they cover certain drugs and, if they do, to see how they're covered.
Moderator_Margaret_Beardsworth: And just as an FYI, Medicare's website is

Bellowslane: (Q) I notice that the cancer drug XELODA is not under any Part D formulary. Is this drug covered under Medicare Part B?

Panelist_Kristin_Brown: (A) If you want information on a specific drug you can our hotline and we can research this for you. Our hotline number 1-800-333-4114 and we are open M-F 9am-5pm ET.

Merle: (Q) As I'm sure you have heard... too many pholks cannot afford these medications and I have also heard that some stop taking them because they cannot afford them during that "off" time.

Panelist_Doyle_Hull: (A) We hear that all the time. Many of the people who approach CVC for financial assistance are Medicare Part D patients who, until recently, never went into the "coverage gap" (or "donut hole") on their Part D plan. Once their doctor prescribes an expensive medication, however, they reach that level pretty quickly.

Panelist_Doug_Taylor: I think another good source for formulary information is the 'SHIP'. (Can someone explain what the SHIP is?) I've found that in SC plans are being added and dropped and the most current information is with a person on the phone.

Panelist_Doug_Taylor: SHIP stands for "State Health.....??"

Moderator_Katie_Kroner: Insurance Program

Moderator_Margaret_Beardsworth: Your state's SHIP program (State Health Insurance Assistance Program) is a national program that offers one-on-one counseling and assistance to people with Medicare and their families.

Lamwatt: I am a SHIP volunteer. We are all trained to assist Medicare beneficiaries with most any problem or question. We also assist with LIS and other assistance programs. Service is totally free. Your SHIP toll-free number should be on the back of your Medicare and You handbook for your state.

Panelist_Doug_Taylor: I have had experience with SHIP myself, with my mom, and even with my support group, and was very impressed with the professionalism and knowledge of the people I talked with.

Phnomore: I have had good luck at Medicare Online comparing drug costs for D...I always enter the drugs I am on plus others that my PH friends are on just in case I may be put on them at some point. shirley in Houston

Panelist_Doug_Taylor: For people needing financial assistance, there is CVC, and state/gov programs, but, people should also ask their specialty pharmacies for help, and even the drug companies.

Phnomore: (Q) Do supplemental or Medigap programs take the place of Medicare D or would you still need D?

Panelist_Doyle_Hull: (A) In general, "Medigap" plans are designed to help pay out-of-pocket costs that "original" Medicare (Parts A and/or B) leaves behind. Some Medigap plans provide some prescription drug coverage but it it usually very limited. In most instances, if you need prescription drug coverage and are a Medicare beneficiary, you will want to enroll in a Part D plan or a Medicare Advantage plan that includes prescription drug coverage.

Panelist_Doug_Taylor: The drug companies will want you to ask everyone from your grandma to your dog, but in the end, if you REALLY need a drug, they are likely to find a way to provide it to you.

Phnomore: (Q) Have there been any changes in how the donut hole works for the upcoming year?

Panelist_Kristin_Brown: (A) The donut hole works in the same way in 2010 as it did in 2009. The only difference is in the amount you pay before you reach and leave the donut hole. In 2010 you will reach the donut hole after you and the plan have spent $2830 toward covered drugs. Catastrophic coverage will begin after YOU alone pay $4550 in out of pocket costs for covered drugs. This is confusing. But it's clarified nicely on Medicare interactive

Panelist_Doyle_Hull: Robert asked how to tell how many drugs are listed on a plan's formulary. I think the best way would be to look at the plan's website or to call the plan and have them send you a full listing. Be aware! There will probably be thousands of drugs listed and, as soon as the list is printed, it will probably be out-of-date.

Merle: (Q) What about ACCESS for assistance. Call your local Representatives or Senators.

Moderator_Katie_Kroner: (A) You're spot on, Merle. I think we've posted ACCESS's info, but just in case: 888-700-7010. They can be helpful with questions about COBRA, social security and other benefit access issues. You state and U.S. elected officials also have constituent services offices that can help you follow up on some concerns. They are better at some things than others, but often worth a call, especially if you have already tried the usual things without success.

PHADebbie: For those who lead Support Groups, you can always refer patients to the PHA's Patient to Patient Helpline for insurance resources (like Caring Voice's 800 #) as well as emotional support.

Merle: I guess I meant APPRISE -- your local County Area Agency on Aging will help.

PHADebbie: PHA's Patient-to-Patient Helpline: 800-748-7274

Joyce: (Q) When this chat is over will the web addresses available to print. I have tried to copy some but not all. I am a SHIIP volunteer and it is a rewarding experience to help. Many of the clients I have dealt with have been so frustrated with the system they just throw up their hands and stick with the same company even though it may not be the best one for them.

Moderator_Katie_Kroner: (A) Yes! PHA will post the chat transcript on our website (where the chat details are currently posted) and you can print it from there.

Dan: (Q) What's the link to the chat transcript?

Moderator_Margaret_Beardsworth: (A) After the chat, we will post the transcript at

Panelist_Kristin_Brown: Here is a question that came in earlier: I have a patient who is Medicare, Medicare HMO and Medicaid. The local HICAP person told her that she did not need to stay in the Medicare HOME, which I agree with. However, if she disenrolls, how then does she get a Medicaid Medicare D plan? Does this happen automatically or does she have to enroll? Her pharmacist told her that she could not disenroll because she would not have any prescription coverage. But she should be eligible as a duel eligible. Answer: This client will be automatically enrolled into a part D plan. All people on Medicaid must be in a part d plan. If they don't enroll, they will be enrolled. There might be a time period when the person (for two or three weeks) does not have a part d plan. In this case, they will have access to Medicare covered drugs through a process called Point of Sale Facilitated Enrollment. this process allows people on Medicaid without a part d plan, to access prescription drugs temporarily.

Doccharli: (Q) Does anyone have knowledge about why the costs of Medicare HMO plans have been pretty well maintained for 2010 while the cost for Medicare Advantage plans have skyrocketed?

Panelist_Doyle_Hull: (A) To be honest, I was unaware of that discrepancy.

Panelist_Doug_Taylor: Re. Medicare Advantage plans... it depends on some locations and the gov subsidy of the plans. My own Advantage plan remains very reasonable for 2010.

Lamwatt: Re: MAPD's in our area we have seen an increase in co-pays and maximum out of pocket expenses and a slight increase in premiums but most of the covered items did not change.

Panelist_Doug_Taylor: Joyce has a good point about sticking with your current plan. AARP's Bulletin just had an article on how many plans are changing and not necessarily for the consumers' good.

Merle: (Q) Do you want my complete list of numbers to call -- I use for the PHA Help Line.

Moderator_Margaret_Beardsworth: (A) Yes - that would be great, Merle!

Doccharli: (Q) Why is the government subsidy different from state to state....Seems pretty unfair.

Panelist_Doug_Taylor: (A) I don't have an answer for that. I agree. But I assume subsidies were negotiated per plan. And it has an impact on additional services that plans may offer such as dental and vision coverage.

Dan: To what plan is Joyce referring? I'm changing my PDP because my current PDP plan is increasing significantly in 2010.

Joyce: I have a strand alone prescription plan with Advantra RX.

Merle: If anyone has major or simple problems - questions not only will your local legislator be willing to help but you can also contact your federal legislators...

Panelist_Doug_Taylor: Obviously all of us on the chat have 'puter access. But for my fellow support group leaders, I encourage you to find help numbers for your SG members who don't have 'puters.

Panelist_Doug_Taylor: Keep in mind plans vary significantly from state to state!

Panelist_Kristin_Brown: Question: "I have already modified my drug list to pick the best matching plan that is not above the amount covered by Extra Help and have submitted for enrollment to that plan. Because I have to change medications, or be subjected to Step Therapy or Prior Authorizations not under my 2009 plan, I qualify for several transition fills. I also understand I must ask for my transition fills within the first 90 days under my new plan. I asked my pharmacist if she knew how to do a Part D transition fill and she said no. This worries me. Other than asking for no more than a 30-day supply for a transition fill, is there anything else I need to do to get my current medications one last time under the transition process?" Answer: if you are entitled to a transition fill, this should happen automatically. If this does not happen, call our hotline at 1-800-333-4114 and we will try to assist you.

Moderator_Margaret_Beardsworth: We are trying to answer all of the questions submitted; however we are running out of time for today's chat. Before we finish Sue, Scarlet, Kristin, Doug and Doyle - is there anything you want to add or resources you would like to recommend?

Merle: Thank you to all the panelists...

PamCarner: When you say Medicare Advantage plans are you talking Plan C--supplemental? And don’t you still have to obtain Plan D for Drugs?

Panelist_Doyle_Hull: (A) By "Medicare Advantage," I'm referring to those plans where a Medicare beneficiary turns over the management of their Medicare Part A, B, and (usually) D benefits to a private health insurance company. Medicare supplement plans are commonly categorized by plan letter names (Plan A, Plan B, and so on) so that sometimes causes some confusion.

Panelist_Doug_Taylor: GOOD LUCK! We all need it!

Panelist_Doug_Taylor: Don't get discouraged, and keep asking

Moderator_Margaret_Beardsworth: At this point, if you have any additional questions (or for some reason we were unable to answer your question) please feel free to email them to me directly at and we will work with the panelists to get them answered.

Panelist_Kristin_Brown: If you have any questions about Medicare please call our hotline M-F 9am-5pm ET 1-800-333-4114 or visit Thank you for all of your questions and to PHA for hosting this great experience.

Moderator_Katie_Kroner: Thanks so much, everyone!

Moderator_Margaret_Beardsworth: As we are finishing up, I want to thank all the panelists - Kristin, Sue, Scarlet, Doug and Doyle!

Vicki: (Q) I am caring for my cousin's medical needs. She is in a nursing home w/dementia. We have spent down so she has Medicaid and Extra Help. Letter to her says new Part D carrier being selected eff. in January. What steps should I take to figure out whether new provider is OK and, if not, how do we select an appropriate one within whatever the $$$ limits are for coverage. (Her provider dropped because price went up is the best I can conclude). Thanks for your advice.

Panelist_Doyle_Hull: (A) You should probably look at the new plan before January rolls around. It will probably be fine, but you should check. The nursing center can print out a list of her medications. You can pull up her plan on the Medicare website, enter the medication information, and see how they'll be covered.

Lamwatt: Vicki, an auto enrollment will be made if you do not choose a plan. If you choose a plan, you need to select one that has a premium at or below the benchmark which is the average cost for that year. If all meds are not covered on the plan they select for you, choose one that does cover meds and enroll in it. You can enroll once per month since you are receiving assistance paying for plan/meds.

Panelist_Doyle_Hull: Thanks to everyone for their questions. Please remember that Caring Voice Coalition [1.888.267.1440] is here to help you with these kinds of questions every day.

Moderator_Margaret_Beardsworth: Also, you can visit for more information about pulmonary hypertension. Don't forget that a copy of the transcript will be available on our website at [obsolete link] And of course, you can always contact me directly at

Moderator_Margaret_Beardsworth: We also want to thank Pfizer, as this e-Learning even is made possible through an unrestricted educational grant from Pfizer, Inc.

Doccharli: Thank you panelists for your timely help and information.


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