Date:______________
Dear Helpline Caller:
Thank you for calling the Medicare Rights Center. We are a national, nonprofit consumer
service organization that works to ensure access to affordable health care for older adults
and people with disabilities through counseling and advocacy, educational programs, and
public policy initiatives.
During a recent phone conversation, one of our counselors assisted you with a Prescription
Drug Plan search using Medicare’s Plan Finder tool. Attached, you will find information about
the Prescription Drug Plans (PDPs) that seem to work best for you. We made this decision
by considering:

Your current list of prescription drugs

The total estimated annual drug cost (including both premiums and co-payments)

Coverage of either all or most of your drugs in the least restrictive way
When you are ready to enroll in a Prescription Drug Plan (PDP)
You should make two phone calls:
 First, call the plan directly to confirm the accuracy of Medicare’s Drug Plan Finder
information
 Then, to enroll in a plan, call 1-800-MEDICARE (1-800-633-4227)
When making these calls, you should record:
 The first and last name of the person you speak to
 The date and time of the call and the reference number of the call
When you enroll into a new plan, you will automatically be disenrolled from your old plan, but
we do encourage you to follow-up with your old plan to confirm. Your new plan coverage will
become effective January 1, 2017. If you do not receive your ID card before your coverage
begins, call your new plan and ask for the following numbers which you can use to get your
medications at the pharmacy as soon as your coverage starts:
 Rx Bin number
 Rx PCN number
 Rx Group number and ID number
If you have additional questions or concerns, please feel free to call us again at 1-800-3334114.
Sincerely,
Medicare Rights Center Helpline Counselor
© 2016 Medicare Rights Center Helpline:800-333-4114 www.medicareinteractive.org
What to consider when comparing Prescription Drug Plans
Below you will find information about the prescription drug plans we discussed during your
counseling session. As you review your Medicare Drug Plan Finder information, you
may also wish to consider:
The cost of each plan:
The “Estimated Annual Cost” is just that—an estimate! Only the monthly premium and
annual deductible are fixed. What you pay for prescriptions may change during the year. If a
drug you take has a very high coinsurance, you may wish to ask your doctor if there is a drug
you can take that will cost you less, such as a generic. If you have Full Extra Help and
Medicaid and/or a Medicare Savings Program your co-payments will be $1.20 or $3.60 for
each prescription drug. If you have Full Extra Help without Medicaid and/or a Medicare
Savings Program your co-payments will be $2.95 or $7.40 each.
Covered drugs:
Review the new plan’s formulary to ensure coverage of your current medications. Does the
plan require that you get special permission before it will cover a medication you need? Pay
attention the following coverage restrictions:
 You may have to get prior authorization or formally ask your Part D plan for
coverage before it will pay
 You may have to try step therapy or a different, less expensive drug first
 You may have a quantity limit, which is a restriction on the number of drugs you are
allowed to take per month
If the plan tells you your drug has been denied because of one of these reasons listed
above, you or your doctor can submit a formal, written request to the plan asking it to pay for
the drug you need. This formal request is called an exception request because you’re
asking the plan to make an exception to its coverage rules. For more information about how
to request an exception or appeal for coverage, call our Helpline at 800-333-4114 or visit
www.MedicareInteractive.org.
Pharmacy network:
 Can I use the pharmacy that I usually go to?
 Can I fill my prescriptions when I travel?
 What happens if I go to pharmacies that are not in the network?
 Can I get my prescriptions by mail order?
Coordinating with your other benefits:
 How will my new Medicare Prescription Drug Plan work with any other drug coverage I receive?
 Could I lose my retiree or employer health coverage if I join a Medicare drug plan?
© 2016 Medicare Rights Center Helpline:800-333-4114 www.medicareinteractive.org
Terms to Know
Original Medicare: The fee-for-service health insurance program run by the federal
government. Original Medicare consists of the following parts:
 Part A covers inpatient services and is also called hospital insurance
 Part B covers outpatient services and is also called medical insurance
Medicare Advantage Plans: Private plans that provide Medicare health benefits and usually
drug benefits. Typically, you must see an in-network provider that works with the plan, in
order for your plan to cover health care services you receive.
 Prior Authorization: A requirement to get prior approval before getting certain
services, items or drugs.
 Referral: A requirement to get a formal recommendation from your primary care
doctor before getting services from another doctor/specialist
Part D: The part of Medicare that covers prescription drugs and is only offered through
private insurance companies. It’s best to get your medications at a preferred, in-network
pharmacy that works with your Part D plan.
 Prior Authorization: A requirement to get prior approval before the plan will cover
a prescription drug
 Step Therapy: A requirement for you to try other drugs that treat your condition
before the plan will cover more expensive medications
 Quantity Limits: A restriction limiting drug coverage to a specific amount of drugs
over a certain period of time
Coinsurance / Copayment: The amount you must pay for each service or item.
 A coinsurance is a percentage of the total cost
 A copayment or copay is a fixed amount
Deductible: The amount you must spend on health care or drugs before your insurance
begins to pay.
Premium: The monthly amount you pay to have health insurance.
Medigaps: Supplemental insurance policies sold by private insurance companies to fill gaps
in Medicare. Medigaps help cover Original Medicare’s 20 percent coinsurance and other
costs, depending on the policy. You can only purchase a Medigap if you have Original
Medicare (not if you have a Medicare Advantage Plan).
© 2016 Medicare Rights Center Helpline:800-333-4114 www.medicareinteractive.org