Medicare Watch

Your Weekly Medicare
Consumer Advocacy Update

Your Story Could Make Medicare Better

April 15, 2010

Volume 1, Issue 7 

Tell Us Your Story

woman with granddaughter Personal stories are powerful. They help us identify health care problems and trends that need attention, and describe how Medicare policies play out in the lives of people with Medicare across the country. The stories we hear from consumers drive the Medicare Rights Center�s policy work.

Are you having trouble paying for the medical care or prescription drugs you need?
Do you or a loved one receive care from more than one doctor or health care provider? If so, are you experiencing problems coordinating that care?
Do you have difficulty getting clear information about how to manage your health?

Tell us how the health care system is or isn�t working for you or your loved ones. Share your story with us.

New Rules Set Refund Deadline

New Medicare rules will help low-income people with Medicare receive refunds for excess drug premiums and copayments they paid after they became eligible for Extra Help, the program that helps pay Part D cost-sharing for consumers with limited incomes.

The new regulations set a 45-day limit for drug plans to reimburse new Extra Help recipients or other payers, such as state pharmaceutical assistance programs (SPAPs) that paid members� drug premiums and copayments. The reimbursements are for copayments and premiums paid above Extra Help levels after the date an individual is eligible for Extra Help—the month they applied—but before the drug plan is informed about his or her Extra Help status.

For almost two years Medicare Rights has called for plans to reimburse consumers and SPAPs by a specified deadline, and to make sure the payments are for the correct amount. The new rules clarify drug plans� obligations to work with SPAPs to better account for reimbursements they are owed.

Dear Marci logo

Dear Marci,

I have some prescriptions I need to fill. How do I get my Medicare private drug plan to cover my drugs?

—Carmen (Columbia, SC)

Dear Carmen,

Your Medicare private drug plan will only cover your drugs if you follow your plan�s rules. Before you go to the pharmacy, find out if your drug is on your plan�s list of covered drugs (called a �formulary�). Also, find out whether there are any restrictions on coverage.

If your drug is not covered or is covered with restrictions and your doctor says you need to continue taking your medication, you should file an exception (appeal) to get your plan to cover the drug.

Visit to learn more.

The excerpt above is adapted from Dear Marci, our weekly newsletter for consumers. Sign up for Dear Marci.



Early this week, the Centers for Medicare & Medicaid Services launched a new and improved Medicare website ( The site features a new look and improved usability, which should help more people with Medicare get access to the information they need. Visit the new website.

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The Medicare Rights Center is 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.

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