Changes to Medicare through the health care law
The Affordable Care Act made significant changes to the Medicare prescription drug coverage (Part D) program. Starting in 2010, more Medicare beneficiaries qualified for the Extra Help program with their Medicare prescription drug plan costs. Medicare beneficiaries who cannot afford their medications for psoriasis and psoriatic arthritis may see considerable savings with Extra Help. If you applied for Extra Help in the past and didn't qualify, you might qualify now. See if you qualify and apply online or call Social Security at 800.772.1213.
Medicare now covers certain preventive services, like mammograms or colonoscopies, without charging you for the Part B coinsurance or deductible
If you're in the donut hole, you'll also get a 50% discount when buying Part D-covered brand-name prescription drugs. The discount is applied automatically at the counter of your pharmacy. The donut hole will be closed completely by 2020.
Medicare for people with psoriasis and psoriatic arthritis
Medicare is a government funded health insurance program for people who have reached the age of 65, or who have become disabled. The official U.S. government site for people with Medicare provides information about the program and tools for comparing prescription drug plans, hospitals, home health agencies and more, or you can call 1.800.MEDICARE (1.800.633.4227).
- You have the right to appeal any decision about your Medicare services.
A Medigap policy is health insurance sold by private insurance companies to fill the "gaps" in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn't cover.
Some Medicare beneficiaries are eligible for Extra Help (800.772.1213) to pay for the costs—monthly premiums, annual deductibles, and prescription co-payments—related to a Medicare prescription drug plan.
Each state has a State Health Insurance Program (SHIP) which educates and assists Medicare beneficiaries, those eligible for Medicare, and caregivers in regard to Medicare, Medicaid, Medigap insurance, prescription drug benefits, and other issues related to health insurance benefits. Contact information for your state's SHIP can also be found by calling the Health Assistance Partnership at 202.737.6340.
The Medicare Rights Center (1.800.333.4114) helps answer questions about Medicare, and has caseworkers that can help people with a specific problem they are having with Medicare, including how to reduce premium and prescription drug costs, and how to appeal a denial by an HMO or a Part D plan.
Medicare Part D (prescription drug coverage)
If you have Medicare Part D, you may experience a gap in coverage (the donut hole) when your out-of-pocket costs reach a certain amount. To help with financial costs:
- Apply for Extra Help from the Social Security Administration or call 800.772.1213.
- First, contact the manufacturer of your medication. if your income is very low, you may qualify for assistance from the company. Even if it cannot help you financially, it may be able to assist you in other ways and direct you to the quickest source of financial help.
- If you have already contacted the manufacturer, apply for grants from patient assistance foundations.
- Use the Medicare Formulary Finder to compare plans.
- Check this list of tips on how to lower your drug costs on Medicare's official website
Other Medicare resources:
- Learn more about the Medicare Open Enrollment Period.
- Benefits Checkup helps people over age 55 find federal, state and other benefit programs that help pay for prescription drugs, health care, utilities and other needs.
Get help navigating your Medicare
NPF Patient Navigation Center can provide up-to-date information on accessing the best care possible. Contact a patient navigator today.