Marci’s Medicare Answers: Medicare savings programs, transition refills and the skinny on Medigap

Dear Marci,

My senior center gave me information about different services that can help seniors to save money, including ones relating to Medicare. One discussed Medicare Savings Programs. What are Medicare Savings Programs?

—Lori

Dear Lori,

Medicare Savings Programs are assistance programs that help to pay certain Medicare costs for people with limited incomes. MSPs can help to pay your monthly Part B premium, and possibly other Medicare costs depending on your income.

To qualify for an MSP, you must meet certain income and asset guidelines in your state, and you must have Medicare Part A, the hospital insurance part of Medicare. If you do not already have Part A, you may still apply for an MSP if you qualify for the MSP that pays your Part A premium. To learn more about MSPs in your state and how to apply, contact your local Department of Social Services, or your State Health Insurance Assistance Program.

If you have an MSP, you will also automatically get Extra Help, the federal program that helps to pay certain Part D prescription drug costs.

—Marci

Dear Marci,

My Part D plan is no longer covering a prescription drug that I have been taking for the past year, but my pharmacist told me that I may be able to get a transition refill while I talk to my doctor to find another medication. What is a transition fill?

—Scott

Dear Scott,

A transition fill, sometimes called a transition refill, is a one-time, 30-day supply of a drug that a Medicare Part D plan must cover when you are new to a plan, or when your current plan changes its drug coverage for the next calendar year. This transition fill is meant to give you temporary coverage for a drug that is not on a plan’s formulary, or that has a drug restriction. Transition fills are not for new prescriptions, but rather for existing ones that you were already taking before your plan changed its list of covered drugs.

You can request from your pharmacist that they provide you with a transition fill for your drug. All Medicare Part D drug plans must cover transition fills. The rules apply to both Medicare Advantage plans that include drug coverage and Medicare stand-alone drug plans. When you use your transition fill, your plan must send you a written notice within three business days. The notice will tell you that the supply was temporary and that you should either change to a covered drug or file a request with the Part D plan (called an exception request) to ask for coverage. If the plan does not cover your drug under the exception request, you can appeal to the plan.

—Marci

Dear Marci,

I am turning 65 soon and plan to enroll in Medicare. I am interested in getting a Medigap to supplement my Medicare coverage. What is the best time to purchase a Medigap?

—Donna

Dear Donna,

Medigap policies are supplemental insurance policies sold by private companies that cover Medicare costs after Medicare has paid on a claim. Remember, you can only have a Medigap with Original Medicare, not a Medicare Advantage plan.

Under federal law, there are specific times during which you have the right to purchase a Medigap. You only have this right if you are 65 or older and enrolled in Medicare, and you buy your policy during a protected enrollment period. You have a six-month protected enrollment period that begins the month you turn 65 and enroll in Medicare Part B. During this period, Medigap companies must sell you a policy at the best available rate regardless of your health status, and cannot deny you coverage. The best available rate may depend on a number of factors, including your age, gender, whether you smoke and where you live. Know that you can apply for a Medigap before this enrollment period begins, so that your Medigap coverage starts as soon as you are enrolled in Part B.

If you miss this open enrollment period, you can also buy a Medigap when you have a guaranteed issue right. Under federal law, if you are age 65 or older, you have a guaranteed issue right within 63 days of when you lose or end certain kinds of health coverage.

Each state must follow rules that are no stricter than the federal guidelines described above regarding Medigap policies. However, some states have additional protections that expand the times when you can purchase a Medigap. Also, many states apply enrollment protections to people with Medicare under age 65. To learn more about Medigaps in your state, you can contact your State Health Insurance Assistance Program.

—Marci

Marci’s Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare. To subscribe to “Dear Marci,” MRC’s free educational e-newsletter, click here.