Most elderly citizens are covered through the Medicare Advantage plan or the Medicare Part D which are both meant for prescription drug coverage. Each plan is unique in that it has a formulary or a list of drugs that are covered.
The only issue is that a lot of these formularies don’t have all the medications that you need and they’re constantly changing.
For instance, an elderly family member’s medication might not be included in this list which means you’ll have to pay for it out of pocket.
If you notice that an important medication isn’t covered then you have the following options to choose from as a course of action.
- Consult with Your Doctor About Alternatives
There are lots of medications that offer the same effects and benefits. If your particular brand isn’t covered you should speak to your physician if there are any alternatives that work the same way.
Ask them if they can prescribe or recommend something else that works just as well to help treat the same medical condition.
- Get an Exception from the Insurance Company
If an elderly member of your family must take a specific drug then you can give your insurance company a call and ask if they can provide an exception to their formulary.
This means that they will provide a special exception to your family’s senior citizen.
A formulary exception is suitable for situations where a physician is required to provide a written statement that gives justification for the necessity of the medication.
Ask your insurance company to provide you with the forms needed for this situation.
- File an Appeal in Case of Denial
If your request for a formulary exception is denied by the drug plan then you can appeal the decision by request a new decision to be made.
You can go through five appeal levels before your matter is solved, or you could go for the comprehensive Mutual of Omaha Medicare Plan G.
- Find a Different Medicare Prescription Drug Plan
If the formulary exception is out of your reach, then you might need to find a new prescription drug plan that meets your elderly family member’s needs.
With all that said, you have until the end of the Open Enrollment Period to change plans which spans from October 15th to December 7th.
If your formulary exception is denied outside of the Open Enrollment period and it’s absolutely necessary for your elderly family member then you might have to actually pay for it out of pocket.
This is your final resort, as you can see, and unfortunately, you have to pay full price.
Check in with the drug manufacturer to see if they have any payment assistance programs that you can take advantage of. Most manufacturer websites offer this option.
Conclusion
Now that you know what to do if your medications aren’t covered by Medicare, you’re in a better position to handle this situation if it ever arises in your life.