What to Tell Your Client if Their Drug Isn't Covered Under Medicare

As an insurance agent, it's essential to help your clients navigate the complex world of Medicare coverage, especially when it comes to prescription drug coverage under Medicare Part D. Sometimes, a client may find that their prescribed medication is not covered by their Medicare plan. Here's what you should tell your clients if they face this issue:

1. Check the Medicare landscape - Determine if the medication is ever covered by Medicare Part D or if it falls under Medicare Part B because it's administered in-office. Some drugs are never covered by Medicare, such as weight loss drugs, cosmetic drugs, and cough and cold medications. Understanding the reason behind the lack of coverage is crucial. #MedicareEligibility
2. Talk to the doctor - Advise your clients to consult with their healthcare provider about alternative medications that may be covered by Medicare or Medicare Advantage. If there are no suitable alternatives, the doctor's support will be necessary to file an appeal for coverage. #DoctorCollaboration
3. Request a formulary exception - A formulary exception is a request to include a non-covered drug in the Medicare plan's list of covered drugs. Your client's doctor must provide justification for the medical necessity of the medication. Encourage your clients to follow up with their providers and insurance companies to ensure their request is granted. #FormularyException
4. Request a tiering exception - If the medication is covered but placed in a high-cost tier, your client or their doctor can request a tiering exception to lower the cost-sharing tier. This will make the drug more affordable for your client. #TieringException
5. Look for a special enrollment period - If the current Medicare plan doesn't provide satisfactory coverage for the medication, your client might qualify for a special enrollment period. This allows them to switch to a more suitable Medicare Advantage or Part D plan outside the standard enrollment periods. #SpecialEnrollmentPeriod
6. Switch plans during annual enrollment - Encourage your clients to explore other Medicare Advantage or Part D plans during the fall annual enrollment period (Oct. 15 - Dec. 7). #OpenEnrollment

Remember, helping your clients understand their Medicare coverage options and guiding them through the process will ensure they get the best possible care and coverage for their needs. #MedicareExpertise #MedicareCoverage #PrescriptionDrugs #MedicarePartD #InsuranceAgentAdvice #networkinsurance #medicareagents #independentagents #amerilife #togetherasone