Common Questions
Have Questions?
We are sure you have questions about Medicare Part D to help you better
navigate the world of prescriptions and pharmacy benefits, we've collected
several common questions. Please review these questions and their answers
to see if they can answer some of your questions.
Medicare prescription drug plans are available to people with Medicare. Insurance companies and other private companies are working with Medicare to offer these drug plans. They negotiate discounts on drug prices.
Medicare Prescription Drug Plans provide insurance coverage for prescription drugs. Like other insurance, if you join you will pay a monthly premium and pay a share of the cost of your prescriptions. Costs will vary depending on the drug plan you choose.
Drug plans may vary in what prescription drugs are covered, how much you have to pay, and which pharmacies you can use. All drug plans will have to provide at least a standard level of coverage, which Medicare will set. However, some plans might offer more coverage and additional drugs for a higher monthly premium. When you join a drug plan, it is important for you to choose one that meets your prescription drug needs.
You can use our Summary of Benefits to compare the benefits offered by DeanCare Rx to the benefits offered by other Medicare Prescription Drug Plans or Medicare Advantage Plans with prescription drug coverage.
2009
The service area for DeanCare Rx includes Wisconsin. You must live in Wisconsin to join DeanCare Rx. If you are enrolled in one and wish to switch to another, you may do so only during certain times of the year. DeanCare Rx offers Plan Benefit Packages as indicated in our Summary of Benefits. Please call Customer Service for more information.
2009
Medicare Part D Eligibility
DeanCare Rx has formed a network of pharmacies. You must use a network pharmacy to receive plan benefits. The pharmacies in our network can change at any time. View the DeanCare Rx Pharmacy Directory (PDF) for a list of pharmacies. If you use out-of-network pharmacies, your copayment will be higher. There are limits in quantity.
No. We cannot pay for any prescriptions filled outside the United States or foreign pharmacies located within the United States, even for a medical emergency.
We do not cover drugs that are covered under Medicare Part B as prescribed and dispensed. Generally, we only cover drugs that are covered under the Medicare Prescription Drug Benefit (Part D) and that are on our formulary.
This voluntary program forms a unique partnership between pharmacists, DeanCare Rx, and members. The main objective of this partnership is to improve the overall level of care and therefore, the outcome for each member. Inherent in the program are incentive to maximize the education of the member as well as promote the use of generics whenever safety and efficacy allow.
If you have a Medigap (Medicare Supplement) policy that includes prescription drug coverage, you must contact your Medigap Issuer to let them know that you have joined a Medicare Prescription Drug Plan. If you decide to keep your current Medigap supplement policy, your Medigap Issuer will remove the prescription drug coverage portion of your policy and adjust your premium. Under certain circumstances, you can also buy a different Medigap policy without prescription drug coverage sold by your Medigap Issuer. Your Medigap Issuer cannot charge you more, based on any past or present health problems. Call your Medigap Issuer for details.
If you or your spouse has, or is able to get, employer group coverage, you should talk to your employer to find out how your benefits will be affected if you join DeanCare Rx. Get this information before you decide to enroll in this plan.
Medicare beneficiaries with low or limited income and resources may qualify for additional assistance. If you qualify, your Medicare prescription drug plan costs, the amount of your premium and your drug costs at the pharmacy will be less. Once you have enrolled in DeanCare Rx, Medicare will tell us how much assistance you are receiving, and we will send you information on the amount you will pay. If you are not receiving this additional assistance, you should contact 1-800-MEDICARE (TTY/TDD users call 1-877-486-2048, 24 hours a day/7 days a week) , to see if you might qualify.
Yes. You will have the option to have the premium deducted from your Social Security check (just like your Part B premium), or you or your former employer can pay your premium directly to Dean Health Insurance.
DeanCare Rx has a transition process to help new members with their prescriptions drugs if those drugs are not on our formulary. You will be able to fill a 30 day supply of your drug. (If you are in a Long Term Care facility, you will receive a 31 day fill of your drug, up to 90 days.) During this time, you can ask us if we cover another drug used to treat your medical condition. If we cover another drug for your condition, you can ask your doctor if this drug is an option for you.
If your doctor believes the drug is medically appropriate for treating your condition, your doctor would give you a prescription for this drug. If your doctor tells you that a drug or drugs on our formulary are not medically appropriate for treating your condition, you have the right to request an exception from us to cover your current prescription. To learn more about our exception process, please see the “Grievance, Appeals and Exceptions”, or you can call our Customer Service Department.
- What is Medicare Part D?
- How can I compare my options?
- Where is DeanCare Rx Available?
- Who is eligible to join?
- Where can I get my prescriptions?
- Will DeanCare Rx cover drugs purchased from outside of the United States?
- Do you cover Medicare Part B or Part D drugs?
- Does DeanCare Rx have a prescription drug formulary?
- What is a Medication Therapy Management (MTM) Program?
- What should I do if I have other insurance in addition to Medicare?
- How can I get help with drug plan costs?
- What are my protections in this plan?
- Can premiums be deducted from Social Security checks?
- If I join DeanCare Rx and my prescription is not on the formulary, what should I do?
What is Medicare Part D?
TopMedicare prescription drug plans are available to people with Medicare. Insurance companies and other private companies are working with Medicare to offer these drug plans. They negotiate discounts on drug prices.
Medicare Prescription Drug Plans provide insurance coverage for prescription drugs. Like other insurance, if you join you will pay a monthly premium and pay a share of the cost of your prescriptions. Costs will vary depending on the drug plan you choose.
Drug plans may vary in what prescription drugs are covered, how much you have to pay, and which pharmacies you can use. All drug plans will have to provide at least a standard level of coverage, which Medicare will set. However, some plans might offer more coverage and additional drugs for a higher monthly premium. When you join a drug plan, it is important for you to choose one that meets your prescription drug needs.
How can I compare my options?
TopYou can use our Summary of Benefits to compare the benefits offered by DeanCare Rx to the benefits offered by other Medicare Prescription Drug Plans or Medicare Advantage Plans with prescription drug coverage.
2009
- 2009 Classic Summary of Benefits (PDF)
- 2009 Value Summary of Benefits (PDF)
- 2009 Enhanced Summary of Benefits (PDF)
- 2008 Classic Summary of Benefits (PDF)
- 2008 Value Summary of Benefits (PDF)
- 2008 Enhanced Summary of Benefits (PDF)
Where is DeanCare Rx available?
TopThe service area for DeanCare Rx includes Wisconsin. You must live in Wisconsin to join DeanCare Rx. If you are enrolled in one and wish to switch to another, you may do so only during certain times of the year. DeanCare Rx offers Plan Benefit Packages as indicated in our Summary of Benefits. Please call Customer Service for more information.
2009
- 2009 Classic Summary of Benefits (PDF)
- 2009 Value Summary of Benefits (PDF)
- 2009 Enhanced Summary of Benefits (PDF)
- 2008 Classic Summary of Benefits (PDF)
- 2008 Value Summary of Benefits (PDF)
- 2008 Enhanced Summary of Benefits (PDF)
Who is eligible to join?
TopMedicare Part D Eligibility
Where can I get my prescriptions?
TopDeanCare Rx has formed a network of pharmacies. You must use a network pharmacy to receive plan benefits. The pharmacies in our network can change at any time. View the DeanCare Rx Pharmacy Directory (PDF) for a list of pharmacies. If you use out-of-network pharmacies, your copayment will be higher. There are limits in quantity.
Will DeanCare Rx cover drugs purchased from outside of the United States?
TopNo. We cannot pay for any prescriptions filled outside the United States or foreign pharmacies located within the United States, even for a medical emergency.
Do you cover Medicare Part B or Part D drugs?
TopWe do not cover drugs that are covered under Medicare Part B as prescribed and dispensed. Generally, we only cover drugs that are covered under the Medicare Prescription Drug Benefit (Part D) and that are on our formulary.
Does DeanCare Rx have a prescription drug formulary?
Top
Yes. DeanCare Rx uses a formulary. A formulary is a preferred list
of drugs selected to meet patient needs. The plan may periodically make
changes to the formulary. If the formulary changes, affected enrollees will
be notified, in writing, before the change is made. You can use the
2009 formularies to determine if your prescription is covered
under the DeanCare Rx formulary. If your prescription is not listed, please
contact Customer Service for options available.
2009
- 2009 Complete Classic Formulary (PDF)
- 2009 Complete Value Formulary (PDF)
- 2009 Complete Enhanced Formulary (PDF)
What is a Medication Therapy Management (MTM) Program?
TopThis voluntary program forms a unique partnership between pharmacists, DeanCare Rx, and members. The main objective of this partnership is to improve the overall level of care and therefore, the outcome for each member. Inherent in the program are incentive to maximize the education of the member as well as promote the use of generics whenever safety and efficacy allow.
What should I do if I have other insurance in addition to Medicare?
TopIf you have a Medigap (Medicare Supplement) policy that includes prescription drug coverage, you must contact your Medigap Issuer to let them know that you have joined a Medicare Prescription Drug Plan. If you decide to keep your current Medigap supplement policy, your Medigap Issuer will remove the prescription drug coverage portion of your policy and adjust your premium. Under certain circumstances, you can also buy a different Medigap policy without prescription drug coverage sold by your Medigap Issuer. Your Medigap Issuer cannot charge you more, based on any past or present health problems. Call your Medigap Issuer for details.
If you or your spouse has, or is able to get, employer group coverage, you should talk to your employer to find out how your benefits will be affected if you join DeanCare Rx. Get this information before you decide to enroll in this plan.
How can I get help with drug plan costs?
TopMedicare beneficiaries with low or limited income and resources may qualify for additional assistance. If you qualify, your Medicare prescription drug plan costs, the amount of your premium and your drug costs at the pharmacy will be less. Once you have enrolled in DeanCare Rx, Medicare will tell us how much assistance you are receiving, and we will send you information on the amount you will pay. If you are not receiving this additional assistance, you should contact 1-800-MEDICARE (TTY/TDD users call 1-877-486-2048, 24 hours a day/7 days a week) , to see if you might qualify.
What are my protections in this plan?
Top
All Medicare Prescription Drug Plans agree to stay in the program for a
full year at a time. Each year, the plans decide whether to continue for
another year. Even if a Medicare Prescription Drug Plan leaves the program,
you will not lose Medicare coverage. If a plan decides not to continue,
it must send you a letter at least 90 days before your coverage will end.
The letter will explain your options for Medicare prescription drug coverage
in your area.
If DeanCare Rx ever denies coverage for your prescription drugs, we will
explain our decision to you. You always have the right to appeal and ask
us to review the claim that was denied. In addition, if your physician prescribes
a drug that is not on our formulary or is not a preferred drug, you may
ask us to make a coverage exception.
Please see the “Grievance,
Appeals and Exceptions”
Can premiums be deducted from Social Security checks?
TopYes. You will have the option to have the premium deducted from your Social Security check (just like your Part B premium), or you or your former employer can pay your premium directly to Dean Health Insurance.
If I join DeanCare Rx and my prescription is not on the formulary, what should I do?
TopDeanCare Rx has a transition process to help new members with their prescriptions drugs if those drugs are not on our formulary. You will be able to fill a 30 day supply of your drug. (If you are in a Long Term Care facility, you will receive a 31 day fill of your drug, up to 90 days.) During this time, you can ask us if we cover another drug used to treat your medical condition. If we cover another drug for your condition, you can ask your doctor if this drug is an option for you.
If your doctor believes the drug is medically appropriate for treating your condition, your doctor would give you a prescription for this drug. If your doctor tells you that a drug or drugs on our formulary are not medically appropriate for treating your condition, you have the right to request an exception from us to cover your current prescription. To learn more about our exception process, please see the “Grievance, Appeals and Exceptions”, or you can call our Customer Service Department.
S5954_WEB09_1008
Last Modified Date: 11/24/2008
