What Seniors Can Do If Medicare Denies Insurance Coverage Of Their Medicines

Armen Hareyan's picture
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Medicare prescription drug coverage has given many seniors peace of mind that they will have access to the medicines they need. But occasionally, because of individual plan rules, the medicine that's prescribed by the doctor isn't always covered. Seniors who encounter this situation have options, but they need to know what they can do about it.

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To equip seniors with the knowledge they need to get the most from their plans, a new brochure available through Your Pharmacy Benefit (YPB), a collaborative consumer education effort, outlines the specific steps people can take to get their medicines covered.

"With a little persistence, Medicare beneficiaries can often get coverage for the medicines they need to stay healthy, while controlling their costs," said Rick Kellerman, M.D., president of the American Academy of Family Physicians, one of the organizations involved in YPB. "People need to understand their rights -- and what they can do to help secure coverage."

Patients have the right to request coverage for their medicines and to appeal Medicare's decision if that coverage is denied, but they must follow a specific process. The brochure helps people decide whether they should start this process, explains how it works and includes definitions of key terms. It also provides hands-on tools such as a sample appeal letter, a step-by-step table of the coverage request process and additional resources such as links to Medicare's appeal forms.

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