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November 28, 2012

Ask SHIP

The Tribune-Star

Q: My husband has a chronic mental health disorder. Medicare doesn’t seem to pay for some of his medications. Why not?

A: You are probably referring to a specific medications that have been excluded from Medicare Part D formularies. This meant that Part D Plans could not cover the costs of these drugs.

These medications (barbiturates and benzodiazepines) are commonly used in the treatment of some mental health conditions, as well as epilepsy and cancer.

Beginning Jan. 1, 2013, barbiturates for certain conditions and benzodiazepines will be allowed as Medicare Part D covered drugs. This means that if your husband has been prescribed any of these medications, your Part D Plan might soon help cover them. Plans vary, so be sure to check with your Part D Plan provider to see which medications will be covered for you in 2013.

You can also compare the formularies and costs of Part D drug plans for 2013 on www.medicare.gov using the Plan Finder tool.

In addition to this change in prescription coverage, you may also see lower costs associated with your husband’s mental health care coverage.

For outpatient mental health treatment (such as psychotherapy), you currently pay 40 percent of the Medicare-approved amount. The amount you will pay for these services will decrease to 35 percent in 2013 and to 20 percent in 2014.

The types of services this covers include a psychiatrist or other doctor; a clinical psychologist; a clinical social worker; and certain other health-care professionals.

Other services covered by Part B include:

n individual and group psychotherapy;

n family psychotherapy (with you present) for your treatment;

n certain lab and diagnostic tests;

n psychiatric evaluations; and

n medication management.

If you have questions about your Medicare coverage for Mental Health Services or anything else related to Medicare, contact SHIP for help. Call 1 -800-452-4800, or visit www.medicare.in.gov.

Q: When I turned 65, I didn’t sign up for Medicare Part B. I think I’m going to need it soon. How do I sign up now?

A: If you didn’t sign up for Medicare Part B when you first became eligible, there is a general enrollment period when you may be able to sign up. You will probably, however, have to pay a late fee (read on for details).

The general enrollment period is Jan. 1 through March 31 of each year. During this time, you can sign up for Medicare Part B at your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-877-772-5772.

If you sign up for Medicare Part B during the general enrollment period, your new coverage will begin on July 1 of the year you sign up.

If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty for as long as you have Medicare. Your monthly premium for Part B may go up 10 percent for each full 12-month period that you could have had Part B, but didn’t sign up for it.

A few exceptions to this fee may occur if you qualify for a special enrollment period. You qualify for a special enrollment period if you’re covered under a group health plan based on your own, your spouse’s or other family member’s employment. The employee must be actively working. Employee retirement coverage does not qualify you for an exception from the Part B penalty.

You can then sign up for Part B: anytime you’re still covered by the group health plan, or during the eight-month period that begins the month after the employment ends or the coverage ends, whichever happens first.

When you have Medicare Part B, you will pay the Part B premium each month. Most people will pay the standard premium amount, which was $99.90 in 2012. However, if your modified adjusted gross income as reported on your IRS tax return from two years ago (the most recent tax return information provided to Social Security by the IRS) is above a certain amount, you may pay more.

If you have questions about Medicare Part B, medicare open enrollment, or anything else related to Medicare, contact SHIP for help. Call 1-800-452-4800, or visit www.medicare.in.gov.

SHIP is a free, unbiased counseling program provided by the Indiana State Department of Insurance. To schedule an appointment with SHIP, call 1-800-452-4800, TTY 1-866-846-0139 or visit www.Medicare.in.gov.

 

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