Switch your drug plan to receive state subsidy funds

I enrolled in a Medicare Part D drug plan. I also enrolled in the State of Maryland subsidy, Senior Prescription Drug Assistance Program. The subsidy pays my Part D drug plan's monthly premium. However, my particular Part D drug plan does not accept the SPDAP subsidy when I enter the dreaded "doughnut hole."

I want to switch to a Part D drug plan that will accept the SPDAP subsidy money to cover my medicines while I am in the doughnut hole. This is especially crucial because I will enter the doughnut hole next month! What can I do and how do I access the help?

Medicare Part D has a coverage gap; it is commonly termed the Medicare Part D "doughnut hole." When a person on Medicare Part D has medicine costs that reach $2,960, they enter the coverage gap and their out-of-pocket cost for medicines greatly increases.

The State of Maryland's Senior Prescription Drug Assistance Program, or SPDAP, can help a person when they enter the Medicare Part D coverage gap. The SPDAP program will pay up to $40/month toward your monthly Part D drug premiums.

As you mention, some (not all) Part D drug plans have contracted with SPDAP to pay for medicines in a persons coverage gap. When you are enrolled in the SPDAP program, you are allowed to change your drug plan one time outside the annual enrollment period (the annual enrollment period runs every Oct. 15 until Dec. 7).

However, a mid-gap drug plan change will present some challenges. Here is what to expect:

Expect to pay full gap-price for your medicines for up to three months. You will be reimbursed for medicines covered by your new Part D plan, but there will be a lag-time.

It takes 60 to 90 days for all the computer systems to synchronize. The computer systems involved include: the new Part D drug plan's database, Medicare's database, the SPDAP database and your pharmacist's database.

Save your receipts!

Check with your pharmacy every 30 days to see if your pharmacist can resubmit the claim to your Part D plan and refund you at the pharmacist counter.

Check with your new Part D drug plan every 30 days. Use the customer service number on the back of your new Part D card to call and to see if the new Part D drug plan shows you active in the SPDAP program (you may also use the term "my State's Pharmacy Assistance Program").

If, after 90 days, you are not able to receive a refund at your pharmacist's counter, call your Medicare Part D drug plan and request they send a refund directly to you. Let them know that you are enrolled in the SPDAP program (Maryland's State Pharmacy Assistance Program), and you are entitled to a refund for medicines, covered by your plan, in the coverage gap.

You may also contact the SPDAP program directly at 1-800-551- 5995 to request assistance with obtaining your refund. You may also contact your local State Health Insurance Assistance Program to request guidance at 410-222-4464, ext. 3080.

Amy Rubino is director of the Senior Health Insurance Assistance Program and the Senior Medicare Patrol for the Anne Arundel County Department of Aging and Disabilities. You may contact either program at 410-222-4464 or [email protected].