Ms. R, a New York State (NYS) resident, found out that she was eligible for Extra Help, a federal program that helps pay for most of the costs of Medicare prescription drug coverage, and enrolled in a Medicare private drug plan. She also already received coverage for most of her prescription drugs through the NYS pharmaceutical assistance program (EPIC), which can help pay her Medicare out–of–pocket costs. When Ms. R used her Medicare drug coverage for the first time, she found that her prescription copayments were $20 each, instead of the $2 for generic drugs and $5 for brand–name drugs to which she was entitled through Extra Help. Ms. R called her local State Health Insurance Assistance Program (SHIP) for help fixing this problem.

A SHIP counselor called Ms. R's pharmacist. Ms. R's drug plan had not been working for some reason and the pharmacist had been billing only EPIC instead. For a high–cost prescription, EPIC's copayments will probably be more expensive than Extra Help's, which is why Ms. R had $20 copayments. After calling her drug plan, the SHIP counselor found out that Ms. R had been issued a plan ID number that was no longer valid, but she had not received a new card with her new ID number on it or any notice that her ID had been changed. The drug plan then notified the SHIP counselor and Ms. R of her new ID number. Ms. R's pharmacist was able to reprocess her claim, and Ms. R received reimbursement from the plan for the extra money that she had spent on her copayments.

To read more cases by subject, go to "Interesting Cases" on our web site
at http://www.medicarerights.org/interestingcasesframeset.html
(http://www.kintera.org/TR.asp?ID=M717303198099374129486865).

(reproduced with permission from Medicare Watch, Issue 14)