Medicare Prescription Drug
Appeals & Grievances

This CMS section is of particular importance to beneficiaries receiving Part D drug benefits.

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Additional CMS Resources:

• Quick Facts about Medicare’s Coverage for Prescription Drugs
• Understanding True Out-of-Pocket (TrOOP) Costs
• Bridging the Coverage Gap
• Part D Special Enrollment Periods: Who is Eligible?

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Part D & Consumers

What is Medicare Part D and who does it affect?

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Enrollment & Eligibility

How and when can people with Medicare enroll?  What are the special enrollment concerns for people with both Medicare and Medicaid?

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Costs for Consumers

What are consumers ’ responsibilities for premiums, deductibles, and co-payments?

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Extra Help

What kind of subsidies will be available nationally and locally to help low-income individuals pay for the new Medicare prescription drug benefit?  How can you apply?

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Getting Your Medications

Will the new benefit affect other assistance, such as food stamps and housing?

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Effect on Other Subsidy Assistance

Which medications will be covered?

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Coverage Determinations, Exceptions, & Appeals

What can you do if a prescription drug isn’t on the formulary, is subject to prior authorization, or is subject to higher co-payments?

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Current as of 9-26-2005