CHICAGO -- The Illinois Department of Insurance is reminding seniors to review their Medicare prescription drug plans during the Medicare Part D open enrollment period to ensure they have the right coverage for their prescription drug needs. Medicare open enrollment season runs this year from November 15th through December 31st.
“As seniors receiving Social Security benefits will not be getting a cost-of-living-adjustment in 2010, it is more important than ever to make sure Medicare prescription drug plans fit both budget and health needs,” said Michael T. McRaith, Director of the Illinois Department of Insurance. “In addition, some insurance companies are not renewing their contracts with the Centers for Medicare and Medicaid Services (CMS), and those customers will have to choose a new option. The Department is here to help you navigate through this process.”
The Department’s Senior Health Insurance Program (SHIP) is offering free, one-on-one counseling services and in communities across the state to assist Medicare-eligible individuals during the open enrollment period. Governor Pat Quinn recently proclaimed the week of November 2 through November 6 as SHIP week to recognize the program’s volunteers and the nearly 300,000 hours of free counseling provided to Illinois’ Medicare beneficiaries.
The Department offers the following advice on Medicare prescription drug plan options:
What are my options if I want Medicare prescription drug coverage?
• You can enroll in a stand-alone Medicare prescription drug plan if you have original (traditional) Medicare; you can enroll in a Medicare Advantage plan (which replaces original Medicare) that includes prescription drug coverage. Private insurance companies sell Medicare prescription drug plans and Medicare Advantage plans approved by Medicare. Everyone with Medicare is eligible to enroll in Medicare prescription drug coverage regardless of income or assets, and coverage is voluntary.
What do I need to consider when choosing a plan?
Compare plans and select the plan:
• If all of your prescriptions are on the plan’s list of drugs (called a formulary).
• If your preferred pharmacy is on the plan’s list.
• If co-payments for prescriptions are affordable.
• If the premium, deductible and cost-sharing requirements are affordable.
• If there is a coverage gap where you are responsible for all of the costs, and whether this is affordable.
• If it is a Medicare Advantage Plan be sure to review the network rules and make sure your current providers (such as doctors and hospitals) are covered.
• If enrollment in the new plan impacts coverage you already have, including employer-sponsored or other retiree coverage, a Medicare supplement insurance plan, or your enrollment in original Medicare.
What if I am already enrolled in a Medicare prescription drug plan or a Medicare Advantage Plan with prescription drug coverage?
• Plan features might change from year to year. Carefully examine all available plans during the annual enrollment period because your current plan may no longer best meet your needs. Review the features of your plan, including the list of drugs covered, the list of participating pharmacies, the premium, the deductible, the cost-sharing requirements, the provider network and any coverage gaps. You do not need to do anything to remain in your current plan. If you enroll in or make changes to your plan during the annual open enrollment period, your new coverage begins January 1, 2010. You should continue to pay premium for your old coverage through December 31, 2009.
What if I already have other prescription drug coverage?
• A Medicare prescription drug plan might provide more coverage than a Medicare supplement insurance (Medigap) policy or your current employer-provided prescription drug coverage. If Medicare considers your existing coverage to be “creditable” – meaning, coverage that is as good as the standard Medicare prescription drug coverage benefit – you are permitted to keep your current coverage without incurring future penalties. However, if you do not enroll in a Medicare drug plan when you are first eligible for Medicare, and you do not have other creditable prescription drug coverage, you may be subject to a penalty if you decide to enroll at a later time. Check with your employer or Medigap plan before dropping an employer-provided prescription drug coverage or Medigap plan because you may not be able to get it back.
What if I am enrolled in a Medicare Advantage plan that is not renewing for 2010?
• Some CMS plans (including some with prescription drug coverage) have chosen not to renew their contracts with CMS for 2010. If you have received notice that your plan will not renew in 2010, you should have received information about your options for selecting a new Medicare Advantage plan or returning to original Medicare. If you return to original Medicare, you can still apply for Medicare prescription drug coverage and/or Medicare supplement (Medigap) coverage.
Are there Marketing Rules I should be aware of?
State and federal rules are in place to protect consumers against abuses in the marketing and sales of Medicare prescription drug plans and Medicare Advantage plans. Individuals who contact you about any type of private Medicare coverage:
• Must be licensed by the state. Check with the Department at www.illinois.insurance.gov or call its toll-free hotline (866) 445-5364.
• May not make unsolicited contact such as door-to-door sales, cold calls or approaching you in a parking lot.
• Must have made an appointment before coming to your home.
• Must arrange in advance the type of products that will be discussed during a scheduled sales appointment. At the appointment, the salesperson may not try to sell you other types of insurance coverage other than the type(s) agreed upon in advance.
• May not try to sell you non-health care related products (like a life insurance policy or an annuity) during a sales or marketing presentation of a Medicare prescription drug or Medicare Advantage plan.
• May not attempt to sell you a plan in certain health care settings, such as in a doctor’s office or in a pharmacy.
• May not attempt to sell you a plan at an educational event.
• May not offer you free meals at promotional or sales events.
• May not offer you gifts or other promotional items whose value is in excess of $15.
How can I avoid Medicare Scams?
Unfortunately, not everyone who contacts you about switching to a Medicare drug plan has the best intentions. To prevent being taken advantage of, here are some additional tips to avoid becoming a victim of scam artists:
• Beware of door-to-door sales people. Remember, agents cannot solicit business at your home without an appointment. Do not allow uninvited agents into your home.
• Do not give out personal information, such as Social Security numbers, bank account numbers or credit card numbers to anyone you have not verified as a licensed agent. People are not allowed to request such personal information in their marketing activities and cannot ask for payment over the Internet. They must send you a bill. Once you decide to purchase a plan and have verified that the agent is licensed, you may give the agent personal information to assist in enrollment and billing.
• Verify that the plan you have chosen is an approved Medicare plan. All of the approved plans are available at www.medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227).
The Department’s mission is to protect consumers by providing assistance and information, by efficiently regulating the insurance industry’s market behavior and financial solvency, and by fostering a competitive insurance marketplace. The Department assists consumers with all insurance complaints, including health, auto, life, and homeowners. Consumers in need of assistance should visit the Department’s SHIP website at www.insurance.illinois.gov/SHIP or call our toll-free hotline at (800) 548-9034.