Department of Insurance Announces Open Enrollment for Medicare Prescription
Drug Coverage Runs November 15 Through December 31
November 19, 2009
enrollment for Medicare Part D Prescription Drug Coverage is Nov.
15 - Dec. 31, 2009. The Senior Health Insurance Information
Program (SHIIP) staff at the Department of Insurance is available
to help Louisiana Medicare beneficiaries enroll in one of a large
number of Louisiana Medicare Stand-Alone Rx plans available in
SHIIP staff can also assist in comparing Medicare Advantage Plans.
Beneficiaries are encouraged to enroll or make changes to their
present coverage by December 8 to ensure that they will be able
to get their
prescriptions on January 1, according to Commissioner of Insurance
Seniors receiving Social Security benefits will not be getting a
cost-of-living-adjustment in the coming year, so it is more important
than ever to make sure your Medicare prescription plan is the best
for your budget and your needs. Also, this year, some plans have
chosen not to renew their contract with the Centers for Medicare
and Medicaid Services (CMS), meaning some seniors may be forced to
choose a new option.
Before selecting a prescription drug plan or changing your coverage,
the Department of Insurance suggests you review the following information:
What are my options if I want to enroll in a Medicare prescription
You can enroll in a stand-alone Medicare prescription drug plan
if you have original (traditional) Medicare; or, 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.
Compare plans and select the one that best meets your individual
needs annually. Here are a few things to consider:
1. See if all
of your prescriptions are on the plan’s list
of drugs (called a formulary).
2. Check to see if your preferred pharmacy is on the list.
3. Find out what co-payments you will be responsible for paying when
filling a prescription.
4. Are the premium, deductible and cost-sharing requirements for
your preferred plan affordable?
5. Is there a coverage gap where you are responsible for all of the
costs, and is this affordable?
6. If it is a Medicare Advantage plan, what are the network rules
and will your current providers be covered?
7. How does enrollment in the new plan impact coverage you may already
have (including employer-sponsored or other retiree coverage or a
Medicare supplement insurance plan) or your enrollment in traditional
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 so carefully examine
all available plans during each annual enrollment period because
your current plan may no longer best meet your needs. Be sure to
check the features of your plan, including the list of drugs covered,
the premium, deductible and cost-sharing you pay, and any coverage
gap. If you are satisfied with your current plan, you do not need
to do anything to keep your plan. If you take no action, you will
remain in your current plan. If you enroll in or make changes to
your plan during the annual enrollment period, your new coverage
automatically begins Jan. 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 employer-provided
prescription drug coverage that you may currently have. 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. 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. If you
do not enroll in a Medicare drug plan when you are first eligible
for Medicare, and you don’t have other creditable prescription
drug coverage, you may be subject to a penalty if you decide to enroll
at a later time.
What if I am enrolled in a Medicare Advantage plan that is not renewing
Certain Medicare Advantage 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
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:
1. Must be licensed by the state. Check with the Louisiana Department
of Insurance to make sure the salesperson is a licensed agent by
2. May not make unsolicited contacts with prospective beneficiaries,
such as door-to-door sales, cold calls or approaching you in a parking
3. Must have an appointment in advance before coming to your home.
4. Must arrange with you 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.
5. 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
6. May not
attempt to sell you a plan in certain health care settings, such as
in a doctor’s office or in a pharmacy.
7. May not attempt to sell you a plan at an educational event.
8. May not offer you free meals at promotional or sales events.
9. May not offer you gifts or other promotional items whose value
is in excess of $15.
Unfortunately, not everyone who contacts you about switching to
a Medicare drug plan has the best intentions. To protect yourself
from scam artists intent on taking advantage of your situation, here
are some additional tips to avoid becoming a victim:
1. Beware of door-to-door sales people. Agents cannot solicit business
at your home without an appointment. Do not let uninvited agents
into your home.
2. Check with the Louisiana Department of Insurance to make sure
the salesperson is a licensed agent.
3. 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
4. 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).
Other Important Considerations
Federal assistance with premiums will be available to Medicare beneficiaries
who meet certain income requirements. If you think you may qualify,
call the Social Security Administration at 1-800-772-1213 or Medicaid
services at 1-888-342-6207.
For more information
about your Medicare prescription drug options including an online
Prescription Drug Plan Finder, go to
www.medicare.gov. Here you can also compare costs and coverage, and
get an estimate of your out-of-pocket costs for the year. Call 1-800-MEDICARE
(1-800-633-4227, TTY 1-877-486-2048) where 24 hour help is available
from trained Medicare representatives. Also, see the listing of plans
in your Medicare & You handbook and information sent to you by
For assistance in reviewing your coverage options, contact a SHIIP
counselor at 1-800-259-5300.
“December is no time to get involved in a rush to make major
health care decisions,” Commissioner Donelon said. “Avoid
the frantic holiday pace by letting SHIIP counselors help you make
an early decision about your 2010 Medicare prescription drug coverage.”