Louisiana Department of Insurance

Released: November 19, 2009

Open 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 2010. 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 Jim Donelon.

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 drug plan?

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 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 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 for 2010?

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 (Medigap) coverage.

Marketing Rules

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 calling 1-800-259-5300.
2. May not make unsolicited contacts with prospective beneficiaries, such as door-to-door sales, cold calls or approaching you in a parking lot.
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 plan.
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.

Medicare Fraud

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 and billing.
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.

More Information

For more information about your Medicare prescription drug options including an online Medicare 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 your plan.

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.”