If you’re a senior who relies on Medicare, you should be aware of changes to the program this year that could affect your benefits.
As with every enrollment season, there are important points you should consider when evaluating your coverage needs. The Oklahoma Insurance Department offers this information to help you wisely consider your options.
The enrollment deadline for Medicare Advantage Plans and Prescription Drug Plans was Dec. 31st. But from now until Feb. 14, Medicare Advantage enrollees can switch to original Medicare if they choose. Keep in mind, however, your prescription drug coverage was part of the Medicare Advantage plan from which you are disenrolling. So, if you opt to make the switch, you should enroll in a separate Medicare prescription drug plan immediately to prevent any lapse in prescription coverage. In most cases, you will not be able to change your options outside this enrollment period, so be sure to carefully review your Medicare benefits and options right now and lock in your coverage for the coming year.
Federal Reforms Bring Medicare Change
The Patient Protection and Affordable Care Act (PPACA) was signed into law last March. This federal health care overhaul includes many significant changes to Medicare. You might notice these differences during 2011.
- Improvements are promised to original Medicare. These include better preventive care, as Medicare beneficiaries will receive free services including diabetes screening, mammograms, some vaccines, and colorectal cancer screenings. Also, beneficiaries are eligible for a yearly wellness exam to develop or update a personalized prevention plan. Check with your plan to see what preventive care and wellness improvements to the original Medicare plan will be available to you.
- Some beneficiaries enrolled in Medicare prescription drug plans have faced a gap in coverage often known as the “donut hole.” This is the point in your annual drug coverage when you and your prescription drug plan together have spent $2,840. At this point you become responsible for the cost of all medications until the total amount paid for this year by you and your prescription plan reaches $6,447.50. Beginning in 2011, beneficiaries who fall into this gap will receive a 50 percent discount on Medicare-covered brand-name drugs, and a 7 percent discount on Medicare-covered generic prescriptions while they are in the “donut hole.”
- Beginning in 2011, seniors enrolled in Medicare Advantage plans cannot be charged more than seniors on traditional Medicare for services such as chemotherapy, dialysis, skilled nursing care and other services deemed appropriate.
State and federal rules are in place to protect you 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 Oklahoma Insurance Department to be sure the salesperson is a licensed agent. You can visit us online at https://www.oid.ok.gov or call toll-free (800) 522-0071 to determine whether the salesperson is licensed.
- May not make unsolicited contact, such as door-to-door sales, cold-calls or approaching you on the street or in a parking lot.
- Must make an appointment to visit your home.
- Must arrange in advance the type of products that will be discussed during a scheduled sales appointment. At that appointment, the salesperson may not try to sell you any other type of insurance or coverage other than the types you agreed in advance to consider.
- May not try to sell you non-health-care-related products, such as a life insurance policy or 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 the doctor’s office or at the pharmacy.
- May not solicit your business at an educational event.
- May not offer you free meals at a promotional or sales event.
- May not offer you gifts or other promotional items of a value exceeding $15.
Fraud Happens, Avoid It
Regrettably, not everyone who contacts a consumer about switching Medicare plans has the best of intentions. To protect yourself from scams, follow these tips:
- Beware of door-to-door salespeople. Agents cannot legally solicit business at your home without an appointment. Do not allow an uninvited agent into your home.
- Do not give out personal information, such as your Social Security, Medicare, bank account or credit card numbers, to anyone you have not verified as a licensed agent. An agent is not allowed to request such information during their marketing activities and cannot ask for payment over the Internet. You must be sent a bill. Once you have decided to purchase a plan and have verified that the agent is licensed, you may give the agent this type of personal information to assist in enrollment and billing.
- Verify that the plan you have chosen is Medicare-approved. All of the approved plans can be reviewed at www.medicare.govor by calling 1-800-MEDICARE; (800) 633-4227.
Other Key Considerations
Federal assistance with premiums is available to Medicare beneficiaries who meet certain income requirements. If you think you may qualify for help paying your premium, call Oklahoma’s SHIP Helpline at (800) 763-2828 or the Social Security Administration at 1-(800) 772-1213.
Medicare beneficiaries may also seek advice in reviewing their options for coverage and obtaining financial assistance by contacting their State Health Insurance Assistance Program (SHIP). In Oklahoma, you can reach the SHIP Helpline at (800) 763-2828.
You can get more information about your Medicare options, learn about new coverage that is required under PPACA, or use Medicare’s online Prescription Drug Plan Finder at www.medicare.gov.
Finally, find out more about your changing insurance needs and receive tips for choosing the coverage that is best for you and your family from the Oklahoma Insurance Department at www.oid.ok.gov or call the SHIP hotline at (800) 763-2828.
About the Oklahoma Insurance Department
The Oklahoma Insurance Department, an agency of the State of Oklahoma, is responsible for the education and protection of the insurance-buying public and for oversight of the insurance industry in the state.