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What are Medicare Prescription
Drug Plans?
In 2003, the federal
government enacted a Medicare prescription drug coverage benefit for
Medicare beneficiaries. Private insurance companies, whose plans
have been approved by Medicare, sell Medicare PDPs. Everyone with
Medicare is eligible to enroll in a PDP, regardless of income or
assets.
What if I am already enrolled in a
Medicare prescription drug plan?
Plans might change from year
to year. Therefore, you should carefully examine all available plans
during each open enrollment season, as you may find that your
current plan no longer best meets your needs. Be sure to check the
features of your plan, including the list of drugs covered and the
amount of premium you pay. 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.
What if I am enrolled in a Medicare
Advantage Plan with prescription drug coverage?
Medicare Advantage plans might
also make changes to important features of your plan from year to
year, including the list of drugs covered, the premium you pay,
cost-sharing requirements and provider networks. Your plan options
should be carefully reviewed during each open enrollment season. If
you take no action, you will remain in your current plan.
Do I need a Medicare prescription drug
plan?
A Medicare prescription drug
plan may provide more coverage than a Medicare supplement insurance
(Medigap) policy or employer-provided prescription drug coverage. If
Medicare considers your employer-provided drug coverage “credible” –
meaning, coverage that is as good as the Medicare prescription drug
coverage benefit – you are permitted to keep your current coverage
without incurring future penalties. Check with your employer.
What about my drug coverage through my
Medigap policy?
The benefit of a Medigap drug
coverage plan is generally not as good as the new Medicare
prescription drug plan, so carefully review the benefits of your
Medigap drug coverage. If you are considering a change, you will
need to make a decision during the enrollment period, or you could
be subject to late enrollment penalties if you decide to enroll in a
PDP later.
Enrollment Dates and Late Enrollment
Penalties
Voluntary enrollment for
Medicare prescription drug plans for 2008 began Nov. 15 and ends
Dec. 31, 2007. If you enroll by Dec. 31, you new Medicare
prescription drug coverage will begin Jan. 1, 2008.
If you are eligible, but wait
to enroll after Dec. 31, you may be subject to late enrollment
penalties. These penalties are generally 1% per month for every
month you delay enrollment. That means if you wait until March, you
would pay a 3% late enrollment penalty. There is no limit on the
penalty, so the longer you wait to enroll, the higher the premium
you will pay. |
What are my options if I want to enroll
in a Medicare prescription drug plan?
You can enroll in a
stand-alone prescription drug plan (Medicare Part D) or you can
choose a Medicare Advantage plan (Medicare Part C) that includes the
new drug benefit.
You will want to compare plans
and select the one that best meets your individual needs. Here are a
few things to check:
- See if all of your
prescriptions are on the plan’s list of drugs (called a
formulary).
- Check for your
preferred pharmacy.
- Find out what
co-payments you will be responsible for paying when filling
a prescription.
- Is the premium for
your preferred plan affordable?
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 tips to
avoid becoming a victim:
- 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.
- Check with your
state’s insurance department to make sure the salesperson is
a licensed agent.
- 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).
Other
Important Things to Consider
Federal
assistance with premiums will be available to Medicare beneficiaries
who meet certain income requirements.
Medicare beneficiaries may seek assistance in reviewing options for
coverage and obtaining financial assistance by contacting their
State Health Insurance Assistance Program (SHIP). Go to the NAIC Web
site (www.naic.org/state_web_map.htm) to link to your state
insurance department.
More
Information
There is more
information available at www.medicare.gov, including an enhanced
online Medicare Prescription Drug Plan Finder.
You can find
more information about your changing insurance needs and tips for
choosing the coverage that is best for your and your family at
www.InsureUOnline.org |