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Switch to Original Medicare to enroll in precription plan

Q: I understand that enrollment for Medicare is currently underway. Can I enroll in a prescription drug plan during that time?

A: This year, annual enrollment runs from Nov. 15 -- Dec. 31, 2010. Additionally, from Jan. 1 - Feb. 14, 2011, Medicare Advantage enrollees can switch to Original Medicare. If you choose to change, you can also enroll in a Medicare prescription drug plan. In most cases you will not be able to change options outside the enrollment period, therefore you should take the time to carefully review your Medicare benefits and options now.

The Patient Protection and Affordable Care Act (PPACA) was signed into law in March. The health care overhaul law includes a number of significant changes to Medicare. You will see the following changes to Medicare this year:

Preventive care -- Beginning in 2011, Medicare beneficiaries will receive free preventive services including diabetes screening, mammograms, some vaccines and colorectal cancer screenings.

Annual physical exams -- Beneficiaries are eligible for a yearly wellness exam to develop or update a personalized prevention plan.

MEDICARE PRESCRIPTION DRUG COVERAGE

Some beneficiaries enrolled in Medicare Prescription Drug plans face a gap in coverage often referred to as the "doughnut hole." This is the portion of your annual drug expenditures, when you may be responsible for the costs of all medications. Beginning in 2011, some beneficiaries who enter the "doughnut hole" will get a 50% discount on Medicare-covered brand name drugs and a 7% discount on Medicare-covered generic prescriptions while in the "doughnut hole."

MEDICARE ADVANTAGE PLANS

Beginning in 2011, Medicare Advantage plans cannot charge you more than traditional Medicare for chemotherapy, dialysis, skilled nursing care, and other services deemed appropriate.

Check with your plan to see if preventive care and wellness improvements to Original Medicare will be available to you.

Every year, some Medicare Advantage and Medicare prescription drug plans choose not to renew their Medicare contracts. If you received a non-renewal notice this year, the notice should also have included information about the options available in your area.

When weighing your options, compare coverages and costs to find the policy that best fits your health care needs. Remember, new Medicare Advantage plans could have different coverage limits, participating doctors and prescription drug lists than your current plan. If you choose Original Medicare, you might want to consider a prescription drug policy and/or a Medicare supplement insurance policy to augment your coverage.

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 our Consumer Services Division to make sure the salesperson is a licensed agent, or check online at www.gainsurance.org

May not make unsolicited contact such as door-to-door sales, cold calls or approaching you in a parking lot.

Must have an appointment to come 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 a doctor's office or 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 exceeds $15.

Unfortunately, not everyone who contacts you about switching Medicare plans has the best intentions. To protect yourself from scams, here are some additional tips:

Beware of door-to-door salespeople. 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, bank account or credit card numbers to anyone you have not verified as a licensed agent. Agents 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).

Federal assistance with premiums is available to Medicare beneficiaries who meet certain income requirements. If you think you may qualify, call the Social Security Administration at 1-800-SSA-1213 (1-800-772-1213).



Web posted on Thursday, December 23, 2010













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