FOR IMMEDIATE RELEASE
Contact: Akiko Takano
Deputy Director of Communications
December 21, 2010
Last Chance to Change Your Medicare Health and Drug Coverage Options without Restriction
-- Fall Open Enrollment Period Ends on December 31 --
New York, NY—Medicare consumers have until Friday, December 31, to make changes to their Medicare health and drug options without any restrictions. The changes will take effect on January 1.
“Even if you are happy with your plan, we urge you to review all of the options that are available,” said Joe Baker, president of the Medicare Rights Center. “Plans change their costs and benefits every year, and what works for you this year may not be your best choice in 2011. See what is available, and if you find an option that is better suited to your needs, act now. It may be too late after January 1.”
Medicare Health Coverage
Medicare consumers have the choice of receiving their Medicare health benefits through Original Medicare, which is administered by the federal government, or through a Medicare private health plan (also known as a “Medicare Advantage” plan), which is run by a private insurance company.
If people choose a Medicare private health plan and then find that they do not like it, they will be able to switch to Original Medicare and a stand-alone prescription drug plan during the Medicare Advantage Disenrollment Period (MADP), which begins January 1 and lasts through February 14. They will not, however, be able to switch from one Medicare private health plan to another, and people with Original Medicare cannot make any changes during the MADP.
“Although the MADP provides an escape hatch for some Medicare consumers—those who choose a Medicare private health plan—there are still potential pitfalls,” said Baker. “People who switch to Original Medicare during the MADP may not be able to buy a Medigap plan to fill the gaps in coverage, or their Medigap choices may be limited. This is why it is very important for people to review all of their options and ask questions before they decide on their choice of Medicare health coverage.”
Before enrolling in a private health plan, consumers should ask questions, including the following:
- Will I be able to use my doctors? Are they in the plan’s network and are they taking new patients who have this plan?
- Which specialists, hospitals, home health agencies and skilled nursing facilities are in the plan’s network?
- How much will it cost to see my primary care physician? A specialist?
- Do I need a referral to see a specialist?
- What service area does the plan cover?
- What kind of coverage do I have if I travel outside of the service area?
For a more detailed list of questions to ask, go to Medicare Interactive.
Medicare Prescription Drug Coverage
Medicare’s prescription drug coverage is available only through private plans. There is no drug coverage option under Original Medicare.
Medicare consumers are advised not only to consider whether their drug(s) are on the plan’s formulary (list of covered drugs), but also to check if the plan places any restrictions on the drugs they take. Restrictions can take the form of quantity limits, prior authorization, and step therapy.
For a step-by-step guide to choosing the best Medicare private drug plan for your needs, including a list of questions to ask before enrolling, go to Medicare Interactive.
The Medicare Rights Center recommends that consumers call the plan to confirm the information they find, and keep a record of the conversation with the plan representative. It also recommends enrolling in a plan by calling 1-800-MEDICARE rather than the plan itself.
- Medicare Interactive (www.medicareinteractive.org), the Medicare Rights Center’s free, web-based counseling tool, can help people choose a stand-alone drug plan or Medicare private health plan that best meets their needs. It provides information about Medicare benefits, rights and options in consumer-friendly language.
- State Health Insurance Assistance Programs (SHIPs) also provide free counseling services. To find your local SHIP, go to https://shiptalk.org or call 1-800-677-1116.
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Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs, and public policy initiatives.
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