Press Release             

Contact: Paul Precht
Director for Policy and Communications

Akiko Takano
Deputy Director of Communications

October 1, 2008

Review 2009 Medicare Health and Drug Plan Options, Consumer Group Advises:
Most Private Plans’ Costs and Benefits Change Every Year

Consumers Can Also Protect Themselves by Knowing the New Marketing Rules That Plans Must Follow

New York, NY – With premiums for most major Medicare drug plans rising sharply in 2009, many people with Medicare will look for alternative coverage as Medicare prescription drug and health plans begin marketing their 2009 plan offerings starting October 1, warned the Medicare Rights Center, a national consumer service organization.

In addition, the group advised, everyone with Medicare who is enrolled in a Medicare private health plan or stand-alone prescription drug plan should review their health coverage options for next year, even if they are happy with their current plan. Besides changing premiums, plans can change which drugs they cover and what restrictions they place on the drugs they do cover, according to Medicare Rights Center president Robert M. Hayes.

He also said that Medicare private health plans routinely change the cost-sharing—the part of the bill paid out of pocket by the patient—for hospital stays and other medical services.

From November 15 to December 31, people with Medicare can change prescription drug and health plan coverage without restriction.

Considering alternative coverage options can be overwhelming, but there are some basic rules to help people make decisions and guard against aggressive or deceptive marketing employed by companies offering these plans, Mr. Hayes said.

“While the government has improved rules to better protect Americans with Medicare from fraudulent and abusive marketing, the rules are far from watertight and enforcement continues to be lax,” said Mr. Hayes. “People need to remain vigilant, and can protect themselves by learning what is and is not allowed by law.”

Protecting Yourself from Marketing Abuse:
  • If a sales agent comes to your door without an invitation, she or he is breaking the law. Do not let them into your home.
  • If you have asked a sales agent for more information, do not feel pressured to enroll after hearing their sales pitch. Take your time and consult with your family, friends and physician if you need to.
  • If you need help, contact your local State Health Insurance Assistance Program (SHIP) office for advice. Call 1-800-677-1116 or go to to find the number of your local SHIP office.

For more information on how to avoid marketing abuse, go to Medicare Interactive:

To learn more about what sales agents can and cannot do, go to Medicare Interactive:

Things to consider before enrolling in any Medicare private drug plan:

First, you should:

  • Make a list of the medicines you take, the dosages and how much you currently pay.
  • Make note of pharmacies you use regularly.

Then decide what type of drug plan you need. If you have:

  • Original Medicare: Choose a stand-alone prescription drug plan (PDP) if you want to continue to receive your other health benefits through Original Medicare.
  • A Medicare private health plan: In general, people in a Medicare private health plan must get Part D drug coverage as part of their private health plan’s benefits package.

Then use the Medicare Drug Plan Finder tool at or call 1-800-MEDICARE to review all options and get details about the plans. Some questions to ask are:

  • Does the plan cover all the medications I am taking?
  • Does the plan require that I get special permission before it will cover the medication I need (such as prior authorization or step therapy)?
  • How much will I pay at the pharmacy (copayments or coinsurance) for each drug? Be aware that certain drugs may cost a lot even if they are covered, so check prices carefully.
  • How much will I pay in monthly premiums and annual deductible?

For a list that includes these and more questions to consider, go to Medicare Interactive:

Always call the plan to confirm the details before signing up.

For people thinking about joining a Medicare private health plan, there are additional considerations, since this choice means they will no longer receive medical benefits through Original Medicare but instead will receive them through a Medicare private health plan.

Original Medicare is the public program that allows you to see almost any doctor anywhere in the country, and 80 percent of people with Medicare choose this option. Those who have Original Medicare can also purchase a stand-alone private drug plan (PDP) to cover their prescription needs. PDPs are available only through private insurance companies. If you choose Original Medicare, and if you do not have supplemental coverage from a current job, a spouse’s job or retiree health coverage, it is advisable to purchase a “Medigap” plan to lower your out-of-pocket costs.

Medicare private health plans are offered by private insurance companies and are usually managed care plans that have rules and restrictions. The plan choices available to people with Medicare differ from county to county, but the most common are health maintenance organizations (HMOs), preferred provider organizations (PPOs) and private fee-for-service plans (PFFS). Many plans also offer Part D drug coverage as part of their benefits packages.

Things to consider before deciding whether or not to join a Medicare private health plan:
  • Will I be able to use my doctors?
  • Which specialists, hospitals, home health agencies and skilled nursing facilities are in the plan’s network?
  • Do I have to pay a plan premium?
  • How much will it cost to see my primary care physician? A specialist?
  • How much will I pay if I go into the hospital?
  • Are my prescription drugs on the health plan’s formulary (list of covered drugs)?
  • Are there any restrictions on when the plan will cover my prescription drugs, like step therapy, prior authorization or quantity limits?
  • Ask if the plan has a limit on out-of-pocket costs, what the limit is and if there are any services that do not count toward that limit.
  • If I join, could I lose my retiree/employer health coverage?

(For a checklist that includes these and other questions to consider, go to Medicare Interactive:

The 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.