Press Release             

Contact: Akiko Takano
Deputy Director of Communications

November 11, 2010

Medicare Consumers Should Review Their Health and Drug Coverage Options Carefully, Consumer Group Urges

--Medicare’s Fall Open Enrollment Period Is November 15 Through December 31--

New York, NY—Everyone with Medicare who is enrolled in a private health or drug plan should review their choices during the upcoming Fall Open Enrollment Period, advises the Medicare Rights Center, a national consumer service organization. Even people who are currently happy with their plan should do so, because plans make changes to their benefit packages every year.

During the Fall Open Enrollment Period, which runs from November 15 through December 31, Medicare consumers can make changes to their health and drug coverage options without restriction. They have the right to make as many changes as they need, and the last change they make before December 31 will go into effect on January 1, 2011.

“This year, as in past years, we urge Medicare consumers to carefully review all of their options,” said Joe Baker, president of the Medicare Rights Center. “Low-cost options may appear attractive at first, but it is very important to read the fine print. You may discover that the low-cost plan will actually cost you more than a plan with a higher premium because of the rules and restrictions.”

Similar plans from the same company have been consolidated for 2011, and the differences among the plans that consumers will have to choose from will be clearer this year. People whose plans have been consolidated will automatically be enrolled in a plan from the same company that has benefits most similar to the plan they had, but they are free to choose another option.

Everyone with a Medicare private health or drug plan should have received their Annual Notice of Change (ANOC) by October 31. The ANOC lists the changes in the plan, such as the premium and copays, and will compare the benefits in 2011 with those in 2010. Plans may also change their names as a result of consolidation, and these too will be listed in the ANOC. People whose plans are being consolidated and who are being enrolled automatically in another plan from the same company will also see how the new plan benefits compare with their old benefits in their ANOC.

Medicare Health Coverage

Consumers who become unhappy with the Medicare private health plan (also known as Medicare Advantage plans) they chose will be able to switch to Original Medicare and a stand-alone prescription drug plan during the newly established Medicare Advantage Disenrollment Period (MADP), which begins January 1 and ends February 14. They will also have the right to add a Part D prescription drug plan during the MADP. They will not, however, be able to switch from one Medicare private health plan to another. People with Original Medicare will not be allowed to make changes during the MADP.

“It is particularly important this year for people to review their options,” said Baker. “People who have buyer’s remorse after choosing a Medicare private health plan will have a chance to switch to Original Medicare during the MADP, but they may not be able to get a Medigap plan to fill the gaps in coverage, or their Medigap choices may be limited. That is why we urge people to ask questions before making their health coverage choices during the Fall Open Enrollment Period.”

The Medicare Rights Center urges people to consider the following questions before enrolling in a Medicare private health plan (like a Medicare HMO):

  • 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?
  • Who can I choose as my Primary Care Physician (PCP)?
  • How much is my monthly premium?
  • How much will it cost to see my primary care physician? A specialist?
  • Do I need a referral to see a specialist?
  • Are my prescription drugs on the plan’s formulary (list of covered drugs)?
  • Does the plan require that I get “prior authorization” before my prescription will be covered, or impose other restrictions (like limiting the quantity or requiring that I try a cheaper medication before it will cover a more expensive one)?
  • How much will I have to pay out of pocket before coverage starts (what is the deductible)?
  • How much will I pay for brand-name drugs? How much for generic drugs?
  • What service area does the plan cover?
  • What kind of coverage do I have if I travel outside of the service area?

For a list that includes these and more questions to ask, go to Medicare Interactive.

Medicare Prescription Drug Coverage

Medicare consumers who have a Part D prescription drug plan should not only find out if a plan covers their drugs, but also pay particular attention to coverage restrictions, such as quantity limits, prior authorization, and step therapy.

How To Choose the Part D Plan (either a stand-alone drug plan or a drug plan that is part of a Medicare private health plan) That Best Meets Your Needs


  • Make a list of the medicines you take, the dosages and how much you currently pay.
  • Make a list 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 (such as an HMO or PPO): Generally, you must get Part D drug coverage as part of your private health plan’s benefits package.

Third, use the Medicare Drug Plan Finder tool at or call 1-800-MEDICARE to review your options and get details.

Fourth, ask questions, such as:

  • Does the plan cover all the medications I am taking?
  • If the plan does not cover a medication I take, does it cover one that will work for me? (Ask your doctor.)
  • 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 I need? (Be aware that certain drugs may cost a lot even if they are covered.)
  • How much will I pay in monthly premiums and annual deductible?

For a list that includes these and more questions to ask, 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.

The Medicare Rights Center offers the following resources, at no charge, to help people choose a stand-alone drug plan or Medicare private health plan that best meets their needs.

State Health Insurance Assistance Programs (SHIPs) also provide free counseling services. To find your local SHIP, go to or call 1-800-677-1116.

For more detailed information about the Fall Open Enrollment Period, please see


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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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