Louisiana Department of Insurance Office of Consumer Advocay
Volume 2, Issue 10

Community Housing and Resource Fair
First Pilgrims Baptist Church
10/15/11
1228 Arts Street
New Orleans, LA
10:00 a.m. - 2:00 p.m.

Shreveport Rental Assoc.
10/17/11
Trejo’s Mexican Restaurant
5015 Youree Drive
Shreveport, LA
6:00 p.m. – 9:00 p.m.

LSUS – Business Education
Risk Management and Ins.
Class of Dr. Harvey Rubin
10/18/11
LSU - Shreveport
8:00 a.m. – 9:00 a.m.

LA Consortium of Insurance and Financial Services
Ethics CE Forum
10/18/11
LSU - Shreveport
9:00 a.m. – 12:00 p.m.

Councilwoman Ronnie Edwards
Monthly Meeting
10/24/11
Claiborne Elementary
4700 Denham Street
Baton Rouge, LA
6:00 p.m. – 7:00 p.m.

For speaking engagements scheduled after the release of the newsletter or for more detailed information about engagements listed in the newsletter, visit our Web site at www.ldi.la.gov. Click on the Events tab found in the center of the home page.

To view previous newsletters, click on Consumer Advocacy under Consumers; then click on Consumer Advocacy Newsletters.

To find out if Consumer Advocacy will be in your area or to request a speaker for your organization or group, call (225) 219-0619 or e-mail
consumeradvocacy@ldi.la.gov

If you no longer wish to receive this newsletter please e-mail the following address with "REMOVE" in the subject line.
consumeradvocacy@ldi.la.gov

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Upcoming Medicare Enrollment Options

The Annual Enrollment Period for Medicare Advantage (MA) plans and Prescription Drug Plans (PDP) is October 15 - December 7, 2011, and the newly selected plan starts January 1, 2012. If you want to disenroll from that newly selected plan, then the disenrollment period is January 1 – February 14, 2012. 

What is Medicare?  

Medicare is health insurance for three groups of people.

  • People who are age 65 and older;
  • People under age 65 with certain disabilities
  • People of any age who have End-Stage Renal Disease

The Centers for Medicare and Medicaid Services (CMS) is the federal office that oversees and runs the Medicare program.

There are four parts of Medicare that cover many types of services: Parts A, B, C, and D

Part A (Hospital Insurance): Helps pay for inpatient charges in hospitals, critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas), skilled nursing facilities (not custodial or long-term care), hospice care and some home health care. 

Part B (Medical Insurance): Helps pay for doctors' services, outpatient hospital care, the services of physical and occupational therapists and some home health care, when it is medically necessary.

Part C (Medicare Advantage Plans (MA):  Combines Medicare Part A (Hospital) and Medicare Part B (Medical) coverage options into one plan. Private insurance companies that are approved by Medicare provide this type of coverage. Medicare pays a set amount of money to these private health plans to coordinate and manage your overall care. In most cases, Part C costs less than the Original Medicare plan (Parts A and B). Part C plans usually offer extra benefits, such as vision, hearing, dental and/or health and wellness programs. The member must remember to use the plan’s network of doctors and hospitals. Many Medicare Advantage plans include Medicare Prescription Drug coverage (Part D). There are several types of Medicare Advantage plans from which to choose.

Part D (Medicare Prescription Drug Plan (PDP): Helps cover the cost of prescription drugs. Anyone who has Original Medicare (Part A and Part B) or Medicare Advantage (Part C) is eligible to enroll in Part D. Private insurance companies that are approved by Medicare provide this type of coverage.    These private PDP companies only offer drug coverage plans, called “stand-alone” plans. PDPs provide discounts on the cost of prescriptions and can save on the cost of medication.

Enrollment in Medicare Part A and Part B - Automatic Enrollment
If you are already receiving Social Security benefits, you will automatically be enrolled in Medicare Part A and Part B without making an additional application.   If you collect Social Security retirement benefits, your Medicare Part A and Part B will start the first day of the month you turn age 65.  If you receive disability benefits from Social Security, your Medicare Part A and Part B will start the first day of the 25th month after your Social Security benefits begin. However, if your disability is Amyotrophic Lateral Sclerosis (ALS, also called Lou Gehrig’s disease), your Medicare Part A and Part B will begin on the first day of the month your Social Security benefits begin.

Enrollment in Medicare Part A and B – Application (Sign Up) Enrollment
People of any age who are diagnosed with End Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant) must apply (sign up) for Medicare Part A and Part B.  You should contact the Social Security Administration for details about other enrollment events.

If you are newly eligible for Medicare because you turned age 65 and are not getting Social Security benefits, you need to apply (sign up) for Medicare Part A and Part B. You can sign up by contacting the Social Security Administration (the local office, national office, or online).   You can sign up for Part A and /or Part B during the Initial Enrollment Period (IEP), that is the 7-month period that starts 3 months before the month you turn age 65 (includes the month you turn age 65) and ends 3 months after the month you turn age 65.

If you miss the IEP for Medicare Part A and Part B, your next opportunity to enroll is during the General Enrollment Period (GEP).  The General Enrollment Period is January 1 through March 31, and the coverage will begin July of that year.   In certain situations, you may get a penalty for enrolling in Medicare during the GEP. You will have to pay this penalty for as long as you have Medicare. Contact the Social Security Administration to determine the amount of the penalty.

Enrollment in Medicare Part C (Medicare Advantage Plan)  
You must have Medicare Part A and Part B to enroll in Medicare Part C.

You can only join one Medicare Advantage Plan at a time, and enrollment in a plan is generally for a calendar year.

You can join a Medicare Advantage Plan under the following conditions:
Initial Enrollment Period:  When you first become eligible for Medicare, which begins 3 months immediately before your first entitlement to both Medicare Part A and Part B;

Annual Enrollment Period: This is the time of year when you may make changes to Medicare Part C.  You may switch to another Medicare Advantage Plan or to Original Medicare from October 15 through December 7, 2011; the new coverage begins January 1, 2012;
 
Special Enrollment Period:  There are about 14 conditions that allow special enrollments, for example, (1) you move from the plan service area and cannot stay in the plan; (2) the plan leaves the Medicare program, (3) you are no longer eligible for Medicaid, and (4) other special situations. For details about the additional SEP conditions, see the resource guides listed at the end of this article.

Disenrollment from Part C (Medicare Advantage Plan)
Disenrollment Period:  January 1 through February 14, 2012 

Your limited options are listed below:

  • If you belong to an MA plan, you can leave your plan and switch to Original Medicare.
  • If you go back to Original Medicare during this time, you will have until February 14 to join a Medicare PDP.  Your coverage will begin the first day of the calendar month after the plan accepts your enrollment.
    • To disenroll from an MA plan and return to Original Medicare during this period, you may
      • Make a request directly to the MA organization.
      • Call 1-800-MEDICARE.
      • Enroll in a stand-alone PDP. 

 
Note: During this period you CANNOT do the following:

  • Switch from Original Medicare to a Medicare Advantage Plan;
  • Switch from one Medicare Advantage Plan to another;
  • Join, switch or drop a Medicare Medical Savings Account Plan;
  • Switch from one Medicare Prescription Drug Plan (PDP) to another.

 

Enrollment in Medicare Part D
You must have Medicare Part A and/or Part B.

You must fill out an application. In most cases enrollment is not automatic.

You can join a Medicare Prescription Drug Plan (PDP) under the following conditions:

Initial Enrollment Period (IEP):  When you first become eligible for Medicare, which begins 3 months immediately before your first entitlement to both Medicare Part A and Part B;

Annual Enrollment Period (AEP): When you can switch to another Medicare Advantage Plan or to Original Medicare from October 15 through December 7; coverage begins January 1;
 
Special Enrollment Period (SEP):  Under certain conditions, you may get a special enrollment period (SEP). The following situations are examples of when you may get an SEP.

    • If you permanently move out of your plan’s service area;
    • If you lose your other creditable prescription drug coverage;
    • If you were not adequately informed that your other coverage was not creditable or that the coverage was reduced so that it is no longer creditable;
    • When you enter, reside in, or leave a long-term care facility like a nursing home;
    • If you qualify for Extra Help, you have a continuous special enrollment period and can change your Medicare prescription drug plan at any time;
    • Or in exceptional circumstances, such as, if you no longer qualify for Extra Help.
    • For details about the additional SEP conditions, see the resource guides listed at the end of this article.

Disenrollment from Part D (Prescription Drug Plan)
Disenrollment Period:  January 1 through February 14, 2012

Your limited options are listed below:

  • If you belong to an MA plan, you can leave your plan and switch to Original Medicare.
  • If you go back to Original Medicare during this time, you will have until February 14 to join a Medicare PDP.  Your coverage will begin the first day of the calendar month after the plan accepts your enrollment.
    • To disenroll from an MA plan and return to Original Medicare during this period, you may:
      • Make a request directly to the MA organization.
      • Call 1-800-MEDICARE.
      • Enroll in a stand-alone PDP. 

 
Note: During this period you CANNOT do the following:

  • Switch from Original Medicare to a Medicare Advantage Plan;
  • Switch from one Medicare Advantage Plan to another;
  • Join, switch or drop a Medicare Medical Savings Account Plan;
  • Switch from one Medicare Prescription Drug Plan (PDP) to another.

For more detailed information about these topics, refer to the following resources used to compose this article:  www.Medicare.gov (the Official U.S. Government Web site for Medicare), Department of Health and Human Services, National Medicare Training Program 2011: Understanding Medicare, Module 1, and “Understanding Medicare Enrollment Periods” (publication number 11219).  You may also contact the Louisiana Department of Insurance, Senior Health Insurance Information Program (SHIIP) at 1-800-259-5301 and ask to speak to a Medicare counselor.

Please note - Eligibility and benefits for those who worked for the railroad are not provided herein. If you are interested in retirement or disability coverage as a railroad retiree, please contact the Railroad Retirement Board (RRB) at 1-877-772-5772.

Supplemental Health Insurance Policies

A serious injury or illness could deplete your finances if you are injured or become ill and do not have health insurance.  Sometimes, even if you have health insurance, it may not be enough to cover the cost and treatment of certain conditions.  A comprehensive health insurance policy provides coverage for a wide variety of health conditions and medications.  However, there are various limited benefit policies, often referred to as supplemental policies that provide limited coverage and benefits for specified losses.  Accident Only, Cancer, Critical Illness and Dental are examples of supplemental policies.  Supplemental policies should not be used as an alternative to a traditional health insurance policy because they only provide limited coverage for a specified disease or illness.

Some supplemental health insurance policies are discussed below:

Accident Only
Accident Only policies cover death, disability, hospital and medical care resulting from an accident.  Benefits vary depending on the policy contract.  Accidental death and dismemberment is a variation of this type of policy.  This policy may pay additional benefits for an accident that results in the death of the insured person due to an automobile accident or accident defined in the policy contract.

Cancer
Cancer policies provide benefits when the insured person is diagnosed with cancer.  The policy outlines a schedule of benefits describing the amount of payments for "covered" cancer treatments.  These policies are not all inclusive and do not cover all types of cancer.

Critical Illness
Critical Illness policies typically pay a lump sum if an insured person is diagnosed with a specified critical illness.  The sum is paid directly to the insured and does not consider any other sources of income the insured has.  Most policies define "critical illness" as stroke, heart attack, cancer that is life threatening, paralysis, deafness, organ transplant, blindness, kidney failure, etc. 

Dental
Dental policies provide benefits for care and treatment of the teeth and gums.  Some policies cover 100 percent of preventative care such as semiannual checkups or treatments, while others may only cover a portion of preventative care. Typically, dental insurance plans provide limited benefits for preventative, basic, major and orthodontic services.  

Disability Income
Disability Income policies pay a weekly or monthly income for a specific period if a person suffers a disability and cannot continue to work.  The disability may involve sickness, injury or a combination of the two.
The disability payment is usually a set dollar amount not to exceed a certain percentage of the insured person’s income.  Be aware that some disability income policies have an elimination period that begins from the start of each disability.  Elimination periods can range from 30 days to 6 months.  Note that during the elimination period, no benefits are be paid.  

Hospital Indemnity
Hospital Indemnity policies provide benefits for each day an insured person is in the hospital.  The benefits are usually specified dollar amounts and are not based on actual expense.  Some policies pay the benefit directly to the insured person while others send payments to the hospital facility.
It is important to have health insurance coverage, but it is even more important to make sure that you have the proper coverage.  In deciding what limited health policies may be beneficial to your specific needs, you should consider your family medical history.  An Accident, Disability Income or Hospital Indemnity policy may be a good way to supplement your existing health insurance policy.  There are many options available, so discuss your specific needs with your insurance producer.    

Remember to read the policy contract to determine what the policy will cover, what it does not cover, what additional benefits are included and how benefits will be paid.  Benefits may differ from one company to another and policies vary.
National Breast Cancer Awareness Month

According to the American Cancer Society, excluding cancers of the skin, breast cancer is the most common cancer among women in the United States.  Men are generally at low risk for developing breast cancer; however, the number of incidences in men is increasing.  Presently, there is no sure way to prevent breast cancer, so the best strategies to fight this disease are to reduce known risk factors and submit to breast examinations for early detection and treatment.

During the month of October you will see many survivors and supporters walk, run and wear pink to support breast cancer awareness campaigns.  Join the cause; encourage examinations and support finding a cure for this disease!

For information on causes, detection, treatment and research for breast cancer, visit the Web sites of The American Cancer Society at www.cancer.org and Susan G. Komen for the Cure at www.komen.org.

Deputy Commissioner
Clarissa A. Preston, CIC, APIR

Office of Consumer AdvocacyP.O. Box 94214Baton Rouge, LA 70804-9214
(225) 219-0619 or (800)259-5300www.ldi.la.govconsumeradvocacy@ldi.la.gov