November 13, 2008
Department of Insurance Announces Open Enrollment for Medicare Prescription
Drug Coverage Runs November 15 Through December 31
Open enrollment for Medicare Part D Prescription Drug Coverage is
Nov. 15 - Dec. 31, 2008. The Senior Health Insurance Information
Program (SHIIP) staff at the Department of Insurance is available
to help Louisiana Medicare beneficiaries enroll in one of a large
number of Louisiana Medicare Stand-Alone Rx plans available in 2009.
SHIIP staff can also assist in comparing Medicare Advantage Plans.
Beneficiaries are encouraged to enroll or make changes to their present
coverage by December 8 to ensure that they will be able to get their
prescriptions on January 1, according to Commissioner of Insurance
Before selecting a prescription drug plan or changing your coverage,
the Department of Insurance suggests you review the following information:
What are Medicare prescription drug plans?
In 2003, the federal government enacted a Medicare prescription
drug benefit for Medicare beneficiaries. Private insurance companies
sell Medicare Prescription Drug Plans (PDPs) or Medicare Advantage
plans approved by Medicare. Everyone with Medicare is eligible to
enroll in Medicare prescription drug coverage, regardless of income
or assets, and coverage is voluntary.
What if I am already enrolled in a Medicare prescription drug plan?
Plan features might change from year to year so carefully examine
all available plans during each annual enrollment period because
your current plan may no longer best meet your needs. Be sure to
check the features of your plan, including the list of drugs covered,
the premium, deductible and cost-sharing you pay, and any coverage
gap. If you are satisfied with your current plan, you do not need
to do anything to keep your plan. If you take no action, you will
remain in your current plan. If you enroll in or make changes to
your plan during the annual enrollment period, your new coverage
automatically begins Jan. 1, 2009.
What if I am enrolled in a Medicare Advantage Plan with prescription
Medicare Advantage plans might also make changes to important features
of your plan from year to year including the list of drugs covered,
the premium you pay, deductibles and cost-sharing requirements, and
provider networks. Carefully review your plan options during each
open enrollment season. If you take no action, you will automatically
remain in your current plan.
What if I already have prescription drug coverage?
A Medicare prescription
drug plan might provide more coverage than a Medicare supplement
insurance (Medigap) policy or employer-provided
prescription drug coverage that you may currently have. If Medicare
considers your existing coverage to be “creditable” – meaning,
coverage that is as good as the standard Medicare prescription drug
coverage benefit – you are permitted to keep your current coverage
without incurring future penalties. Check with your employer or Medigap
plan before dropping an employer-provided prescription drug coverage
or Medigap plan because you may not be able to get it back. If you
do not enroll in a Medicare drug plan when you are first eligible
for Medicare, and you don’t have other creditable prescription
drug coverage, you may be subject to a penalty if you decide to enroll
at a later time.
What are my options if I want to enroll in a Medicare prescription
You can enroll in a stand-alone prescription drug plan (Medicare
Part D) or you can choose a Medicare Advantage plan (Medicare Part
C) that includes a drug benefit.
Compare plans and select the one that best meets your individual
needs annually. Here are a few things to consider:
1. See if all
of your prescriptions are on the plan’s list
of drugs (called a formulary).
2. Check to see if your preferred pharmacy is on the list.
3. Find out what co-payments you will be responsible for paying
when filling a prescription.
4. Are the premium, deductible and cost-sharing requirements for
your preferred plan affordable?
5. Is there a coverage gap where you are responsible for all of
the costs, and is this affordable?
6. If it is a Medicare Advantage plan, what are the network rules
and will your current providers be covered?
7. How does enrollment in the new plan impact coverage you may already
have (including employer-sponsored prescription drug coverage or
a Medigap plan) or your enrollment in traditional Medicare?
New Marketing Rules
Beginning Oct. 1, 2008, new federal rules were put in place to protect
consumers against abuses in the marketing and sales of Medicare prescription
drug plans and Medicare Advantage plans. According to these new rules,
individuals who contact you about any type of private Medicare coverage:
1. Must be licensed by the state. Check with the Louisiana Department
of Insurance to make sure the salesperson is a licensed agent by
2. May not make unsolicited contacts with prospective beneficiaries,
such as door-to-door sales, cold calls or approaching you in a parking
3. Must have an appointment in advance before coming to your home.
4. Must arrange with you 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.
5. 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
6. May not attempt
to sell you a plan in certain health care settings, such as in
office or in a pharmacy.
7. May not attempt to sell you a plan at an educational event.
8. May not offer you free meals at promotional or sales events.
9. May not offer you gifts or other promotional items whose value
is in excess of $15.