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OFIR's Tips for Seniors Purchasing Medicare Prescription Drug Coverage


Changes force some consumers to choose new polices  

FOR IMMEDIATE RELEASE
November 13, 2009
Contact: Jason Moon 517-335-1700

LANSING- Seniors receiving Social Security benefits will not be getting a cost-of-living-adjustment in the coming year, so it is more important than ever to make sure your Medicare prescription plan is the best for your budget and your needs. Also, this year, some plans have chosen not to renew their contract with the Centers for Medicare and Medicaid Services (CMS), meaning some seniors may be forced to choose a new option. During open enrollment for Medicare prescription drug coverage, Nov. 15 - Dec. 31, 2009, the Office of Financial and Insurance Regulation (OFIR) offers the below information to help consumers get smart about their insurance options. Michiganconsumers with further questions regarding Medicare and its programs should contact the Michigan Medicare Assistance Program (MMAP) at 800-803-7174 or www. mmap inc.org . MMAP is a free counseling service for Medicare beneficiaries and their caregivers.

"Selecting the prescription drug coverage that best suits your needs can be difficult, so we've developed tips for Michiganseniors to consider before enrolling in a Medicare prescription drug plan," OFIR Commissioner Ken Ross said.

What are my options if I want Medicare prescription drug coverage?

You can enroll in a stand-alone Medicare prescription drug plan if you have original (traditional) Medicare; or, you can enroll in a Medicare Advantage plan (which replaces original Medicare) that includes prescription drug coverage. Private insurance companies sell Medicare prescription drug plans and 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 do I need to consider when choosing a plan? 

Compare plans and select the one that best meets your individual needs. Consider:

  • If all of your prescriptions are on the plan's list of drugs (called a formulary).
  • If your preferred pharmacy is on the plan's list.
  • What co-payments you will be responsible for paying when filling a prescription.
  • If the premium, deductible and cost-sharing requirements for your preferred plan are affordable.
  • If there is a coverage gap where you are responsible for all of the costs, and whether this is affordable.
  • If it is a Medicare Advantage plan - review the network rules and if your current providers (such as doctors and hospitals) are covered.
  • How enrollment in the new plan impacts coverage you already have (including employer-sponsored or other retiree coverage or a Medicare supplement insurance plan) or your enrollment in original Medicare. 

 

What if I am already enrolled in a Medicare prescription drug plan or a Medicare Advantage Plan with prescription drug coverage?

Plan features might change from year to year. Carefully examine all available plans during the annual enrollment period because your current plan may no longer best meet your needs. If your current plan is not changing, you do not need to do anything to remain in the plan. If you enroll in or make changes to your plan during the annual open enrollment period, your new coverage begins Jan. 1, 2010. You should continue to pay premium for your old coverage through Dec. 31, 2009.
 
What if I already have other prescription drug coverage?

A Medicare prescription drug plan might provide more coverage than a Medicare supplement insurance (Medigap) policy or your current employer-provided prescription drug coverage. 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. However, if you do not enroll in a Medicare drug plan when you are first eligible for Medicare, and you do not have other creditable prescription drug coverage, you may be subject to a penalty if you decide to enroll at a later time. 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.

What if I am enrolled in a Medicare Advantage plan that is not renewing for 2010?

Certain Medicare Advantage plans (including some with prescription drug coverage) have chosen not to renew their contracts with CMSfor 2010. If you have received notice that your plan will not renew in 2010, you should have received information about your options for selecting a new Medicare Advantage plan or returning to original Medicare. If you return to original Medicare, you can still apply for Medicare prescription drug coverage and/or Medicare supplement (Medigap) coverage.

For more information, contact the Michigan Medicare Assistance Program (MMAP) at 800-803-7174 or www. mmap inc.org .


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