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PrattTribune - Pratt, KS
  • Consumer alert: Watch out for Medicare Part D, Advantage fraud

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  • During the open enrollment period for Medicare Part D and Medicare Advantage plans, Sandy Praeger, Commissioner of Insurance, is urging Kansas Medicare beneficiaries to be alert to any potential scams surrounding sign-up activity.
    "Unfortunately, not everyone who contacts Medicare-age Kansans about switching to a Medicare drug plan has the best intentions," Commissioner Praeger said. "Educating yourselves is very important in fighting potential fraud and illegal sales."
    The open-enrollment period for Medicare Prescription Drug Plan and Medicare Advantage plans began Oct. 15 and ends Dec. 7, 2013.
    Commissioner Praeger is also reminding Medicare beneficiaries not to confuse the Medicare enrollment with the new health insurance marketplace enrollment that opened Oct. 1.
    "If you are covered by Medicare, you don't need to visit the online marketplace," Commissioner Praeger said.
    To protect your family members or yourself from fraudsters intent on taking advantage of the situation, Commissioner Praeger offers the follow tips.
    • Beware of door-to-door salespeople. Agents cannot solicit business for either Medicare Part D or Medicare Advantage Plans at your home without an appointment. Do not let uninvited agents into your home. Also, Medicare has no official sales representatives. Beware of any salesperson who says that he/she is a Medicare representative.
    • Check with us at the Kansas Insurance Department (KID) to make sure the salesperson is a licensed agent. Call 800-432-2484 to speak with a Consumer Assistance representative.
    • No marketing in educational or care settings are allowed. Federal regulations prohibit the marketing of Medicare products in places where health care is delivered or at an educational event.
    • No free lunches, either. Federal regulations prohibit offers of free meals for listening to a sales presentation for a Medicare product or for signing up for a particular plan.
    • Do not give out personal information, such as Medicare numbers, Social Security numbers, bank account numbers or credit card numbers to anyone not verified as a licensed agent. Salespeople are not allowed to request such personal information in their marketing activities and cannot ask for payment over the Internet. They must send the beneficiary a bill. Once he or she has decided to purchase a plan and has verified that the agent is licensed, the customer may give the agent personal information to assist in enrollment and billing.
    • Verify that the plan chosen is an approved Medicare plan. All of the approved plans are available at www.medicare.gov under the "Finding Plans" section, or by calling 800-MEDICARE (800-633-4227).
    • Read and understand the plan. Be sure that the chosen plan matches the beneficiary's needs and that the beneficiary can continue to see his or her current health care providers if desired.
    Page 2 of 3 - "With health care such an important topic in today's society, consumers have to arm themselves with all the information they can," Commissioner Praeger said. "Being a savvy Medicare beneficiary or family member of a beneficiary helps all of us fight fraudulent activities."
    Kansas Medicare beneficiaries can contact the KID Consumer Assistance Division for more information about Medicare Part D. Call 800-432-2484. Those who have questions about the health insurance marketplace for consumers under 65 can go to www.insureKS.org.
    Questions and answers regarding Medicare Part D and Medicare Advantage Plans
    • What are Medicare Prescription Drug Plans (PDPs)?
    In 2003, the federal government enacted a Medicare prescription drug coverage benefit for Medicare beneficiaries. Private insurance companies, whose plans have been approved by Medicare, sell Medicare PDPs. Everyone with Medicare is eligible to enroll in a PDP, regardless of income or assets.
    • What if I am already enrolled in a Medicare PDP?
    Plans might change from year to year. Therefore, you should carefully examine all available plans during each open-enrollment season, as you may find that your current plan no longer best meets your needs. Be sure to check the features of your plan, including the list of drugs covered and the amount of premium you pay.
    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.
    • What if I am enrolled in a Medicare Advantage Plan with prescription drug coverage?
    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, cost-sharing requirements and provider networks. Your plan options should be carefully reviewed during each open enrollment season.
    • What are my options if I want to enroll in a Medicare PDP?
    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 the new drug benefit.
    You will want to compare plans and select the one that best meets your individual needs. Here are a few things to check:
    - See if all of your prescriptions are on the plan's list of drugs (called a formulary).
    - Check to see that your pharmacy participates with the plan.
    - Find out what copayments you will be responsible for paying when filling a prescription.
    - Is the premium for your preferred plan affordable?
    - Check the Medicare.gov "Finding Plans" section on the Internet.
    Page 3 of 3 - • What if I am eligible but wait to enroll?
    If you do not enroll at your first opportunity, you may be subject to late-enrollment penalties. These penalties are generally one percent per month for every month you delay enrollment. There is no limit on the penalty, so the longer you wait to enroll, the higher the premium you will pay. You will pay this higher premium for the entire time you have your plan.
    Other important things to consider
    Federal assistance with premiums will be available to Medicare beneficiaries who meet certain income requirements. Kansas Medicare beneficiaries may seek assistance in reviewing options for coverage and obtaining financial assistance by contacting the Senior Health Insurance Counseling for Kansas (SHICK) program, 800-860-5260. Appointments may be scheduled with the Prescription Assistance Program at Pratt Regional Medical Center. Call 620-450-1422.

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