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Medicare Prescription Drug Coverage Annual Enrollment
11/18/2009
During open enrollment for Medicare prescription drug coverage, Nov. 15 - Dec. 31, 2009, the Alabama Department of Insurance offers this information to help you get smart about your insurance options.

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 is 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. Review the features of your plan, including the list of drugs covered, the list of participating pharmacies, the premium, the deductible, the cost-sharing requirements, the provider network and any coverage gaps. You do not need to do anything to remain in your current 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 CMS for 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.

Marketing Rules

State and federal rules are in place to protect consumers against abuses in the marketing and sales of Medicare prescription drug plans and Medicare Advantage plans. Individuals who contact you about any type of private Medicare coverage:

  • Must be licensed by the state. Check with the Alabama Department of Insurance to make sure the salesperson is a licensed agent.
  • May not make unsolicited contact such as door-to-door sales, cold calls or approaching you in a parking lot.
  • Must have made an appointment before coming to your home.
  • Must arrange 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.
  • 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 plan.
  • May not attempt to sell you a plan in certain health care settings, such as in a doctor’s office or in a pharmacy.
  • May not attempt to sell you a plan at an educational event.
  • May not offer you free meals at promotional or sales events.
  • May not offer you gifts or other promotional items whose value is in excess of $15.

Medicare Fraud

Unfortunately, not everyone who contacts you about switching to a Medicare drug plan has the best intentions. To protect yourself from scam artists intent on taking advantage of your situation, here are some additional tips to avoid becoming a victim:
  • Beware of door-to-door sales people. Remember, agents cannot solicit business at your home without an appointment. Do not allow uninvited agents into your home.
  • Do not give out personal information, such as Social Security numbers, bank account numbers or credit card numbers to anyone you have not verified as a licensed agent. People are not allowed to request such personal information in their marketing activities and cannot ask for payment over the Internet. They must send you a bill. Once you decide to purchase a plan and have verified that the agent is licensed, you may give the agent personal information to assist in enrollment and billing.
  • Verify that the plan you have chosen is an approved Medicare plan. All of the approved plans are available at www.medicare.gov  or by calling 1-800-MEDICARE (1-800-633-4227).

Other Important Considerations

Federal assistance with premiums is available to Medicare beneficiaries who meet certain income requirements. If you think you may qualify, call the Social Security Administration at 1-800-SSA-1213 (1-800-772-1213).

Medicare beneficiaries may seek assistance in reviewing options for coverage and obtaining financial assistance by contacting their State Health Insurance Assistance Program (SHIP).


Getting Prepared for Flu Season
10/8/2009

Health Insurance

The World Health Organization (WHO) is advising countries in the northern hemisphere to prepare for a second wave of pandemic spread. In many cities and towns, schools and hospitals are already dealing with wide-spread outbreak. A vaccine for the H1N1 strain of flu is expected later this fall, and the U.S. Centers for Disease Control suggest that the following groups consider the vaccine: pregnant women, people who live with or care for children younger than 6 months of age, healthcare and emergency medical services personnel, persons between the ages of 6 months and 24 years old, and people 25 through 64 years of age who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems.
It’s always important to understand your health insurance policy, but with the potential for an increased demand for health care services, you need to be even more aware of your specific plan details. Take a few minutes to read your policy carefully in order to answer the following questions:
1. Is the vaccination covered by my insurance?
  • The seasonal flu vaccine and the H1N1 flu vaccine will be administered separately. Because H1N1 vaccinations have not yet been authorized by the Food and Drug Administration, they may not be covered by health insurance. Check with your insurance company to verify that your coverage will extend to the H1N1 vaccine.
2. Do I have a cost-sharing responsibility for the vaccinations?
  • Many health insurance policies have co-payments for yearly flu vaccinations. Ask your insurance company if you will have a co-pay for the H1N1 vaccine and what the cost will be.
3. If an office visit is required to obtain the vaccinations, does it require a separate co-payment?
4. Does your policy require a pre-authorization for hospital admission or other services?
5. What is your co-payment for the most common H1N1 treatments?
  • The two drugs doctors can prescribe to treat H1N1 flu are Tamiflu and Relenza. In addition, you should know of any limitations on the number of doses covered by your policy – per prescription or per year.
6. Does your policy cover over-the-counter medications?
7. Is your coverage accepted at walk-in care facilities?
  • If your area is heavily affected by the spread of the H1N1 flu outbreak, your regular physician might not be able to see you in a timely manner.
8. What is your out-of-network co-payment? 
  • If you must go to an out-of-network provider, be aware you will likely pay a higher co-payment for your office visit and any tests run during the visit.

Be prepared for any eventuality with the following checklist:

  • Have your health insurance ID card readily available.
  • Review your health insurance policy provisions. Know which doctors and hospitals are in your network.
  • Make note of your co-payments. Know how much a doctor’s office visit will cost. Check to see if your co-payments go up if you go out-of-network.
  • Keep handy a list of pharmacies and medications covered by your health insurance policy.
  • If you have plans to travel, make sure you check to see if there are any doctors or medical facilities in-network where you will be visiting.
  • Make sure you have contact details for your health insurance company available in case you have questions.
  • Ask your employer or insurance company for any and all applicable health insurance information that might be available to you in a simple-to-reference format. Post this information where it can easily be accessed by everyone.

Business Interruption Insurance

Business owners might be concerned about having to shut down their operations due to an outbreak or absenteeism. Check your business interruption policy to see what eventualities will trigger coverage under your plan. Coverage generally requires the interruption to be caused by physical damage or loss (e.g., fire or weather). Business interruption policies generally will not be triggered by epidemic or pandemic warnings or alerts from public officials. Business owners will need to rely on existing risk management and business continuity plans to mitigate losses due to emerging public health crises.

More Information

The federal government has created a Web site with information: www.pandemicflu.gov.

The U.S. Centers for Disease Control also has extensive information about H1N1 Influenza on its Web site: www.cdc.gov/swineflu/.

If you are unable to resolve any concerns you have about your health insurance with your insurance company, contact the Alabama Department of Insurance at 800-433-3966. You may ask a question or file a complaint through its website at www.aldoi.gov.

Beware of insurance fraud during this time of heightened awareness. To avoid insurance fraud, make sure the company you're dealing with is reputable and licensed to do business in your state. Before signing any paperwork or writing a check, STOP; CALL the Alabama Department of Insurance; and CONFIRM that the insurance company or agent is legitimate and licensed in Alabama.

DOI To Participate in Alabama I-Day 2009
9/23/2009
“I am happy the Department of Insurance again has the opportunity to be a part of this great program,” said Commissioner Ridling. “I encourage everyone with an interest in the insurance industry in our state to attend."
The program has been approved for 6 hours continuing education credit for insurance producers and 3.4 CLE hours for Alabama attorneys.
For additional information, click here to view the complete I-Day flyer.
March 13, 2010
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