Smaller Print Larger Print
800-336-4529 618-985-4529
For most Medicare beneficiaries, the ACEP will be the only opportunity to change drug plans for the year. Many seniors continue to find the complexity of choices and terms a challenge to sort out. One common mistake that occurs during the ACEP is the confusion that surrounds Medicare Advantage Plans which are lumped together with Medicare drug plan choices.

Life Care Planning, Estate Protection, Disability,
VA & Medicaid Assistance Lawyers

Medicare Drug Plan: Important Deadline Looming

Medicare Drug Plan: Important Deadline Looming

 

Each fall, the Centers for Medicare & Medicaid Services mails a geographic-specific "Medicare & You" handbook to all households of people with Medicare. In 2008, there are 59 geographic-specific versions with drug and health plan comparison charts for particular states or regions. With the Annual Coordinated Election Period (ACEP) coming soon, Medicare prescription drug plan rates and drug plan benefits have recently been made available through the handbook, the Medicare help line (1-800-MEDICARE) and on the Medicare web site, www.medicare.gov.

 pl

For most Medicare beneficiaries, the ACEP will be the only opportunity to change drug plans for the year. Many seniors continue to find the complexity of choices and terms a challenge to sort out. One common mistake that occurs during the ACEP is the confusion that surrounds Medicare Advantage Plans which are lumped together with Medicare drug plan choices.

 

Over the years, these Medicare private health plans have been known by several names with the most recent being Medicare Advantage (MA) Plans. As an alternative to original Medicare, a MA plan can include Health Maintenance Organizations (HMO), Participating Provider Organizations (PPO), Private Fee-For-Service (PFFS) Plans or Medicare Medical Savings Account (MSA) Plans. A Medicare beneficiary automatically receives original Medicare unless he/she chooses to enroll in a MA Plan.

 

During the marketing frenzy, it's easy for seniors to get confused because there are two ways to get Medicare prescription drug coverage; either through a stand-alone drug plan or through a MA plan. Sometimes the person on Medicare is so intent on comparing the drug plan benefits and making sure his or her drugs are on the plan formularies, he or she loses sight that a particular drug plan may be a part of a Medicare Advantage Plan. Most MA's include prescription drug coverage as part of the plan. However, deciding to enroll in a MA entails much more than simply choosing drug coverage.

 

There are plenty of differences between original Medicare and Medicare Advantage Plans. With the Medicare annual enrollment period beginning November 15 and ending December 31, Medicare beneficiaries and their families are encouraged to become as informed as possible. Once a Medicare election is made, except for special situations, the person on Medicare is locked into his/her choice for the entire calendar year.

 

Elderly Duped Into Health Plans

 

State insurance regulators testified before Congress earlier this year that health-insurance agents have tricked elderly customers into signing up for policies they can't afford and that can cut off access to longtime doctors.

 

Under traditional Medicare, patients can go to any doctor or hospital.  Under Medicare Advantage, the U.S. is paying United Health Group Inc., Humana Inc. and other companies $76.3 billion this fiscal year to offer coordinated care and lower expenses to enrollees.


Insurance companies receive 12 percent more for selling Medicare Advantage policies on average above what they would receive by selling a traditional Medicare policy.  Critics of Medicare Advantage policies say aggressive marketers have committed abuses, including enrolling mentally incompetent people and the deceased.

 

Because of these abuses, the government is allowing persons to drop out of private health plans where the insurance agent signed them up using unethical marketing practices.  Between June and July of this year, the government granted 1,448 requests to withdraw from the subsidized Medicare Advantage plans and denied none.

 

Medicare ``should require that every plan make expressly clear that people who feel they have been invalidly enrolled be able to get out,'' said Robert Hayes, director of the Medicare Rights Center, the New York-based nonprofit group that urged the government to publicize that option.

 

Richard Habiger is an elder law attorney.  You may contact him at 618-549-4529 or Richard@HabigerElderLaw.com.