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People With Medicare Should Review Their Health and Drug Coverage Options Carefully, Medicare Rights Center Urges

October 16, 2013  
•  Press Releases

People With Medicare Should Review Their Health and Drug Coverage Options Carefully, Medicare Rights Center Urges
–Medicare’s Fall Open Enrollment Period Is October 15 Through December 7—

New York, NY– Everyone with Medicare who is enrolled in a private health or drug plan should review their choices during the Fall Open Enrollment Period, advises the Medicare Rights Center, a national, nonprofit consumer service organization. Even people who are currently happy with their plan should do so, because plans make changes to their benefit packages every year. Those enrolled in Original Medicare can also decide at this time to switch to a private plan.

The Fall Open Enrollment Period runs from October 15 through December 7. During this time, Medicare beneficiaries can make changes to their health and drug coverage options without restriction. They have the right to make as many changes as they need, and the last change they make on or before December 7 will go into effect on January 1, 2014.

“Medicare beneficiaries need to be aware of any changes to their current plan and carefully review all of their options in time to make a decision by December 7,” said Joe Baker, President of the Medicare Rights Center. “While reviewing your options, it is important that you contact the plan to confirm any information you find. Once you have made your decision, you can enroll in the plan by calling 1-800-MEDICARE.”

Everyone with a Medicare Advantage plan (also known as a Medicare private health plan) or Medicare drug plan should have received their Annual Notice of Change (ANOC) by September 30. The ANOC lists the changes in the plan, such as the premium and copays, and will compare the benefits in 2014 with those in 2013.

Medicare Health Coverage

The Medicare Rights Center urges people to consider the following questions before enrolling in a Medicare Advantage plan:

  • Will I be able to use my doctors? Are they in the plan’s network and are they taking new patients who have this plan?
  • Have my doctors’ experiences with this plan been positive? What problems have my doctors seen with patients in this plan?
  • Which specialists, hospitals, home health agencies and skilled nursing facilities are in the plan’s network?
  • Who can I choose as my Primary Care Physician (PCP)?
  • How much is my monthly premium?
  • How much will it cost to see my primary care physician? A specialist?
  • Do I need a referral to see a specialist?
  • Are my prescription drugs on the plan’s formulary (list of covered drugs)?
  • Does the plan require that I get “prior authorization” before my prescription will be covered, or impose other restrictions (like limiting the quantity or requiring that I try a cheaper medication before it will cover a more expensive one)?
  • How much will I have to pay out of pocket before coverage starts (what is the deductible)?
  • How much will I pay for brand-name drugs? How much for generic drugs?
  • What service area does the plan cover?
  • What kind of coverage do I have if I travel outside of the service area?

Use the Medicare Plan Finder tool at or call 800-MEDICARE to review your options and get details.

For a list that includes these and more questions to ask, go to Medicare Interactive (

People with Medicare who become unhappy with the Medicare Advantage plan they chose are able to switch to Original Medicare and a stand-alone prescription drug plan during the Medicare Advantage Disenrollment Period (MADP), which begins January 1 and ends February 14. They will also have the right to add a Part D prescription drug plan during the MADP. They will not, however, be able to switch from one Medicare Advantage plan to another. People with Original Medicare will not be allowed to make changes during the MADP.

People with Medicare will also have a Special Enrollment Period (SEP) to enroll in a Medicare Advantage or Part D plan with a five-star rating (on a scale of one to five). The SEP can be used at any time during the year, but only once per year, and to make only one change. Learn more about the new SEP on page 3 of Fall Open Enrollment Period: A Resource for Journalists:

Although people who become unhappy with their Medicare Advantage plan will have a chance to switch to Original Medicare during the MADP, they may not be able to get a Medigap plan to fill the gaps in coverage, or their Medigap choices may be limited. This is another reason that Medicare Rights urges beneficiaries to ask questions before making their health coverage choices during the Fall Open Enrollment Period.

Medicare Prescription Drug Coverage

Medicare beneficiaries who have a Part D prescription drug plan should not only find out if a plan covers their drugs, but also pay particular attention to coverage restrictions, such as quantity limits, prior authorization and step therapy.

How To Choose the Part D Plan (either a stand-alone drug plan or a drug plan that is part of a Medicare Advantage plan) That Best Meets Your Needs

  • Make a list of the medicines you take, the dosages and how much you currently pay.
  • Make a list of pharmacies you use regularly.

Then decide what type of drug plan you need. If you have:

  • Original Medicare: Choose a stand-alone prescription drug plan (PDP) if you want to continue to receive your other health benefits through Original Medicare.
  • A Medicare Advantage plan (such as an HMO or PPO): Generally, you must get Part D drug coverage as part of your Medicare Advantage plan’s benefits package.

Third, use the Medicare Plan Finder tool at or call 800-MEDICARE to review your options and get details.

Fourth, ask questions, such as:

  • Does the plan cover all the medications I am taking?
  • If the plan does not cover a medication I take, does it cover one that will work for me? (Ask your doctor.)
  • Does the plan require that I get special permission before it will cover the medication I need (such as prior authorization or step therapy)?
  • How much will I pay at the pharmacy (copayments or coinsurance) for each drug I need? (Be aware that certain drugs may cost a lot even if they are covered.)
  • How much will I pay in monthly premiums and annual deductible?

For a list that includes these and more questions to ask, go to Medicare Interactive (

The Medicare Rights Center recommends that beneficiaries call the plan to confirm the information they find, and keep a record of the conversation with the plan representative. It also recommends enrolling in a plan by calling 800-MEDICARE rather than the plan itself.

The Medicare Rights Center offers the following resources, at no charge, to help people choose a stand-alone drug plan or Medicare Advantage plan that best meets their needs.

Medicare Interactive:
This free, web-based resource provides consumer-friendly information about Medicare benefits, rights and options.

Telephone Counseling
Beneficiaries who prefer to speak with a counselor can call the Medicare Rights Center’s toll-free helpline at 800-333-4114. Counselors are available Monday through Friday.

State Health Insurance Assistance Programs (SHIPs) also provide free counseling services. To find your local SHIP, go to or call 800-677-1116.

For more detailed information about the Fall Open Enrollment Period, please see


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About Medicare Rights
The Medicare Rights Center, a national nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities.

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