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News November 2015

Washington Watch

Medicare Open Enrollment: Time to Re-evaluate Your Plan and Help Prevent Scams

By Alan M. Schlein

The law is clear. Under Medicare’s rules, insurance agents are prohibited from knocking on doors, making cold calls or sending unsolicited emails. Many manage to work around that by handing out business cards to get us to call them or getting your information at health fairs and other events by offering incentives like lunches, prizes etc.

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Medicare will never call you and ask for your personal information – NEVER. Nor will Medicare email you or visit your home unannounced to collect data. For the record, the federal government has no plans to issue new Medicare cards and lost or stolen card can be replaced at www.ssa.gov or by calling 1-800-772-1213.

Re-evaluating Your Medicare Plan

Medicare’s open enrollment period is a really good time to re-evaluate your plan and see if you are getting the best deal you can. But the old adage, if you like your plan stick with it, no longer applies.

There will be sticker shock from some dramatic price hikes and co-pay increases in Part D prescription drug costs. Just look at the recent case of Daraprim, the medicine to treat malaria-related parasites, which jumped in price from $13.50 to an astronomical $750 a pill – yes you read that correctly – before the outrage got so pronounced that the new owners backed off. 

While that became the poster-child for out-of-control drug prices, lots of other far more common prescription drugs have shot up. Many health insurance programs cover all your meds, but many others place a cap on the total cost – for many it’s $1,500 a year. That’s for the amount that is recovered from the insurance company, so it doesn’t go far for most seniors who average several routine prescriptions; many get a supplemental drug plan to cover the costs.

The latest study, AARP’s Rx Price Watch Report from November 2014, found the average retail price of more than 200 brand name drugs jumped nearly 13 percent in 2013. These include medicines for diabetes, high cholesterol and treating hypertension. Certain generic prices also jumped dramatically, like doxycycline hyclate, the commonly used antibiotic which soared from $20 for 500 capsules to $1,849 for the same amount between October 2013 and April 2014. But that same AARP analysis found that of 280 generic prescriptions, there was a 4 percent decline in prices. A new AARP RX Price Watch is expected late in November.

If you are on a fixed income, as many seniors are, and often stop taking life-saving medications because they can’t pay for them. Congress has held hearings about the price jumps, a spate of recent pharmaceutical company mergers and the possibility of price gouging. But no legislation is moving any time soon to fix these potential problems in the gridlock of Capitol Hill.

What everyone needs to pay detailed attention to is exactly what medicines your health insurance covers. Each year, many Part D insurers (or Part C plans that include prescription drugs) change the list of drugs they cover, known as their formulary. They also regularly change the prices, resulting in changes to your premiums, co-pays and deductibles. While you can’t predict what medicines you may need in the future, you certainly can scope out the ones you are currently taking and pay attention to any changes from your insurer.

By law, insurers are required to send seniors an annual letter notifying them of changes to their pharmacy benefits, including price changes or dropping of particular drugs. But Dr. Rajul Patel of the University of the Pacific Pharmacy School told the Sacramento Bee recently, these notices are often as thick “as a phone book” and are often overlooked by consumers.

The lesson is that you only have one chance a year to change your prescription drug plan so now is the time to pay attention to this. Medicare.gov, the government’s primary website for Medicare information provides a useful comparison tool that lets you plug in your drugs and dosages and compare plans by costs (https://www.medicare.gov/find-a-plan/questions/home.aspx).

Depending on where you live, you might be able to get help from counseling and advocacy programs, or a local medical school, that help review your specific medical plans and recommend changes.

One trick that is often helpful is to do an annual review of all of your medicines. In many cases, you can simply talk to your local pharmacist, taking a comprehensive list of all your meds (and vitamins, supplements etc.) to double check that you aren’t taking medications that contradict each other or ones that are simply unnecessary. As many of us have learned firsthand, your primary doctor may not know exactly what a specialist has prescribed for you. Some health insurance companies also will advise you on if your meds have contradictory effects and they may also counsel you on how to get the most from your plans.

Patel says these reviews should help you clarify what you are taking, why you are taking them and should also make sure if two different doctors are prescribing medications from the same pharmacological class.

 

Tips for Preventing Medicare Scams

Medicare’s open enrollment, the time you can keep or switch your Medicare coverage, runs from October 15 until December 7. To Medicare scammers, open enrollment means open season on seniors.

The best advice to prevent yourself from being taken advantage of by these con artists and scammers is jarring but to the point: be rude and just hang up the phone.  If a solicitation comes via email or on a website, don’t click on the link as it may open you up to a computer virus.

You may also need to watch out for predatory insurance agents, who sometimes try to sell you unnecessary or inappropriate coverage or worse, try to steal your Medicare numbers. A step below the con artist, there are some shady insurance agents who are simply trying to increase their commissions by persuading seniors to sign up for new plans that don’t help them get their medications or see the doctors they want.

So don’t believe it when agents tell you that you must change your plan every year. That’s another effort to get your information or your money. The law is clear. Under Medicare’s rules, insurance agents are prohibited from knocking on doors, making cold calls or sending unsolicited emails. Many manage to work around that by handing out business cards to get us to call them or getting your information at health fairs and other events by offering incentives like lunches, prizes etc.

According to folks at the Senior Medicare Patrol (http://www.smpresource.org/), an advocacy group designed to help Medicare beneficiaries prevent fraud, seniors are often provided with free bus transportation and some cash to spend at local gambling casinos in exchange for giving insurance agents their Medicare card information. Ultimately, the insurance agent usually “helps” the senior get different Medicare coverage – and the agent gets a financial commission. Often, the new plan is useless or much less helpful than the coverage you already had.

Most insurance agents are not scam artists. The vast majority are solid folks. But since many make their money based on commissions, some play outside the rules.

Another open enrollment scam is to pressure or persuade seniors to buy supplemental insurance products that will supposedly save you thousands of dollars. Before you sign anything, compare these “medigap” policies on the federal government’s useful comparison tool at www.Medicare.gov.

One of the more popular scams of recent years is when seniors get unsolicited phone calls saying they must add a prescription drug plan or they will lose their Medicare benefits altogether. Flag that in the bull pucky category. Prescription drug plans under Medicare are voluntary and are supplemental to your Medicare benefits.

Sid Kirchheimer, author of Scam-Proof Your Life, who follows these kinds of scams for the AARP, says the most common ploy is for a scammer to pose as an employee of Medicare, or the Centers for Medicare & Medicaid Services (CMS) or other government agencies, and claim that a new Medicare card is being issued. Then, in order to get your new card, you must verify or update sensitive information, including your Medicare or Social Security number.

Sid’s advice – don’t fall for it. Medicare will never call you and ask for your personal information – NEVER. Nor will Medicare email you or visit your home unannounced to collect data. For the record, the federal government has no plans to issue new Medicare cards and lost or stolen card can be replaced at www.ssa.gov or by calling 1-800-772-1213.

Scammers also often try to get you to give them your bank account numbers, saying they need to process payments on an overdue medical bill. Don’t be fooled, even if they accurately cite a few digits from your checks. The right answer – just hang up.

Caller ID and email addresses can also be manipulated easily, so if it looks like the White House is calling or the email is coming from the federal government, get a number and ask to call back. Then get some help before even thinking about returning the call or email.

Kirschheimer also points out that free is never free. Free medical supplies are often efforts to get you to give up your personal information. They may want your credit card number for alleged shipping charges. Same thing goes for free medical checkups at storefronts or clinics that pop up suddenly – what they usually want is your personal information.

According to the Senior Medicare Patrol advocates, another scam is to call a senior saying they are owed a $250 refund because they have reached the prescription drug coverage gap known as the “doughnut hole.” The senior is then asked to provide all kinds of personal information (birth date, Social Security number, bank account information and Medicare numbers) – a veritable feast of identity theft if the senior falls for it.

The most important rule to prevent identity fraud is to never give out your Social Security or Medicare number to a stranger.

To reiterate, Medicare will never call you and ask for your ID numbers. Treat your SSN and Medicare numbers the way you treat a credit card – don’t give it out without first checking out if they are legit. And if you are actually due a $250 refund because you hit the doughnut hole, Medicare will send the check to you in the mail to your home without asking for you to register for a rebate.

One important lesson learned from the highly-publicized Obamacare rollout a few years ago is that Medicare’s open enrollment is different than states’ open enrollment to sign up for Obamacare. Don’t get confused even though they both occur at the same time. To clarify, the Medicare open enrollment occurs from October 15 until December 7 and the open enrollment for the state-based health insurance marketplaces created by the federal Affordable Care Act, starts Nov. 15. While the Obamacare open enrollment overlaps with Medicare’s open enrollment, they are not the same thing. The Obamacare stuff is for folks who don’t have any health coverage. It’s against the law for someone who knows that you have Medicare to sell you a marketplace plan.

[Also contributing: Sacramento Bee, Kaiser; AARP, AgingCare.com]

 

Useful Tips to Avoid Scammers

  1. If someone calls you saying you must switch your Medicare plan to keep your doctor, call your doctor directly and check it out.
  2. Be aware of unsolicited phone calls or people showing up at your residence claiming to be Medicare agents. That goes against Medicare’s own policy rules.
  3. No one can move you out of your Medicare plan without your consent.
  4. Don’t fall for free giveaways, prizes in exchange for signing Medicare forms.
  5. Similarly, be suspicious of people offering free medical equipment or services, and requesting your Medicare number. If something is really free, they don’t need your Medicare number.
  6. Look at http://www.smpresource.org/ or find your local Senior Medicare Patrol group and learn other ways you can protect yourself and your family and friends. You can also call (877) 808-2468 or 1-800-MEDICARE.

 

Alan Schlein runs DeadlineOnline.com, an internet training and consulting firm. He is the author of the bestselling “Find It Online” books.

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