Who can talk to you about Medicare drug coverage?
November 1, 2020
The Medicare Part D (prescription drug coverage) Open Enrollment Period is now in full swing. (See page 7 for details - Editor.) For those who don’t know, from Oct. 15 to Dec. 7 each year, Medicare provides an opportunity for beneficiaries who have Part A (Hospital) coverage and/or Part B (Medical) coverage to: join a Medicare Part D plan, change their Medicare Part D plan or dis-enroll from Medicare Part D. Enrollment, disenrollment, and plan changes can also be made to Medicare Advantage (MA) plans, however, since there are no public MA plans available in Alaska, MA plan changes will not affect Alaskan beneficiaries.
Decisions made during the Part D Open Enrollment Period for 2021 will go into effect on January 1 of the upcoming year. To that end, there are communications that you may receive via mail or your email that are designed to assist you in making a decision to stay in your current plan or choose another. Let’s discuss what will communications will come your way, who they are from, and what are the Medicare Part D communication and marketing rules.
Notice of change
Firstly, if you already have a Medicare Part D plan, your current plan provider must send you an Annual Notice of Change or ANoC letter. This usually arrives in September. If you did not receive it, contact your Part D plan. This document informs you of what changes are being made to the plan for the upcoming year. Changes can include the monthly premium, the annual deductible (the maximum annual deductible a plan can charge in 2021 is going up from $415 to $435), what medications that will be offered by the plan and if you will be affected by changes in the formulary, and the tier level on which each type of medication is placed and co-pay for each tier level. The plans must also must inform you of changes in their relationship to their pharmacy network. All of these changes can affect your costs.
The ANoC can be delivered to you via U.S. mail or by email. If you receive it via email, you can request from your plan to receive it by regular mail.
Evidence of coverage
Another document you should receive if you are already enrolled in a Part D plan is called the Evidence of Coverage, or EOC. The EOC is often mailed to you with your ANoC letter and this document is a list of Part D plan costs and benefits. These costs and benefits will also take effect on January 1 of the upcoming year. This is a great place to start if you have questions regarding your current Part D plan. Some of the companies may send you a notice informing you where online you can find the Evidence of Coverage document, but you can request a hard copy be mailed to you.
This document can be up to 200 pages in length so it can be advantageous to choose the online version. The online version allows you to search specific topics as well. If you have trouble finding the information you desire, don’t hesitate to contact your plan’s customer service department.
Strict rules for marketing Medicare plans
There is a difference between what communications can occur between a company and a current “customer,” and companies that want to market their plan to beneficiaries who are not current customers. There are certain rules about how plans can market their offerings for Part D. Here are a few of them, from the Medicare Rights Center’s “Getting Medicare Right” publication:
“Companies cannot call you if you did not give them permission to do so, visit you in your home, nursing home, or other place of residence without your invitation, ask for your financial or personal information (like your Social Security Number, Medicare number, or bank information) if they call you, provide gifts or prizes worth more than $15 to encourage you to enroll (gifts or prizes that are worth more than $15 must be made available to the general public, not just to people with Medicare), disregard federal and state consumer protection laws for telemarketing, the National Do-Not-Call Registry or by calling from the number you wish to register), market their plans at education events or in health care settings (except in common areas). They also cannot sell you life insurance or other non-health products at the same appointment (known as cross-selling), unless you request information about such products. They cannot compare their plan to another plan by name in advertising materials, use the term “Medicare-endorsed” or suggest that their plan is a preferred Medicare plan. Plans can use the Medicare in their names as long as it follows the plan name (for example, the Acme Medicare Plan) and the usage does not suggest that Medicare endorses that particular plan above other Medicare plans. They also cannot imply that they are calling on behalf of Medicare”.
Yes, this may seem like a lot of rules, possibly in part due to previously devious behavior by companies in the past.
If you suspect that you have been contacted by someone you feel has violated the Medicare Marketing rules, try to save any proof that you may have, especially if they gave you a business card or you have the caller ID, and report the incident to 1-800-Medicare or the Medicare Information Office in Alaska at 1-800-478-6065.
The State of Alaska Medicare Information Office has trained counselors across the state who are ready to assist you with making your best choice for Part D for 2021. It is best not to delay in making an appointment for counselor assistance as appointments are filling up fast. Call 1-800-478-6065. This is a toll-free number within Alaska.
Nila Morgan is a Certified Medicare Counselor who works at the Anchorage Senior Activity Center.