Date: November 19, 2009
For more information contact: Jim Guidry, (608) 264-6239 or jim.guidry@wisconsin.gov
Commissioner Reminds Seniors of Medicare Open-Enrollment Period
Madison, WI—The open-enrollment period for Medicare enrollees began on November 15, 2009. Consumers are receiving information regarding available choices and options from the Centers for Medicare and Medicaid Services (CMS), health insurers and prescription drug providers. Wisconsin Insurance Commissioner Sean Dilweg reminds seniors to carefully consider their options and make decisions based on their best estimations of their medical needs for the upcoming year.
"Most seniors will be able to find the plan that suits their needs whether it is traditional Medicare, Medicare Advantage, Medicare supplement, or a prescription drug plan," said Dilweg. "It is important for seniors to review their choices and ask questions."
Medicare is a federal program that provides health insurance for people age 65 or older and others who qualify for the program. There are several options for coverage under the Medicare program. Traditional fee-for-service Medicare, also called Original Medicare, includes Part A (hospital coverage) and Part B (medical coverage - covers preventative care and outpatient care, such as doctors' office visits). Relatively recent additions to the Medicare program include Medicare Part C (Medicare Advantage - offered by private insurance companies through a contract with Medicare) and Part D (prescription drug coverage - outpatient prescription drug coverage offered by private insurance companies through a contract with Medicare). Part C and Part D are not part of traditional fee-for-service Medicare, but are a part of the Medicare program administered by the federal government.
The Medicare Advantage and Medicare Part D open-enrollment is from November 15 to December 31, 2009. With each new enrollment period Dilweg reminds seniors to check their current plan for any changes for 2010 such as premium changes or benefit changes, including changes to the plan's cost shares. In addition, if a plan has decided not to continue its contract with the federal government in 2010, the plan should have already notified its beneficiaries that coverage with that plan will end on December 31, 2009, along with the options those beneficiaries have.
"Seniors receiving Social Security benefits will not be getting a cost-of-living adjustment in the coming year," said Dilweg. "It is even more important to make sure your Medicare coverage such as Original Medicare, Medicare Advantage or Prescription Drug coverage is the best for your budget and your needs."
When considering a change in Medicare coverage, it is very important to evaluate the cost-sharing provisions of any new plan. Medicare Advantage plans have different deductibles and co-payments and those differences can be quite significant. Generally, the higher the cost shares, the lower the premium charged by the plan. However, should you get sick, the more out-of-pocket expenses you will incur.
Seniors should use the open-enrollment time to the fullest in order to make their evaluations. Dilweg cautioned that seniors not make decisions too quickly and take the time to make the right decision. Seniors may feel pressured to change plans without actually determining if the new plan suits their personal medical needs. Additionally, seniors may lose some rights to change their plan if they make the wrong decision and need to change. They may have to wait until the next open-enrollment period a year from now.
New regulations issued by CMS in 2008 were designed to protect beneficiaries from deceptive or high-pressure marketing and sales tactics by private insurance companies and their agents during the Medicare Advantage and prescription drug open-enrollment period. The regulations include prohibitions on telemarketing and other unsolicited sales contacts. Although Medicare Advantage plans are regulated by the federal government, the Wisconsin Office of the Commissioner of Insurance still regulates insurance agents and their actions.
OCI has a number of resources for seniors. Publications including 12 Things to Know Before Signing up for Medicare Part D, Medicare Advantage Plans in Wisconsin, Medicare Supplement Insurance Approved Policies, and Wisconsin Guide to Health Insurance for People with Medicare are all available at OCI's Web site. If you or someone in your family is a Medicare beneficiary and you have questions regarding agent activity or wish to file a complaint involving an agent, contact OCI at 1-800-236-8517. Further information and complaint forms are also available at the OCI Web site: oci.wi.gov.
Created by the Legislature in 1871, Wisconsin's Office of the Commissioner of Insurance (OCI) was vested with broad powers to ensure that the insurance industry responsibly and adequately met the insurance needs of Wisconsin citizens. Today, OCI's mission is to lead the way in informing and protecting the public and responding to its insurance needs.