Dates and Benefit Changes Seniors Should Know

If you’re a senior who relies on Medicare for your health care needs, you should be aware of changes this year that will affect your benefits. As with every enrollment season, there are important things you should watch out for and consider when evaluating your coverage needs. The National Association of Insurance Commissioners (NAIC) is here to help you get smart when considering your options.

Enrollment Period Changes

This year, annual enrollment runs from Nov. 15 – Dec. 31, 2010. Additionally, from Jan. 1 - Feb. 14, 2011, Medicare Advantage enrollees can switch to Original Medicare. If you choose to change, you can also enroll in a Medicare prescription drug plan.

In most cases you will not be able to change options outside the enrollment period, therefore you should take the time to carefully review your Medicare benefits and options now.

PPACA Changes

The Patient Protection and Affordable Care Act (PPACA) was signed into law in March. The health care overhaul law includes a number of significant changes to Medicare. You will see the following changes to Medicare this year.

Improvements to Original Medicare

  • Preventive care – Beginning in 2011, Medicare beneficiaries will receive free preventive services including diabetes screening, mammograms, some vaccines and colorectal cancer screenings.
  • Annual physical exams – Beneficiaries are eligible for a yearly wellness exam to develop or update a personalized prevention plan.

Medicare Prescription Drug Coverage

  • Some beneficiaries enrolled in Medicare Prescription Drug plans face a gap in coverage often referred to as the “doughnut hole.” This is the portion of your annual drug expenditures, when you may be responsible for the costs of all medications. Beginning in 2011, some beneficiaries who enter the “doughnut hole” will get a 50% discount on Medicare-covered brand name drugs and a 7% discount on Medicare-covered generic prescriptions while in the "doughnut hole."

Medicare Advantage Plans

  • Beginning in 2011, Medicare Advantage plans cannot charge you more than traditional Medicare for chemotherapy, dialysis, skilled nursing care, and other services deemed appropriate.
  • Check with your plan to see if preventive care and wellness improvements to Original Medicare will be available to you.

Non-renewal Notices

Every year, some Medicare Advantage and Medicare prescription drug plans choose not to renew their Medicare contracts. If you received a non-renewal notice this year, the notice should also have included information about the options available in your area.

When weighing your options, compare coverages and costs to find the policy that best fits your health care needs. Remember, new Medicare Advantage plans could have different coverage limits, participating doctors and prescription drug lists than your current plan. If you choose Original Medicare, you might want to consider a prescription drug policy and/or a Medicare supplement insurance policy to augment your coverage.

Marketing Rules

State and federal rules are in place to protect you against abuses in the marketing and sales of Medicare prescription drug plans and Medicare Advantage plans. Individuals who contact you about any type of private Medicare coverage:

  • Must be licensed by the state. Check with your state’s insurance department to make sure the salesperson is a licensed agent. Find a link to your state insurance department’s website at
  • May not make unsolicited contact such as door-to-door sales, cold calls or approaching you in a parking lot.
  • Must have an appointment to come to your home.
  • Must arrange in advance the type of products that will be discussed during a scheduled sales appointment. At the appointment, the salesperson may not try to sell you other types of insurance coverage other than the type(s) agreed upon in advance.
  • May not try to sell you non-health care related products (like a life insurance policy or an annuity) during a sales or marketing presentation of a Medicare prescription drug or Medicare Advantage plan.
  • May not attempt to sell you a plan in certain health care settings, such as a doctor’s office or a pharmacy.
  • May not attempt to sell you a plan at an educational event.
  • May not offer you free meals at promotional or sales events.
  • May not offer you gifts or other promotional items whose value exceeds $15.

Medicare Fraud

Unfortunately, not everyone who contacts you about switching Medicare plans has the best intentions. To protect yourself from scams, here are some additional tips:

  • Beware of door-to-door salespeople. Agents cannot solicit business at your home without an appointment. Do not allow uninvited agents into your home.
  • Do not give out personal information, such as Social Security, bank account or credit card numbers to anyone you have not verified as a licensed agent. Agents are not allowed to request such personal information in their marketing activities and cannot ask for payment over the Internet. They must send you a bill. Once you decide to purchase a plan and have verified that the agent is licensed, you may give the agent personal information to assist in enrollment and billing.
  • Verify that the plan you have chosen is an approved Medicare plan. All of the approved plans are available at or by calling 1-800-MEDICARE (1-800-633-4227).

Other Important Considerations

Federal assistance with premiums is available to Medicare beneficiaries who meet certain income requirements. If you think you may qualify, call the Social Security Administration at 1-800-SSA-1213 (1-800-772-1213).

Medicare beneficiaries may seek assistance in reviewing options for coverage and obtaining financial assistance by contacting their State Health Insurance Assistance Program (SHIP). Go to the NAIC website ( for a link to your state insurance department.

More Information

For more information about your Medicare options, the new required coverages under the PPACA or to use Medicare’s online Prescription Drug Plan Finder, go to

Find more information about your changing insurance needs and tips for choosing the coverage that is best for you and your family at

November 2010

About the NAIC

Formed in 1871, the National Association of Insurance Commissioners (NAIC) is a voluntary organization of the chief insurance regulatory officials of the 50 states, the District of Columbia and five U.S. territories. The NAIC has three offices: Executive Office, Washington, D.C.; Central Office, Kansas City, Mo.; and Securities Valuation Office, New York City. The NAIC serves the needs of consumers and the industry, with an overriding objective of supporting state insurance regulators as they protect consumers and maintain the financial stability of the insurance marketplace. For more consumer information, visit


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