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the medicare drug plan
6 Key Facts

1. Anyone on Medicare can get coverage regardless of income or health.

2. You are not obligated to enroll, but there may be consequences if you don't sign up when you are first eligible to do so.

3. To get Medicare drug coverage, you must select one approved private drug plan among many offering different choices. There is no single government plan.

4. Is your income limited? If you qualify for a part of the program known as "Extra Help." you'll pay very little for your medications.

5. Are your drug costs very high? You'll pay no more than 5 percent of the cost of each prescription after you've spent a certain amount of money out-of-pocket in any one year.

6. Do you have better drug coverage already? You probably won't need Medicare's Part D coverage. But it's wise to check.

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Medicare Prescription Drug Coverage Guide

Part 6: Signing Up for a Plan

How to enroll and avoid hard sells

How can I avoid hard sells?

It may not happen to you, but some beneficiaries have been pressured into buying Medicare insurance plans that they didn’t understand or want. Typically, beneficiaries are sold Medicare Advantage plans (which combine health services with drug coverage) without realizing that this means leaving traditional Medicare and maybe not being able to receive covered care from their regular doctors and hospitals. Although the federal government cracked down hard on these unethical practices and made some of them illegal in 2008, it’s by no means certain that they have stopped entirely. Here’s what you need to know to protect yourself against falling for a hard sell:

  • It’s illegal for a plan to send anyone to your home uninvited to sell Medicare insurance of any kind. Don’t believe anyone who says they’re “from Medicare.”

  • It’s illegal for anyone representing a plan to call you on the phone with a sales pitch, unless you requested the call or already have a relationship with the plan.

  • It’s illegal for a plan to enroll you in a plan on the phone — unless you call the plan to do so.

  • It’s illegal to ask you for any personal or financial information on the phone.

  •  It’s illegal for a plan to offer free meals, cash or other gifts to encourage you to enroll, or to give sales presentations anywhere that patients go for health care related services (such as doctors’ offices, hospitals and long-term care facilities) or at educational events.

  • If you ask a sales agent to come to your home to discuss a particular kind of insurance (whether a stand-alone drug plan, a Medicare Advantage health plan or medigap supplementary insurance), be aware that the agent must discuss only that type of insurance. If you want to discuss a different type, you must schedule a separate appointment, at least 48 hours after the first.

  • If a sales agent signs you up for a Medicare Advantage plan, the plan should call you to check that you understand its conditions and consequences and offer you the chance of withdrawing from the enrollment if you want to.

  • Don’t be rushed into enrolling. Take a few days to consider.

  • Don’t sign anything until you’re sure the plan is what you want. If you’re not sure, call the Medicare help line at 800-633-4227 and quote the plan’s name and ID number to learn what kind of plan it is and how enrolling in it might affect your current coverage.

  • Don’t sign anything until you know that the doctors, specialists and hospitals you prefer will accept the plan — even if a salesperson tells you it’s “good anywhere.”

If you use an independent insurance agent, try to choose one who is not paid to sell just one plan but can help you review many options to find your best deal.

Better still, go to the Medicare website for impartial information on all the options — original Medicare, Medicare Advantage plans, prescription drug plans and medigap supplementary policies — and to compare their costs and benefits. Or call the Medicare help line at 800-633-4227.

What can I do if I find I’ve been tricked into joining a plan?

If you find you’ve enrolled in a Medicare Advantage plan because you were confused or misled, call the Medicare help line and ask to be reenrolled in original Medicare or switched to another MA plan. Medicare will investigate your case.

If you already have medical bills the plan refuses to pay, ask to be reenrolled in the traditional (aka original) Medicare program retroactively, so Medicare can pay the bills at its usual rate. If that doesn’t work, ask to talk to a caseworker at your regional Medicare office.

If you’re receiving Extra Help, you can switch to another MA plan or back to original Medicare at any time.

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