FRAUD ALERT (2-27-08)
The Dept. of Human Services has had three reports of the following Medicare fraud activity in Iowa in the last four months. This activity is fraudulent.
Here is the information received from DHS: A Medicare client called and reported that a company by the name of "Pharma-bay" called her. She said they told her that everyone on Medicare had to sign up - and that the Medicare consumer would get a new card. They asked her for her bank number and they told her it would cost her $389.00 per month and that amount would be withdrawn from her account. They left a phone number of 866-380-1481. When called, the consumer gets the recorded message that it is "customer service" (not a name of a company) and to hold.
It appears to be a Canadian pharmacy company that fills prescriptions by mail over the internet. Further Internet research found it is fraudulent. Please share this information with consumers you serve and be alert to this company operating in your service delivery area.
Medicare will not call and request someone's bank account number. These numbers should only be given out when the beneficiary has initiated the call and knows the organization they are IDAling with is legitimate. If consumers receive similar calls, they should report them immediately. The Senior Health Insurance Information Program (SHIIP) office can help consumers verify the legitimacy of any call or mailing s/he receives which claims to be Medicare related You can contact SHIIP at 1-800-351-4664 with any questions or concerns.
2008 Medicare D Enrollment
Important Information for Everyone Eligible:
Once a year, Medicare offers consumers the opportunity
to change prescription drug plans or enroll in a plan if earlier
IDAdlines were missed. This annual election period runs from November
15 through December 31of each year. New plans will be effective
January 1, 2008.
There have been several plan changes which will
impact older Iowans and persons with disabilities. Six plans were
dropped and five new plans were added. Eighteen plans reduced
premiums and 29 plans increased premiums. The lowest premium will
be $13.90. None of the plans cover brand name drugs in the coverage
gap, but several cover generic drugs. There are sixteen plans
which are available at $0 for people who qualify for low income
subsidies. It is very important that older Iowans and persons
with disabilities review their current plan and see if it will
still provide the best coverage for 2008. Iowa will have 52 stand
alone prescription drug plans in 2008 compared to 53 in 2007.
Every Part D product that offered a plan in 2007
must send an Annual Notice of Change to enrolled consumers by
October 31, 2007. This notice explains formulary (drugs covered),
benefit and premium changes for 2008. It is very important
to watch for this notice and read it carefully. Consumers may
be able to save by changing plans for 2008.
Consumers whose plan will not be available in 2008
should receive a plan termination letter by October 2. Consumers
who have drug coverage through an employer provided plan must
receive a notice by November 15 stating their coverage for 2008
is as good or better than Medicare's. This is called a creditable
2008 Part D Cost-Sharing
The Centers for Medicare & Medicaid Services (CMS)
has announced the cost-sharing under the standard Part D benefit
for next year. These changes will go into effect on January 1,
- The out-of-pocket threshold on drug expenditures before
reaching catastrophic coverage will be $4,050.
- The 2008 Part D deductible is $275.
- The coverage gap is reached when total drug costs (what
a consumer and the plan pay) equals $2,510.
By the middle of October 2007, consumers will be
able to go to http://www.medicare.gov
to do a comparison of the Medicare drug plans available for 2008.
This Internet tool can help consumers decide to stay with a current
plan or switch to a plan that better meets their needs for the
For individuals without access to a computer or
who need additional assistance, other options are available. Family
members may be able to help; go to your local public library,
or call the Senior Health Insurance Information Program (SHIIP).
SHIIP is provided at no cost to the consumer and is a confidential
service. SHIIP counselors are available across the state to help
consumers compare Medicare drug plans. For the SHIIP site nearest
you call 1-800-351-4664 (TTY 1-800-735-2942) or go to http://www.shiip.state.ia.us
Should a consumer choose to change plans, the consumer
must enroll in the new plan between November 15 and December 31,
2007. During this same period consumers can enroll in a Medicare
prescription drug (Part D) plan the enrollment IDAdline was missed
earlier this year. SHIIP counselors can assist older adults with
enrollment in a Part D plan as well. If consumers are happy with
their current plan and what the plan is going to be offering next
year no further action is necessary, enrollment will continue
from 2007 into 2008.
Qualifying older adults and persons with disabilities
whose income and resources fall below certain levels will get
help paying their premium for Medicare drug coverage, and for
some of the cost of their prescriptions. If consumers have not
received word about the plan they have been assigned to, contact
the Social Security Administration at 1-800-772-1213, TTY - 1-800-325-0778
or by going to http://www.ssa.gov
If consumers are currently receiving prescription
drug benefits for the "extra help" or low income subsidy, the
consumer will need to confirm income/resource levels still qualify
for this benefit. Be aware that some consumers may no longer qualify
and others may be reassigned to a new plan. Consumers are encouraged
to verify their continued coverage If a consumer has been assigned
to a new plan, checking the new plans covered drugs to verify
necessary medications are covered is recommended.
There are three enrollment periods for Medicare
- Consumers eligible for Medicare for the first time
will get an Initial Enrollment Period. They will be able to
join a drug plan any time during a seven month period which
includes the three months before they are eligible, the month
of eligibility and the three months after.
- Annual Election Period - This period runs November 15-December
31 each year. Medicare drug coverage will begin January 1
of the next year. These individuals may pay a higher premium
because they didn't enroll in a plan when they were first
eligible. The Annual Election Period will also be the time
when anyone who is enrolled in a plan can change to a different
plan for the next year.
- The final way to enroll in a plan or change plans is through
one of the Special Enrollment Periods, including:
- Change in residence-A permanent move to a state
outside of the area a plan covers will allow consumers
the opportunity to change plans.
- Employer group health plan change-Employer group
health plans usually have one time a year when members
may change their health plan choice or coverage. A Special
Enrollment Period at that time allows the member to enroll
in an employer Part D plan or disenroll from the employer
plan to enroll in a Medicare drug plan.
- Qualify for Extra Help with Medicare drug costs
or Medicaid-Individuals who become eligible for Extra
Help with Medicare drug costs or qualify for Medicaid
will get a Special Enrollment Period to enroll in Part
D if they are not currently in a plan. They can also use
the period to change plans. A person on Medicare can apply
for the Extra Help at any time.
ILLEGAL PLAN MARKETING
Private Medicare drug and health plan representatives
are prohibited from going to an individual's home without an invitation.
If this happens to you, do not feel pressured to allow them into
your home or to sign up for a new plan without first doing research.
The drug plan representative cannot force you to sign anything,
even if you have invited them into your home to give you information
about their particular plan. If a drug plan representative does
come to your home uninvited, be sure to report this activity by
calling either Medicare at 1-800-MEDICARE (1-800-633-4227). TTY
users should call -1-877-486-2048 or Iowa's Senior Health Insurance
Information Program (SHIIP) at 1-800-351-4664. (TTY 1-800-735-2942).
If you have questions about Medicare prescription
drug coverage call SHIIP at 1-800-351-4664 (TTY 800-735-2942)
or go to http://www.shiip.state.ia.us.
Local SHIIP counselors are also available across the state to
assist you. SHIIP services are free, confidential and objective.