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 They asked her for her bank number and they told her it would cost her $389.00 per month and that amount would be withdrawn from her account.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 coverage notice.

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, 2008.

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 next year.

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.

Extra Help

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 for assistance.

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.

Enrollment Periods

There are three enrollment periods for Medicare drug coverage:

1. 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.
2. 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.
3. 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.