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Marci’s Medicare Answers

December 2013


Dear Marci,

I heard that Medicare star ratings are helpful for those wanting to make changes to their Medicare coverage during Fall Open Enrollment. What are Medicare star ratings?


Dear Ariel,

Medicare star ratings are quality ratings for Medicare Advantage and Part D plans. Each year, Medicare scores how well plans perform in several categories, including quality of care and customer service. Star ratings range from one to five stars, with five being the highest score and one being the lowest score. Medicare also assigns plans one overall star rating to summarize the plan’s performance as a whole. New star ratings are released each fall.

Keep in mind that a plan’s star rating is only one factor to look at when comparing different plans during Fall Open Enrollment, the time of the year that spans from October 15-December 7. During Fall Open Enrollment, people with Medicare can make any changes to their Medicare coverage, with their new coverage taking effect January 1 of the next year. Even though a plan has a high star rating, it may not be right for you. You should take a look at the plan’s costs, benefits and rules, before considering the plan’s star rating.

If Medicare gives a plan only one or two stars for three years in a row, Medicare will consider the plan to be a low-performing plan. In order to enroll into a low-performing plan, you will need to call the plan directly to do so. You will not be able to enroll through the online Medicare Plan Finder tool. If you do enroll into a low-performing plan, Medicare should mail you a letter informing you about the plan’s low performance. You will be allowed to stay in the plan; however, you should make sure that the plan’s costs, coverage benefits and rules will best meet your individual needs in 2014.  If you are in a consistently low-performing Medicare Advantage plan, keep in mind that you are entitled to a one-time Special Enrollment Period (SEP) throughout the year to switch to a plan with 3 or more stars or to a plan with no rating because it’s new. To use this SEP, you will need to call 800-MEDICARE directly.

Lastly, people with Medicare are allowed a Special Enrollment Period (SEP) to enroll into a five-star Medicare Advantage plan or Part D plan once each calendar year. In order to use this SEP, the plan must have an overall five-star rating and must be offered in your service area.

To learn more about a particular plan’s star rating, you can call 800-MEDICARE or go online and visit www.medicare.gov/find-a-plan.


Dear Marci,

I got a call from a person who said that he was from Medicare. This person told me that I would need to give him my bank account information before he could help me with my Medicare problems. Are Medicare representatives allowed to ask me for that type of information?


Dear Jillian,

No, Medicare representatives will never call you and ask for personal information like your bank account number or Social Security number. Also, Medicare private plans cannot ask for your financial or personal information if they call you. In fact, plans cannot call you if you have never been a member of the plan and you did not ask for that plan to call you. In addition, plans are not allowed to send you emails without your approval.

Keep in mind that you should also be wary of websites, callers or individuals saying that they are asking for your personal information, because of the health care law. People with Medicare should not have to give out their personal information to Medicare representatives as a result of the health care law. In general, be wary of callers who ask for your Social Security number or bank account number. For example, you should be suspicious of callers who say that they are from Medicare and ask for your bank account information. Take down the name of the person you spoke to, as well as the date and time of the call, but be sure not to give out any personal information. You can report callers and people pretending to be government officials to 800-MEDICARE or to your local Senior Medicare Patrol. To locate your state Senior Medicare Patrol, you can go online and visit www.smpresource.org.

Remember, it’s not safe to give out your information to unidentified callers. You can always call 800-MEDICARE or dial a number that you trust and know, before giving out your personal information if you need to.  It is very important that you guard such personal information closely to avoid becoming a victim of fraud or identity theft. If you have any questions about your Medicare benefits, you can call 800-MEDICARE or go online and visit www.medicare.gov.


Dear Marci,

I received a blue notice in the mail that lists the drugs I took in 2013. The notice also lists which of these drugs will be covered under my new drug plan in 2014. What does this blue notice mean?


Dear Gina,

This blue notice is sent out to people who have Extra Help, the federal assistance program that helps people with Medicare pay their prescription drug costs. In particular, you will receive this notice if you have Extra Help and your Medicare prescription drug plan (Part D plan) is ending at the end of year.

You should have already received another blue notice from the Centers for Medicare & Medicaid Services (CMS) in late October telling you that you may be reassigned to a different Part D plan beginning January 1, 2014, since your current plan is ending. The notice should have also told you that you can choose your own Part D plan by December 31, 2013 to avoid being assigned to a plan.

You will receive this blue follow-up notice from CMS in December if you have not actively chosen a different Part D plan for 2014. This notice will include the name of the Part D plan you will be assigned to if you do not make any changes. If you get this notice, you should review whether the Part D plan assigned to you will cover the prescription drugs that you need in 2014. Since you have Extra Help, you will pay low costs for prescription drugs that are covered under your Part D plan. You will also be able to change your Part D plan once a month. However, it is important that you read through this notice carefully and make sure that the Part D plan will cover most, if not all, of the medications you need in 2014. Extra Help helps you pay for your prescription drugs only if the drugs are covered by your Part D plan.

If the Part D plan on the notice does not cover some of the drugs that you need, you can call 800-MEDICARE to select a different Part D plan for 2014. Remember, you must do this by December 31, 2013. To learn about other Part D plans in your area, you can contact 800-MEDICARE or go online and visit www.medicare.gov/find-a-plan. You can also contact your local State Health Insurance Assistance Program for help in finding a Part D plan that best suits your needs.


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Marci’s Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare. To subscribe to “Dear Marci,” MRC’s free educational e-newsletter, click here.


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Last Modified: 09/19/2013 14:08:42
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