The Annual Open Enrollment Period for Medicare closed on December 7. Up to that date, Medicare beneficiaries had the option to change their Medicare coverage, switching their Medicare Advantage or Medicare Part D plan. If you reviewed your plan, you may have sought advice from an Elder Benefit Specialist at an ADRC, insurance agents, or even a friend. Any changes, either to your current plan, or if you opted to switch coverage, will go into effect on January 1, 2024.

Whether you enrolled in a new Medicare Advantage plan, a Part D plan, or there are changes to your current plan, the details may not have been clear to you. These details could affect your benefits in a negative way. Here are some of the situations that you may run into:

1. I went to the pharmacy, and I was told that my new plan didn’t cover one of my prescriptions. What do I do? 

Contact your doctor to see if there is a medication that you can take in place of the one that is no longer covered, or if there is a generic option.  If your prescriptions are not covered by an alternative option or a generic, you may be allowed to change your plan.  Contact your Elder Benefit Specialist in your county and they may be able to find a plan that does cover your prescriptions. You can find your Elder Benefit Specialist at the following link: https://www.dhs.wisconsin.gov/benefit-specialists/counties.htm.

2. I called to make an appointment with my physician, and they said that my doctor is no longer covered under my new health care coverage, that they were out of network now. What do I do?

You can choose to get a new physician that is covered under your new plan.  Most of the time this is not what people want to do, especially when you have a physician that you like and are comfortable with, and they know your medical history.  You can contact your Elder Benefit Specialist in your county and there are certain cases where the Elder Benefit Specialist can assist you getting into a plan that your physician is covered and in network.  There is no guarantee that they can help you change your plan, though. They are there to assist you with this change if they can.

3. The insurance agent that helped me sign up for a new plan did not get me into a plan that covered all my prescriptions or my physician. I believe that they did not have my best interests in mind and were deceitful. Is this a type of Medicare fraud? Is there anything I can do to report this agent?

While most insurance agents are honest and are committed to getting the plan that best meets your needs, there are always a few that do not have your best interests in mind. That agent could have committed Medicare enrollment fraud. Medicare enrollment fraud occurs where an insurance agent and/or a broker does not follow the strict guidelines of the Centers for Medicare and Medicaid Services (CMS) when signing people up for Medicare Advantage plans or Part D plans.  We encourage you to report suspected fraud or abuse. Contact us at Wisconsin Senior Medicare Patrol via email: smp-wi@gwaar.org or our toll free, confidential helpline: 888-818-2611.

Our mission at Senior Medicare Patrol is to empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, abuse, and errors through outreach, counseling, and education.  We are here to help you identify and then report suspicious activity or issues and to guide you to a resolution.