Medicare Information, Scams and News

Medicare's Open Enrollment Period is officially open for business! Now through December 7, Medicare subscribers can compare all their coverage options that become part of their plan on January 1.

Beginning in 2024, Medicare subscribers will get some new pluses – like relationship counseling and telehealth. To get an idea of what’s available and to review a summary of your current coverage, it’s a simple click away.

Then, select "Compare Plan Details" on your summary page to see a side-by-side comparison of how your current plan's costs and benefits will change in 2024.

Even if you’re happy with your current plan, comparing options is worth the time. For one thing, with the dramatic changes in prescription costs, you can input your prescription medications to get better estimates of your prescription drug costs at local pharmacies.

Your health care needs may have changed, too, and there may be another plan that serves those changes better than your current one. “Think about which benefits matter most to you, and explore all your coverage options to find your best fit. You could save money, find better coverage, or both,” the Center for Medicare and Medicaid Services (CMS) said.

Medicare expert simplifies what’s going on

Medicare isn’t as straightforward as everyone would like it to be. There are formularies, donut holes, Medicare Part C, the list goes on and on. ConsumerAffairs reached out to Stephanie Abt, an independent insurance broker and founder of the Abt Insurance Agency, to lay out the things you can do during the Open Enrollment period. She put together this explainer video that explains things in simple terms.

“However, it's important to know that when it comes to Medicare Supplement/Medigap plans, there is no annual 'open enrollment' period for these plans. Medigap plans generally have only one open enrollment period, and that begins when you are new to Medicare Part B,” Abt reminds seniors.

“So it's important to keep in mind that depending on your situation, you may have to pass through medical underwriting in order to change or enroll in a new Medicare Supplement Plan during this fall Annual Election Period.”

'Honey, Captain Kirk says we should buy this Medicare plan…'

There’s one other thing that Medicare enrollees should know. On September 30, a new rule went into effect that prohibits ads about “Medicare Advantage” intended to mislead people. So, if William Shatner, Joe Namath, or Jimmy Walker comes on TV pitching Medicare Advantage, they are going to have to clearly state what insurance plan they’re advertising. 

And because marketers can be crafty, CMS warns consumers that if they see any pitch using the Medicare logo or card, the marketing company is only trying to fool consumers into believing that a celebrity endorser represents the federal government.

The new rules also require insurance agents and brokers who market Medicare Advantage plans to explain the coverage they’re offering and show evidence that the benefits of a plan are really available in the state or county where a consumer lives.

One last provision that will make consumers happy is that a broker can’t keep calling a person to try and sell them a plan until 12 months after they first asked for information or expressed interest in a plan.

And, of course, there’ll be scams

For scammers, Open Enrollment is like shooting at fish in a barrel: 65 million people trying to figure things out and only having two months to do it. They were out in droves, last year, and they'll be back at it again this year.

“Seniors may be contacted by someone purporting to be from their insurance company asking them to verify information. This is a common tactic of identity thieves trying to trick their victims into providing information,” Scamicide’s Steven Weisman said in an email to ConsumerAffairs.

“They also may be contacted by people claiming to have supplemental insurance programs that will save them thousands of dollars. Here too, you cannot be sure that they are legitimate when they contact you by phone, text message, email or even regular mail.” 

One last gamble Weisman said scammers are likely to try is to send phishing emails that appear to come from your employer requesting you to review and okay your health care benefits. But, if you click on the link to approve those benefits, that click could do you in!

Weisman said that those links are either infected with malware which will wreck your computer until you pay a ransom to get it removed or lead you to a site where they’ll try to trick you into providing personal information that can lead to your becoming a victim of identity theft.

It’s taken a year for President Biden’s lower-cost prescription drug law, included in the Inflation Reduction Act, to find its way toward becoming official, but that day has come.

The Centers for Medicare and Medicaid Services (CMS) has announced that Medicare is now able to directly negotiate the prices of prescription drugs, positively impacting the finances of millions of Americans.

The first 10 drugs covered under Medicare Part D selected for negotiation under the Medicare Drug Price Negotiation Program include:

1. Eliquis (Prevention and treatment of blood clots)

2. Jardiance (Diabetes; Heart failure)

3. Xarelto (Prevention and treatment of blood clots; Reduction of risk for patients with coronary or peripheral artery disease)

4. Januvia (Diabetes)

5. Farxiga (Diabetes; Heart failure; Chronic kidney disease)

6. Entresto (Heart failure)

7. Enbrel (Rheumatoid arthritis; Psoriasis; Psoriatic arthritis)

8. Imbruvica (Blood cancers)

9. Stelara (Psoriasis; Psoriatic arthritis; Crohn’s disease; Ulcerative colitis)

10. Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill (Diabetes)

A promise of transparency

“Transparency” gets ballyhooed a lot in the consumer world, but CMS brass is going on record that it’s serious when it uses that word.

“Promoting transparency and engagement continue to be at the core of how we are implementing the new drug law and the Medicare Drug Price Negotiation Program, and that is why we set out a process for the first round of negotiation that engages the public throughout,” said Dr. Meena Seshamani, deputy administrator and director of the Center for Medicare. 

Hold your horses

Don’t head down to the drugstore asking for a price break, yet. CMS says the manufacturers of these drugs first have to agree to the process. Those companies have until October 1 to sign off on that and then will have until September 2024 to make that commitment real.

At that point, CMS will publish the "maximum fair prices” for those 10 drugs, but it will be another two years – 2026 – until the negotiated prices for those drugs go into effect.

However, there may be a short-term option. With CVS Caremark offering lower prescription costs with its new Cost Saver program and Kroger doing a deal with Mark Cuban's CostPlus Drugs, it's possible that those 10 drugs destined for price decreases might become available at a better price point sooner than 2026.

What do fraudsters love more than anything else? One single source they can tap into and outwit millions and millions of people.

There are big tech companies, mobile phone companies, banks, and credit card companies, but who else has millions? Medicare's endless number of beneficiaries, that’s who – all 65 million of them. If you include everyone on Medicaid, CHIP, and marketplace plans, that number goes to 160 million potential victims.

Medicare scams have become a never-ending loop. They pop up during open enrollment, they get wrapped up in impersonation scams, they even go as far as offering DNA tests to try and get someone's Medicare credentials. And those credentials are a golden ticket to information that can be monetized in any number of ways. 

Medicare scams place cash-strapped beneficiaries in a worse financial bind because scams increase healthcare costs and taxes for everyone, a Centers for Medicare & Medicaid Services (CMS) spokesperson told ConsumerAffairs. 

Protecting yourself

CMS’ top tip to every one of its members is to guard their Medicare number just like they would their Social Security and credit cards.

“You should only share your Medicare number with trusted healthcare providers,” the spokesperson said, adding that enrollees should become familiar with how Medicare uses someone's private information. "If you join a Medicare health or drug plan, the plan will let you know how it will use your personal information."

It's also important to remember that Medicare will never call anyone to sell them anything or visit anyone at their home. Medicare, or someone representing Medicare, will only call and ask for personal information in these two situations:

1. A Medicare health or drug plan may call you if you’re already a member of the plan. The agent who helped you join can also call you.

2. A customer service representative from 1-800-MEDICARE can call you if you’ve called and left a message or a representative said that someone would call you back.

If you sense that there’s something funny going on, CMS offers Medicare recipients a very detailed list of what phone numbers to call, online options, etc.

The agency also has state-by-state connections and for a local perspective and assistance, members may also want to contact the Senior Medicare Patrol (SMP). It helps monitor reports of scams and potential fraud in every state and does local outreach and education to Medicare beneficiaries and their families/caretakers.

“Honey, Captain Kirk says we should buy this Medicare plan…”

There’s one other thing that Medicare enrollees should know. Beginning September 30, a new rule from Medicare prohibits ads about “Medicare Advantage” intended to mislead people.

So, if William Shatner, Joe Namath, or Jimmy Walker comes on TV pitching Medicare Advantage, they are going to have to clearly state the name of the insurance plan they’re advertising. 

Because marketers can be crafty, CMS warns consumers that if they see any pitch using the Medicare logo or card, the marketing company is probably trying to fool consumers into believing that a celebrity endorser represents the federal government. Use of those logos and cards will be disallowed starting on Sept. 30, as well.

The new rules also require insurance agents and brokers who market Medicare Advantage plans to explain the coverage they’re offering and show evidence that the benefits of a plan are really available in the state or county where a consumer lives.

One last provision that will make consumers happy is that a broker can’t keep calling a person to try and sell them a plan until 12 months after they first asked for information or expressed interest in a plan.

Wednesday was a big day for Medicare legislation on Capitol Hill.

There were three separate bills to amend parts of the Social Security Act that relate to Medicare. Among them is one designed to eliminate a provision under the Medicare Advantage program that inadvertently penalizes Medicare Advantage plans for providing high-quality care to Medicare beneficiaries; another ensures access by Medicaid beneficiaries to appropriate quality foot and ankle care and modifies the requirements for diabetic shoes to be included under Medicare.

But the centerpiece Medicare legislation on Wednesday was the unveiling of the Medicare for All Act of 2019.

The legislation proposed by Sen. Bernie Sanders (I-VT) and 14 Democratic colleagues would, in Sanders’ words, “guarantee health care to every American as a right, not a privilege.”

“The United States spends far more per capita on health care than any other nation; however, 34 million Americans do not have health insurance, thousands of people die each year because they cannot afford medical care, almost one in three adults with insurance have been unable to afford the care they need and nearly half fear bankruptcy in the event of a health emergency,” Sanders said.

The upshot for the consumer

The big question, of course, is what Sanders’ plan means for the consumer.

The short answer is that it depends on if you currently have health insurance and, if you do, how you’re covered. The New York Times untangled that dilemma and found the answers to some of those if’s, and’s, and but’s:

• People insured through work would have new taxes but no more premiums.

• People with Medicaid would have more choices but possibly higher taxes.

• People currently with Medicare would have more generous coverage.

• The uninsured would all get health care.

• People who buy their own insurance would have new taxes but fewer out-of-pocket expenses.

• Veterans would keep their existing health care system.

• Native Americans could also keep their current source of care.

Bringing healthcare costs down to a reasonable level

Sanders also proposes changing the way health providers and drug companies would be compensated -- a welcome sight for every consumer’s sore eyes.

If the bill makes it all the way through the legislative maze, doctors and hospitals are likely looking at pay cuts but will no longer face unpaid bills. The profit margins at drug manufacturers would most likely be smaller, and health insurance companies would largely be eliminated.

“In my view, the current debate over Medicare for All really has nothing to do with health care. It’s all about greed and profiteering. It is about whether we maintain a dysfunctional system which allows the top five health insurance companies to make over $20 billion in profits last year,” Sanders said.

“The American people are increasingly clear. They want a health care system which guarantees health care to all Americans as a right. They want a healthcare system which will lower healthcare costs and save them money. They want a health care system which will guarantee them freedom of choice as to which doctor or hospital they can go to. They want a health care system which will substantially lower the cost of prescription drugs. They want Medicare for seniors which will finally cover dental care, hearing aids and eyeglasses. In other words, they want Medicare for All, and that’s what we will deliver to them.”

A new study conducted by researchers from Tufts University suggests that healthy food prescriptions could be the answer for a number of traditional health concerns. The researchers say that if Medicare/Medicaid were to start doling out these prescriptions, the results would not only be cost effective but also leave patients with countless health benefits.

“We found that encouraging people to eat healthy foods in Medicare and Medicaid -- healthy food prescriptions -- could be as or more cost effective as other common interventions, such as preventative drug treatments for hypertension or high cholesterol,” said researcher Yujin Lee, PhD.

“Healthy food prescriptions are increasingly being considered in private health insurance programs, and the new 2018 Farm Bill includes a $25 million Produce Prescription Program to further evaluate this approach.”

Food as medicine

The researchers modeled two scenarios to measure how consumers’ health and overall cost would be affected by this change. The team used three years’ worth of data from the National Health and Nutrition Examination Survey (NHANES) to determine sample population sizes of those who would be eligible for Medicare, Medicaid, or both.

In the first model, the researchers aimed to see the effects of Medicare and Medicaid picking up the tab for 30 percent of fruit and vegetable purchases via an electronic debit card. The second model also included fruits and vegetables, while also adding seafood, plant-based oils, whole grains, and nuts/seeds.

Perhaps the biggest finding was that, overall, consumers wouldn’t be relying on healthcare as often. The researchers estimated that the first model would reduce healthcare costs by nearly $40 billion, while the second, more broad model would knock down healthcare costs by over $100 billion.

“Our findings support implementation and evaluation of healthy food prescriptions within healthcare systems to improve the diet and health of Americans,” said researcher Renata Micha.

From a health standpoint, the researchers found similar results. Estimating the results of current beneficiaries over the course of their lifetimes, the second model was predicted to prevent 120,000 cases of diabetes and over 3.2 million cases of cardiovascular disease; the first model was estimated to prevent nearly two million cases of cardiovascular disease.

“Medicare and Medicaid are the two largest healthcare programs in the U.S., together covering one in three Americans and accounting for 1 in every 4 dollars in the entire federal budget,” said researcher Dr. Dariush Mozaffarian. “These new findings support the concept of Food is Medicine: that innovative programs to encourage and reimburse healthy eating can and should be integrated into the healthcare system.”

Effects for body, mind, and planet

Recent studies have explored the countless benefits of eating healthy for physical and mental health, as well as for the environment.

Researchers have also charted out how low-income families can eat healthy on a limited budget; however, making sure that consumers have access to proper federal programs is key.

“This research demonstrates that menus that meet USDA guidelines can be purchased by a family of four when shopping at a bulk supermarket, but any reduction in SNAP benefits or increase in food costs would make it difficult for these economically vulnerable families to maintain a healthy lifestyle,” said researcher Dr. Karen M. Jetter.