Tips for Changing Your Part D Plan

During Open Enrollment

*From The Medicare Minute*

Medicare Part D, the prescription drug benefit, is the part of Medicare that covers most outpatient prescription drugs. Part D is offered through private companies either as a stand-alone prescription drug plan for those enrolled in Original Medicare or as a set of benefits included with your Medicare Advantage Plan. Sometimes a plan’s premium increases or the plan does not cover your new medications.

Before you start looking at plans, make sure you know the prescriptions you take, the dosages of each, and the pharmacies you usually use.
Does this plan cover my drugs? You should also find out if there are any restrictions on your covered drugs, such as prior authorization, step therapy, or quantity limits.
What are the costs associated with this plan? Medicare’s Plan Finder tool provides an estimated out-of-pocket cost for the year for each plan, based on your medications and dosages.
Are my pharmacies preferred and in-network? You will pay less at preferred in-network pharmacies.
What is the plan’s star rating? Medicare uses a star rating system to measure how well plans perform in different categories, like quality of care and customer service. Medicare’s Plan Finder tool includes plans’ star ratings.

New in 2023! While comparing plans, it may be helpful to know that starting in 2023 all Part D plans will cover vaccines at no cost to you and will cap your monthly insulin costs at $35, due to the Inflation Reduction Act.

You can make changes to your coverage during Medicare’s Open Enrollment Period, which spans October 15 through December 7 each year. Plans may change their costs and the drugs they cover from year to year. It is important to review your plan notices to learn if prices will change and if your drugs will still be covered next year.

If you receive your drug coverage as part of your Medicare Advantage Plan, you can also make changes during the Medicare Advantage Open Enrollment Period, which spans January 1 through March 31 each year. This period can be helpful for anyone who is not satisfied with the change they made during the fall.

You can contact your Senior Health Insurance Program (SHIP) for any other Medicare-related questions or concerns you have. SHIP counselors are government funded to provide trusted, unbiased Medicare counseling at no cost to you.

Use the online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP to help you choose the plan that is best for you!

Illinois Psychologist Convicted

of Health Care Fraud

A federal jury convicted a licensed Illinois psychologist of defrauding Medicare by submitting fraudulent claims for psychotherapy services he never provided.

Renato F. Duarte, aka Ren Duarte, 63, of Chicago, submitted Medicare claims from July 2016 through June 2019 for psychotherapy services purportedly provided to nursing home patients in Chicago and surrounding areas.

Duarte was convicted of four counts of health care fraud and is scheduled to be sentenced on April 18, 2023. Duarte faces a maximum penalty of 10 years in prison on each count.

You can read the whole press release from the Department of Justice here.

If you or someone you know has had any potential home health care fraud please contact the Illinois SMP at (800)699-9043.

November and December 2022 Presentations and Fairs*

November 11^th at 11:00 AM – SMP and Pathlights Informational Session

Alsip-Merrionette Park Library (11960 S Pulaski Rd. Alsip, IL 60803)

November 16^th at 10:00 AM – Aging Care Connections Senior Fair (Spanish)

Summit Park District (5700 S Archer Rd. Summit, IL 60501)

November 18^th at 10:30 AM – Types of Medicare Fraud with BINGO

West Suburban Senior Services (439 Bohland Ave. Bellwood, IL 60104)

December 1^st at 10 am – SMP presentation with BINGO

Northbrook Senior Center (3323 Walters Ave. Northbrook, IL 60062)

December 8^th at 12:30 pm – SMP presentation with BINGO

Salermo’s Meal Site (9301 W 63rd St. Hodgkins, Illinois 60525)

December 21^st at 11:00 am – SMP presentation with BINGO

Senior’s Citizens Academy (650 E. Phoenix Center Drove Phoenix, Illinois 60426)

December 22^nd at 11:00 am – SMP presentation with BINGO

Barrington Park District (235 Lions Drive Barrington, IL 60010)

*Please note that all events are in person

Have a wonderful week!

Travis Trumitch

travis.trumitch@ageoptions.org

Please share this Fraud Alert with colleagues, consumers, or other professionals in your area. If you would like to sign up to receive the Fraud Alert directly, visit click here.

This project was supported, in part by grant number 90MPPG0036, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.

The Illinois SMP at AgeOptions partners with agencies across the state to empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors, and abuse through outreach, counseling, and education.

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