Rules About Getting Help

Many people may offer to help you. This help may be very valuable. But some people who offer to help may be trying to sell a particular drug plan. You need to understand what kind of help people are allowed to give you—and how to protect yourself.

What helpers or assistants might help you do:

  • They can help you sort out what your options are for drug coverage—depending on what coverage you currently have.
  • They can give you facts and information. For example, they can
    • Help you find out which plans in your area cover your drugs.
    • Tell you what limits each plan places on your drugs and what your drugs would cost with each plan.
  • If there is access to the internet , they can help you use the Medicare.gov Plan Finder. You can use this tool to find out how you would have to pay for specific plans in your area. You can also find out how much your drugs would cost under a specific plan.
  • If you want to find out about the Extra Help available for people with limited incomes and resources, they can help you find out if you might be eligible. They can help you complete the application for this Extra Help. They can either fill out a paper application, or file an application online through BenefitsCheckUp or on the Social Security Administration website.

Who can help me join a plan or apply for extra help with costs?

Anyone can help you fill out the forms. But you will be giving some personal information to complete the application. Use common sense about who you should trust:

  • Family members.
  • Medicare staff.
  • Social Security Staff (in their office) – if you are applying for the extra help. If you are not at their office, they should have federal employee identification.
  • Staff at the  senior center, Area Agency on Aging or State Health Insurance Assistance Program (SHIP) near where you live.

Anyone who helps you should use official forms—not copies. These forms should say they are from Medicare or the Social Security Administration. If they enter your information on a web site, it should be on a site you trust.

What helpers may ask:

  • What type of drug coverage and insurance plans you currently have and how much drug coverage you have.
  • What prescription drugs you are taking.
  • Which drug stores you like to use.
  • What your income and resources are. If you have limited income and resources, you may be eligible for extra help paying the costs of the Medicare Prescription Drug Coverage.

What helpers SHOULD NOT do:

  • They should not recommend any specific plan.
  • They should not say things like “most people choose plan X” or “plan Y is the best plan.”
  • They should not pressure you into making a decision about your drug coverage or joining a plan if you are not ready.

Are there special rules for people selling Medicare prescription drug plans?

  • They cannot come to your home unless you invite them
  • They can call you—but there are rules.

What plans CAN DO on the phone:

  • They may call you to talk about their plan.
  • They must call between 8 a.m. and 9 p.m. under federal law. They may be able to call at other times under state law.
  • All you need to do is say “stop” to end unwanted sales calls. Plans must honor all “do not call again” requests.
  • If you are on the National Do Not Call Registry, they should not call you.

What plans CANNOT DO on the phone

  • They cannot call you and then ask you to enroll over the phone.
  • They cannot ask you to pay for your plan over the phone. They must send you a bill.
  • They should not ask you for your bank account or credit card information.

These rules are to protect you from people who call and claim to represent plans, but are only trying to get your personal information. It does not help if they give you a number to call back unless you know that the number they have given you is for an official Medicare prescription drug plan.

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