Minnesota Rural Health Association presents

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Minnesota Rural Health Association
presentsPharmaceutical Options for Seniors

• Robin Weis
• MN River Area Agency on Aging
• 2/9/07

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Senior LinkAge Line (SLL)

• Statewide information and assistance phone line
• 1-800-333-2433
• 7 Call Centers in MN- Slayton, Rochester, Metro,
  St. Cloud, Duluth, Fergus Falls, Warren
• Monday-Friday, 8 a.m. to 430 p.m.
• Resources online at www.minnesotahelp.info
• Call specialists are certified health insurance
  counselors thru the MN Board on Aging and
  Certified Information and Referral Specialists
  thru the Alliance of Information and Referral
  Systems (at a minimum)
• Senior Outreach Specialists and trained
  volunteers provide in-person assistance

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SLL- Who we Serve

• Seniors (60 and older)
• Medicare Beneficiaries of all ages
• Caregivers
• Grandparents raising grandchildren
• People of all ages needing prescription
  assistance
• Professionals working with these populations

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Options Based on Individual Circumstances

• Medicare
• Medicare Part D
• Medical Assistance
• Medicare Supplemental Polices
• Health Plans and Advantage Plans
• Employer/Retiree Plans
• Veteran Benefits
• RxConnect
• Foundations

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Medicares Rx Coverage

• Medicare Part A and B continues to cover
  prescription drugs that were covered prior to
  Medicare Part D
• Medicare approved hospital stay
• Medicare approved nursing home stay
• Medications that cant be self- administered
• Most prescriptions are NOT covered by Medicare
  Part A and B.

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Medicare Part Ds Rx Coverage

• Multiple options with varying premiums,
  deductibles, coverage gap and cost sharing.
• Stand alone plans or Medicare Advantage/Health
  Plans
• Formulary
• Pharmacy Networks- Mail order an option with some
  companies
• Enrollment periods
• Creditable Coverage

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Medical Assistance Rx Coverage

• Drastically changed since Medicare Part D
• Medicare Part D covered meds are no longer
  covered under Medical Assistance
• Can change plans monthly if enrolled in a MN
  Health Care Program
• MSHO/MnDHO- Medicare A, B and D
• Wellpoint- Point of Sale Option

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Medicare Supplemental Polices

• Prescription coverage not available for purchase
  after 1/1/06
• 80 or 50 coverage still available on plans in
  place prior to 12/31/05
• Should compare current policy with Medicare Part
  D options
• 50 coverage under supplemental plans is not
  creditable coverage

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Health Plans and Advantage Plans

• Medicare Cost Plans
• Medicare Advantage Plans
• Medicare Advantage HMO Plans
• Medicare Advantage Private Fee-for-Services
  (PFFS) plans
• Medicare Advantage Preferred Provider
  Organization (PPO) Plans
• Medicare Advantage Special Needs Plans (SNPs)
• Medicare Medical Savings Account Plans

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Medicare Cost Plans

• Some provide drug coverage for their members only
• Members may opt out of drug coverage and buy a
  stand alone Medicare Part D plan

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Medicare Advantage (MA) Plans

• Many Medicare Advantage Plans provide
  prescription drug coverage
• If drug coverage is offered, enrollees must get
  drug coverage from their plan.
• In most plans if they enroll in a stand-alone
  plan, they will be dis-enrolled from their health
  care coverage.

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Medicare Medical Savings Account (MSA) Plans

• Will begin to see options in MN in 2007
• MSA plans do not have drug coverage
• Enrollees have the option of enrolling in a
  stand-alone Medicare Part D plan

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Employer/Retiree Plans

• Must refer to the coverage handbook to see how
  drugs are covered
• Each plan varies
• Consider premium costs paid by the senior

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Veteran Benefits

• Encourage to contact the county Veteran Service
  Officer if not currently receiving drug coverage
  thru VA
• VA guidelines change frequently

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RxConnect- objective, neutral service that
discusses all pharmaceutical options

• Using web sites to compare various prices
• Mail order
• Review benefits available through a health
  plan,Medicare supplement plan or HMO
• Enrolling in publicly funded programs
• Negotiating with a local pharmacist
• Getting help from the drug companies
• Medicare Prescription Drug coverage
• Prescription savings discount cards

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Discount Card Example

• TogetherRx Access
• Can not have current drug coverage
• Can not be a Medicare beneficiary
• Uses local pharmacy
• Free, little paperwork required
• Discount available on over 300 brand names and
  some generics
• Most receive 25-40 off of brand-name drugs

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Help from Drug Companies

• Most require no current drug coverage, however
  some helping in Medicare Part D coverage gap
• Guidelines and applications often change
• Income guidelines and sometimes asset guidelines
• Physician participation
• Renewals required frequently
• www.needymeds.com or www.rxassist.org

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Foundations

• Vary by foundation
• Examples
• www.healthwellfoundation.org
• www.patientaccessnetwork.org

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Contact Information

• Robin Weis
• 507-836-8547, ext. 112
• srlinkage_at_swrdc.org