Agenda

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Agenda

• What is the extra help?
• Who is eligible for the extra help?
• How much extra help is available?
• How/where to apply for the extra help
• Enrollment periods for the extra help
• How to get more information

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Extra Help with Medicare Prescription Drug Plans

• Available January 2006
• Offered through private prescription drug plans
  (PDPs)
• Can be offered by Medicare Advantage plans (like
  an HMO or PPO)

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Extra Help with Medicare Prescription Drug Plans

• Limited income and resources
• Provides help paying
• monthly premiums,
• deductibles, and
• co-payments
• Replaces Discount Card
• No 30 Annual Fee
• No Annual 600 Drug Credit

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Eligibility for Extra Help

• Must be entitled to Part A and/or enrolled in
  Part B
• Enrollment is voluntary
• Enrollment penalties for persons who wait
• Exception for those covered under other
  comparable insurance

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Eligibility for Extra Help

• Annual income below 14,700 (individual)
• Annual income below 19,800
• (married couple living together)
• May not have to pay monthly premiums or
  deductibles
• Co-payments could be as low as 1

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Eligibility for Extra Help

• Higher annual income
• Support other family members living with you
• Earnings from work

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Eligibility for Extra Help

• Resources limited to
• 10,000 for individual
• 20,000 for married couple
• Additional 1,500 per person allowed for burial
  expenses

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Eligibility for Extra Help

• Resources that count
• Bank accounts
• Stocks and
• Bonds
• Resources that do not count
• House or
• Automobile

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Automatic Enrollment for Extra Help to Dual
Eligibles

• Currently entitled to Medicare Medicaid
• Currently entitled to Medicare SSI
• State currently pays for monthly premiums
• QMB
• SLMB or
• QI

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Enrollment Periods for Extra Help

• Initial enrollment
• November 15, 2005 - May 15, 2006
• Subsequent years
• Open enrollment November 15 - December 31
• Penalty will apply for late enrollment

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Medicare Prescription Drug Plans Your Costs in
2006

• You will choose a prescription drug plan pay a
  premium of about 37 a month
• You will pay the first 250 (called a
  deductible)
• Medicare will pay 75 of costs between 250
  2,250 in drug spending. You will pay only
  25 of these costs.
• You will pay 100 of the drug costs above 2,250
  until you reach 3,600 in out-of-pocket
  spending
• Medicare will pay about 95 of the costs after
  you have spent 3,600

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Medicare Prescription Drug Plans Your Costs in
2006

• Group 1
• Full benefit dual eligibles with incomes below
  100 FPL
• Group 2
• Full benefit dual eligibles and non-dual eligible
  beneficiaries with incomes of 100-135 FPL and
  limited resources (6,000 per individual and
  9,000 married couple)
• Group 3
• Beneficiaries with incomes of 135-150 FPL and
  limited resources (10,000 individual and 20,000
  married couple)

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Medicare Prescription Drug Plans Your Costs in
2006
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For More Information on Medicare Prescription
Drug Plans

• Call 1-800-MEDICARE
  (1-800-633-4227)
• Visit www.medicare.gov
• Information on drug plans in your area beginning
  in October 2005

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How to Apply for Extra Help

• June through August 2005
• Complete application received in the mail from
  Social Security
• Call Social Security toll free
• 1-800-772-1213
• Beginning July 1, 2005
• Apply online at www.socialsecurity.gov