Medicare Prescription Drug Plans

1
Medicare Prescription Drug Plans

• What Do You Need To Know?

2
Medicare Basics

• Part A
• Hospital Insurance
• Part B
• Medical Insurance (doctor visits)
• Part C
• Medicare Advantage
• Part D
• NEW Prescription Drug Benefit

3
Eligibility and Enrollment

• Entitled to Part A and/or enrolled in Part B
• Must reside in the plans service area
• Program voluntary (for most)
• Must enroll with the drug plan
• Monthly fees apply (for most)

4
Prescription Drug Benefit

• Available to everyone with Medicare
• Medicare contracts with private companies
• Benefits begin as early as January 2006
• Financial aid is available through the Social
  Security Administration
• Income and resource limits apply

5
Example of Standard Prescription Drug Coverage

• Estimated 32 monthly premium
• 250 deductible
• Co-insurance of 25 of drug costs from 250 to
  2,250 (total drug spending)

6
Example of Standard Prescription Drug Coverage

• Coverage gap from 2,250 to 5,100
• Beneficiary pays 100 of drug costs
• Catastrophic coverage after 5,100 (3,600 in
  out-of-pocket costs)
• Beneficiary pays only 5 of drug costs

7
Five Main Groups

• No Prescription Drug Coverage
• Consider the current costs of your medications
• Do you qualify for extra help?

8
Five Main Groups

• Employer/union coverage (including VA, TRICARE,
  and FEHB)
• Is your current coverage as good as the standard
  Medicare prescription coverage?
• Contact your plan administrator

9
Five Main Groups

• Medicare and Medicaid
• Auto-enrolled unless plan chosen before January
  1, 2006
• Automatically qualify for the extra help
• Do not need to complete the application for extra
  help

10
Five Groups

• Medicare Advantage Plan or other Medicare Health
  Plan
• Provide medical and drug coverage
• Similar to HMO or PPO, required to use doctors in
  plan

11
Five Groups

• Medigap Policy with Prescription Drug Coverage
• In general, the Medicare prescription drug
  coverage will offer savings
• If you join a Medicare drug plan, contact your
  Medigap insurer

12
Need Help?

• Call 1-800-MEDICARE
  (1-800-633-4227)
• Visit www.medicare.gov
• For extra help
• - Social Security Administration
• - 1-800-772-1213
• - www.socialsecurity.gov
• - 1-800-AGELINE (1-800-243-5463)

13
Resources

• For enrollment
• 1-800-MEDICARE (1-800-633-4227)
• www.medicare.gov
• For extra help
• Social Security Administration
• 1-800-772-1213
• www.socialsecurity.gov
• 1-800-AGELINE (1-800-243-5463)

14
Resources

• Alabama Medicaid Agency
• www.medicaid.state.al.us

15

• This presentation made possible by support from
  the American Pharmacy Cooperative, Inc.

16
Enrolling in Medicare Part D
17
Initial Enrollment Period

• If you have Medicare and Medicaid, choose a drug
  plan before January 1, 2006
• If you fall in one of the other four groups you
  have until May 15, 2006, to enroll

18
Initial Enrollment Period

• Penalty of 1 per month added to monthly fee if
• Enrollment is delayed and
• Beneficiary is without creditable coverage

19
You Have Responsibilities

• Decide if you should participate
• Apply for extra help with Social Security
• Choose a plan that best meets your needs
• Enroll in a Prescription Drug Plan
• Change plans, if necessary
• Pay your premiums, co-pays and deductibles

20
Applying for Extra Help

• For those with limited income and resources
• Contact Social Security at 1-800-772-1213

21
Applying for Medicare Savings Program

• For those with limited income
• Contact Medicaid at 1-800-362-1504

22
What You Need To Do To Prepare

• You have time. Sign up ends May 15, 2006. Choose
  wisely.
• Find out if you qualify for extra help from
  Social Security.
• Think of the three Cs
• Cost
• Coverage
• Convenience

23
Cost

• What do you currently pay for your medications?
• True out-of-pocket costs
• How much do you want to pay?
• Deductible?
• Co-pay?
• Premium?
• Medication costs?

24
Coverage

• Make a list of the drugs you currently take
• Name of the medicine
• Dosage
• How often you take it
• Cost (not just your co-pay)

25
Convenience

• Write down the names of the pharmacies you use.
• Find out what plans they accept.
• Do you want to use a mail order pharmacy?
• How much do you travel?

26
Protect Your Personal Information

• Dont pay cash, write a check
• Only plans that are approved by Medicare can
  offer a Medicare prescription drug plan
• Social Security is making follow-up calls to
  people

27
Protect Your Personal Information

• You do not HAVE to join or else lose benefits
• Cannot enroll over the phone, only promote the
  plan
• Keep your personal information safe!

28
Protect Your Personal Information

• Dont give your personal information out
• Never give your bank account, credit card or
  social security number out over the phone
• Never pay cash or send enrollment payments over
  the internet
• Persons working with Medicare will never show up
  uninvited at your home

29
Need Help?

• Call 1-800-MEDICARE
  (1-800-633-4227)
• Visit www.medicare.gov
• For extra help
• - Social Security Administration
• - 1-800-772-1213
• - www.socialsecurity.gov
• - 1-800-AGELINE (1-800-243-5463)

30
Resources

• For enrollment
• 1-800-MEDICARE (1-800-633-4227)
• www.medicare.gov
• For extra help
• Social Security Administration
• 1-800-772-1213
• www.socialsecurity.gov
• 1-800-AGELINE (1-800-243-5463)

31
Resources

• Alabama Medicaid Agency
• www.medicaid.state.al.us

32

• This presentation made possible by support from
  the American Pharmacy Cooperative, Inc.

33
Special Information For People Now On Medicaid
and Medicare
34
What Will be Different Under Part D

• Full Dual Eligibles
• Previously had drug coverage under Medicaid
• Medicaid drug coverage ends 12/31/05
• Auto-assigned to a Part D plan
• Can change plans monthly
• Automatically qualify for extra help

35
What Drugs are not Covered and How Medicaid Will
Help

• Full Dual Eligibles
• Will continue to receive coverage for certain
  excluded drugs by Medicaid
• Still subject to Medicaid approval (PA) or other
  requirements

36
Part D Excluded Drugs Covered by Medicaid

• Over-the-counter drugs
• Cough and Cold medicines
• Most vitamin and mineral products
• Drugs for weight gain or loss
• Barbituates
• Benzodiazpines

37
The Auto-Assignment Process

• How assignments made
• Recent changes
• Changing plans
• What to do if you have other insurance for your
  medicine now

38
Medicare Savings Program

• QMB, SLMB, Q1 recipients
• Can choose to participate
• Participants must choose a plan
• Auto-assigned to a Part D plan
• Automatically qualify for extra help

39
Need Help?

• Call 1-800-MEDICARE
  (1-800-633-4227)
• Visit www.medicare.gov
• For extra help
• - Social Security Administration
• - 1-800-772-1213
• - www.socialsecurity.gov
• - 1-800-AGELINE (1-800-243-5463)

40
Resources

• For enrollment
• 1-800-MEDICARE (1-800-633-4227)
• www.medicare.gov
• For extra help
• Social Security Administration
• 1-800-772-1213
• www.socialsecurity.gov
• 1-800-AGELINE (1-800-243-5463)

41
Resources

• Alabama Medicaid Agency
• www.medicaid.state.al.us

42

• This presentation made possible by support from
  the American Pharmacy Cooperative, Inc.

43
Special Information forHealth Care Providers
44
Identifying Recipients with a Part D Plan

• Yellow recipient letter
• Medicare Pharmacy Line
• 1-866-835-7595
• E1 eligibility transaction to the TrOOP
  facilitator

45
Dual Eligibles If Not Auto Enrolled

• Point of Sale Facilitated Enrollment
• CMS Contractor (WellPointe)
• Pharmacist to bill special account that will
  engage in a series of steps
• CMS website has instructional video on this
  process

46
Identifying PDPs for Nursing Home Patients

• Procedure for up to 100 recipients
• Procedure for over 100 recipients
• Questions about these procedures, contact
• Michele Ramirez 215-861-4159

47
Identifying PDPs for Nursing Home Patients

• Fax number
• 1-785-830-2593
• Mailing information
• Medicare Nursing Home Requests
• 3383 Greenway Drive
• Lawrence, KS 66046-5504
• 785-838-2107 (delivery only)

48
Options for Full Dual Eligibles

• One time fill
• Switch to a therapeutic equivalent drug
• Appeals process
• Change PDP

49
What Drugs are not Covered and How Medicaid Will
Help?

• Full Dual Eligibles
• Will continue to receive coverage for certain
  excluded drugs by Medicaid
• Still subject to Medicaid approval (PA) or other
  requirements

50
Part D Excluded Drugs Covered by Medicaid

• Over-the-counter drugs
• Cough and Cold medicines
• Most vitamin and mineral products
• Drugs for weight gain or loss
• Barbituates
• Benzodiazpines

51
Information on PDPs

• CMS website www.medicare.gov
• Medicare 1-800-633-4227
• Medicare and You 2006 Handbook
• Alabama Medicaid website www.medicaid.state.al.u
  s

52
Need Help?

• Call 1-800-MEDICARE
  (1-800-633-4227)
• Visit www.medicare.gov
• For extra help
• - Social Security Administration
• - 1-800-772-1213
• - www.socialsecurity.gov
• - 1-800-AGELINE (1-800-243-5463)

53
Resources

• For enrollment
• 1-800-MEDICARE (1-800-633-4227)
• www.medicare.gov
• For extra help
• Social Security Administration
• 1-800-772-1213
• www.socialsecurity.gov
• 1-800-AGELINE (1-800-243-5463)

54
Resources

• Alabama Medicaid Agency
• www.medicaid.state.al.us

55

• This presentation made possible by support from
  the American Pharmacy Cooperative, Inc.

56
Using the Medicare Website to Find a
PrescriptionDrug Plan
57
www.medicare.gov
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Need Help?

• Call 1-800-MEDICARE
  (1-800-633-4227)
• Visit www.medicare.gov
• For extra help
• - Social Security Administration
• - 1-800-772-1213
• - www.socialsecurity.gov
• - 1-800-AGELINE (1-800-243-5463)

83
Resources

• For enrollment
• 1-800-MEDICARE (1-800-633-4227)
• www.medicare.gov
• For extra help
• Social Security Administration
• 1-800-772-1213
• www.socialsecurity.gov
• 1-800-AGELINE (1-800-243-5463)

84
Resources

• Alabama Medicaid Agency
• www.medicaid.state.al.us

85

• This presentation made possible by support from
  the American Pharmacy Cooperative, Inc.