Medicare Prescription Drug Coverage

1
Medicare Prescription Drug Coverage

• Atlanta Regional Office
• Centers for Medicare Medicaid Services
• September 12, 2005

2
Basic Medicare Facts

• For people 65 older
• People under 65 with certain disabilities
• People with End-Stage Renal Disease

3
Medicare Prescription Drug Coverage

• Medicare will offer prescription drug coverage
  beginning on January 1, 2006.

4
Protection for You

• Medicare prescription drug coverage is important.
  It protects you from high out-of-pocket costs.

5
Who is Eligible for Medicare Prescription Drug
Coverage

• Medicare prescription drug coverage is available
  to everyone who has Medicare Part A and/or Part
  B.

6
If You Are Eligible for Medicare Prescription
Drug Coverage

• Eligible individuals may enroll in a
• Medicare Prescription Drug Plan (PDP) or
• Medicare Advantage Prescription Drug Plan (MA-PD
  plan).

7
If You Enroll in an Medicare Advantage Plan

• Individuals enrolled in an Medicare Advantage
  (MA) plan must receive Medicare prescription drug
  coverage from the MA-PD plan.

8
What You Need To Do

• People with Medicare will need to decide how they
  want to get their prescription drug coverage.
• Information about plans will be available October
  2005.

9
Enrollment Period

• You can first enroll in a Medicare prescription
  drug plan from November 15, 2005 through May 15,
  2006.

10
Standard Medicare Prescription Drug Coverage Costs

• Costs for a plan with standard Medicare
  prescription drug coverage might look like this
• 33.15 monthly premium
• 250 deductible
• 25 coinsurance
• 100 between 2,250 and 5,100
• 5 coinsurance from 5,100 and up

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Out-of-Pocket Expenses

• Out-of-pocket expenses include any deductibles
  and coinsurance that you pay.
• Does not include the monthly premium.

12
Covered Medicare Prescription Drugs

• Plans cover brand-name and generic drugs.
• Covered Medicare prescription drugs may be
  different with different plans.

13
Persons with Limited Income and Resources

• If the person with Medicare has limited income
  and resources, there is extra help for paying for
  co-payments, deductibles, monthly premiums, and
  coinsurance.

14
Persons with Limited Income and Resources

• Some people will be automatically eligible for
  the extra help.
• They are considered deemed.

15
Persons with Limited Income and Resources

• Many people may have already received an
  application for the extra help from the Social
  Security Administration this summer.

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Drug Coverage from Another Source

• If a person with Medicare already has drug
  coverage from another source, he or she needs to
  decide whether to continue the current coverage
  or change to a Medicare prescription drug plan.

17
Drug Coverage from Another Source

• People with Medicare who currently have
  prescription drug coverage will be notified by
  their current insurance plan if their current
  drug coverage is at least as good as Medicare
  prescription drug coverage.

18
Drug Coverage from Another Source

• If the drug coverage the person with Medicare
  currently has supplements Medicare prescription
  drug coverage, then he or she may want to enroll
  in a Medicare prescription drug plan.

19
Drug Coverage from Another Source

• If current coverage is not as good as Medicare
  prescription drug coverage, and the person with
  Medicare doesnt enroll in a Medicare
  prescription drug plan, he or she may face a
  higher premium later.

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If Current Coverage from Another Source

• is at least as good as Medicare prescription drug
  coverage, then decide whether to keep current
  coverage or enroll in Medicare plan.

21
If Current Coverage from Another Source

• is not as good as Medicare coverage or have no
  drug coverage, then need to enroll in a Medicare
  plan when first eligible, or pay a higher premium
  to enroll later.

22
If Current Coverage from Another Source

• supplements Medicare prescription drug coverage,
  then enroll in a Medicare plan for complete
  coverage at the lowest premium.

23
Your Decision

• Deciding whether or not to enroll in a Medicare
  prescription drug plan is an important decision.

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In Summary

• Starting January 1, 2006, Medicare prescription
  drug coverage will help people with Medicare pay
  for the prescriptions they need.

25
In Summary

• Medicare prescription drug coverage is available
  to all people with Medicare.
• There is additional help for those who need it
  most.

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In Summary

• The Medicare prescription drug coverage pays for
  brand-name and generic drugs.

27
In Summary

• People with Medicare can choose between at least
  two Medicare prescription drug plans.
• Choose a plan that is right for you.

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For More Information

• http//www.cms.hhs.gov/medicarereform
• http//www.medicare.gov
• http//ssa.gov
• 1-800-669-8387 (Georgia Cares)
• 1-800-Medicare (1-800-633-4227)

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Questions

• We will have a question and answer session at the
  conclusion of the State Health Benefit Plan
  presentation.

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• THANK YOU

31
State Health Benefit PlanRetiree Option Change
Period

• Retiree Option Change Period
• October 17 through November 8, 2005

32
SHBP Plan ChangesEffective January 1, 2006

• New PPO
• HMO Live or Work Rule Removed
• Dependent Verification Process Changes
• New High Deductible Health Plan (HDHP)
• New Medicare Policy
• Coordination of Benefits with Medicare Part D

33
New PPO

• Effective January 1, 2006, SHBP will offer a
  new PPO Option and United Healthcare will be
  the administrator. See the Decision Guide for
  information about this change.

34
HMO Live or Work Rule Removed

• Live or work rule for HMOs no longer based on the
  county where you live.
• You may join an HMO if it is offered in your area
  or surrounding counties.
• Out-of-State Coverage You may not have all
  options available.

35
HMO Live or Work Rule Removed(Continued)

• Before making your selection contact the HMO
  directly to see if services are available.
• You will not be allowed to change your HMO
  selection until the next Retiree Option Change
  Period.

36
Dependent Verification

• Verify dependents prior to their benefit
  expiration or they will not be eligible after the
  expiration date.
• The student verification process will change. You
  will receive a request to recertify your
  students status 90 days prior to your
  dependents birth date. Coverage will end the
  last day of the month of your dependents birth
  month if SHBP does not receive the information.

37
Dependent Verification(Continued)

• i.e., Johns birthday is November 2, and he is a
  full-time student approved through November 30,
  2005. To continue coverage past November 30, SHBP
  must receive a competed student status form and
  the annual certification from the schools
  registrars office. If this information is not
  received by November 30, John will not be
  eligible for future coverage.
• As a retiree you cannot re-add your dependents
  unless you experience a Qualifying Event.

38
High Deductible Health Plan (HDHP)

• Manage your healthcare dollars
• Pay lower premiums
• If eligible, contribute to a Health Savings
  Account
• In return for the lower premiums and ability to
  contribute to a HSA,

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HDHP (Continued)

• you will
• Have a higher deductible with benefits payable
  only after you meet the deductible (except for
  some preventive care coverage)
• Pay coinsurance (a percentage of the cost of
  care) after you have satisfied the deductible,
  rather than set dollar co-payments.
• Carry remaining HSA money to the following year.

40
HDHP (Continued)

• You can contribute to a Health Savings Account
  (HSA)
• You will need to contact a bank or financial
  organization to set up your HSA
• Retain dollars for eligible expenses
• Can earn interest/offer investment options
• You will be responsible for selecting your HSA
  vendor, setting up your account, and making
  contributions.

41
Georgia Law Requirement

• Georgia State law requires that SHBP pay
  benefits after Medicare has paid.
• Georgia Code 45-18-2

42
SHBP New Medicare Policy Effective January 1, 2006

• SHBP will calculate premiums and claims payment
  based upon Medicare enrollment for retirees over
  age 65 or those eligible for Medicare due to
  disability.
• SHBP will coordinate benefits for members who are
  enrolled in Medicare.
• SHBP will pay primary benefits on members not
  eligible or not enrolled in Medicare.

43
SHBP New Medicare Policy Effective January 1, 2006

• SHBP coordination will also begin for retirees
  who enroll in the Medicare Part D Prescription
  Drug Plan (PDP).
• SHBP premiums will be adjusted for each part of
  Medicare for which the retiree is not enrolled.

44
If You Are Eligible for Medicare Part D

• You may enroll in a
• Prescription Drug Plan (PDP) or
• If you are currently enrolled in Kaisers
  Medicare Advantage (Senior Advantage Plan), you
  will be automatically enrolled in Kaiser MA PD.

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If You Are Eligible for Medicare Part
D...(continued)

• If you select another PDP, coverage under the
  Kaiser Senior Advantage Plan ends and you will
  not be covered by SHBP. This will leave you with
  Medicare coverage only Parts A, B and D.

46
Prescription Drugs Covered by Medicare Part D

• Medicare Part D covers prescription drugs based
  on the PDPs formulary.
• PDP and SHBP formularies may vary.
• SHBP co-payments will be based on SHBPs
  formulary.
• SHBP will provide payment based on SHBPs
  formulary for covered non-preferred drugs after a
  co-payment.

47
SHBP Pharmacy Benefit January 1, 2006

• Your Current Co-pays Will Not Change!
• PPO/Indemnity HMO
• Generic 10 10
• Preferred 30
  25
• Non-Pref. Brand 100 50
• Quantity Level Limits and Prior Authorizations
  will apply.

48
HOW SHBP WILL COORDINATE

• SHBP will pay secondary benefits
• (by wrapping around Medicare Part D).
• Part D 250 deductible - you pay your co-pay and
  SHBP will pay its normal benefit.
• 251-2,250- Part D pays 75 and the remaining
  25 will be shared between you (co-pay) and SHBP.

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HOW SHBP WILL COORDINATE (continued)

• 2,251 - 5,100 Part D pays 0 and you will pay
  your co-pay and SHBP will pay its normal
  benefit.
• 5,101 up Part D pays 95 and the remaining 5
  will be shared between the member (co-pay) and
  SHBP, depending on the balance.

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Whats Next

• You will receive
• Medicare drug information in October 2005.
• SHBP Membership Worksheet in your Retiree Option
  Change packet by October 17, 2005.

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What You Need To Do

• Review the information you received about the
  Medicare prescription drug plans and determine
  which plan best suits your needs.
• If you elect to join a PDP, complete the
  information and return to the PDP.
• DO NOT RETURN TO SHBP.

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What You Need To Do (continued)

• If your Medicare information on your Personalized
  Change Form in your Retiree Option Change Packet
  is not correct, send a copy of your Medicare card
  to SHBP for any parts not listed.
• You MUST mail to SHBP a copy of your Medicare
  Part D card as soon as you receive it, in order
  to pay the correct SHBP premium.

53
What You Need To Do (continued)

• Determine if you want to change your coverage
  option with SHBP and mail your election by
  November 8 to SHBP.
• Please update your address with SHBP if you have
  recently moved.

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GENERAL INFORMATION

• The State Health Benefit Plan does not have
  Medicare Prescription Drug information.
• Questions should be directed to
• 1-800-Medicare
• (1-800-633-4227)

55
Creditable Coverage Notice

• Information about Creditable Coverage will be
  provided by SHBP in your Retiree Option Change
  Packet.

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Caution

• Be very careful about giving out personal
  information.
• Do not give personal information over the phone
  without confirming that the person asking is who
  they say they are and they need to know that
  information specifically.
• SHBP and Medicare both have most of your
  information on file.

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For More Information

• www.cms.hhs.gov/medicarereform
• www.medicare.gov
• www.ssa.gov
• 1-800-669-8387 (Georgia Cares)
• 1-800-633-4227 (Medicare)

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• Questions

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THANK YOU