Medicare Prescription Drug Plans

1
2005 National Medicare You Training Program
CMS Congressman Bishop Medicare Information
Meetings 2005
2
What You Need to Know

• General Overview
• Medicare Prescription Drug Coverage

3
Medicare Prescription Drug Coverage

• Begins January 1, 2006
• Available for all people with Medicare
• Part A, Part B, or both
• Cannot be incarcerated or live outside the U.S.
• Must join a Medicare drug plan to get coverage
• Initial enrollment period November 15, 2005,
  through May 15, 2006
• Join by December 31, 2005, for coverage beginning
  January 1, 2006

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Plan Choices

• Two types of Medicare drug plans
• Medicare Prescription Drug Plans
• Medicare Advantage Plans and other Medicare
  Health Plans with prescription drug coverage

5
Rx Drug Coverage Enrollment

• Coverage is not automatic
• Except people who qualify for extra help
• Initial Enrollment Period (IEP)

6
Annual Coordinated Election Period (AEP)

• November 15 December 31 every year
• People who dont have a Medicare drug plan can
  enroll
• People who currently have a Medicare drug plan
  can switch
• Change effective January 1
• Special Enrollment Period (SEP) may apply in
  special circumstances

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Standard Coverage

• Standard coverage in 2006
• Minimum coverage drug plans must provide
• In 2006, person with Medicare pays
• A monthly premium
• 250 deductible
• 25 of yearly drug costs from 250 to 2,250
• Person pays 25 500 plan pays 75 1,500
• 100 of next 2,850 in drug costs
• 5 of drug costs (or a small copayment) after
  3,600 out of pocket
• 250 500 2,850 3,600

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Extra Help With Drug Costs

• Available for many people with limited income and
  resources
• Those below Federal poverty level save over 95
  on average
• People with lowest income and resources
• Pay no premiums or deductibles
• Have small or no copayments
• Those with slightly higher income and resources
• Have a reduced deductible
• Pay a little more out of pocket

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Eligibility for Extra Help

• Income
• Below 150 Federal poverty level
• 1,197 per month for an individual or
• 1,604 per month for a married couple
• Based on family size
• Resources
• Up to 11,500 (individual)
• Up to 23,000 (married couple)
• Includes 1,500/person funeral or burial expenses
• Counts savings and stocks
• Does not count home the person lives in
• Higher amounts for Alaska and Hawaii

2005 amounts
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Automatic Eligibility for Extra Help

• Some people may automatically qualify
• People with Medicare who
• Get full Medicaid benefits
• Get Supplemental Security Income (SSI)
• Get help from Medicaid paying their Medicare
  premiums
• All others must apply

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How to Apply for Extra Help

• Social Security Administration (SSA) sent
  applications to people who may be eligible
• Those who think they may qualify can
• Call the Social Security Administration,
  1-800-772-1213
• Visit www.socialsecurity.gov
• Apply at their State Medical Assistance office.
• People who are not sure should still apply
• Even if they did not get an application
• www.socialsecurity.gov can help people decide
• There is no risk or cost to apply

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Things to Consider

• What is current health insurance coverage?
• Is there currently prescription drug coverage?
• Even those with current drug coverage should ask
• Is Medicare prescription drug coverage right for
  me?

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Coverage on Average at Least as Good as Medicares

• People with other coverage
• Will not pay a penalty if they wait to enroll
• If coverage is at least as good as Medicare
  prescription drug coverage
• Possible examples
• Some group health plans (GHP)
• Some Medigap policies
• VA coverage
• Military coverage including TRICARE

14
Late Enrollment

• Most people will have to pay a penalty if they
  wait to enroll
• Additional 1 of base premium for every month
  they were eligible but not enrolled
• For as long as they are enrolled in a Medicare
  prescription drug plan
• Unless they have other coverage that, on average,
  is at least as good as Medicare prescription drug
  coverage

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Special Enrollment Period

• Change in residence
• Move out of plans service area
• Move into or out of a long-term care facility
• People with Medicare and
• Full Medicaid benefits
• Medicare Savings Programs
• People Medicare enrolled in a plan
• Involuntary loss of coverage
• Others

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Which Drugs Are Covered?

• Drugs, biologicals, insulin
• Available only by prescription
• Medical supplies associated with injection of
  insulin
• Syringes, needles, alcohol swabs, gauze
• Brand-name and generic drugs

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Which Drugs Are Not Covered?

• Drugs excluded by MMA law
• But some plans may choose to cover
• Non-prescription drugs
• Drugs that are covered for a person under
  Medicare Part A or Part B

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Plan Marketing

• Plans began marketing October 1, 2005
• Medicare prescription drug plans may
• Use the Medicare Rx seal
• Send information or call people with Medicare

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Protecting Against Fraud and Identity Theft

• Medicare prescription drug plans may not
• Contact people with Medicare before October 1,
  2005
• Sell door-to-door
• Enroll people by phone
• Unless the person calls them OR
• The person is adding drug coverage to their
  Medicare Advantage or other Medicare Health Plan

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Protecting Against Fraud and Identity Theft

• Those who think someone is using their personal
  information should call
• 1-800-MEDICARE (1-800-633-4227)
• TTY users call 1-877-486-2048
• Fraud Hotline at 1-800-447-8477
• TTY users call 1-800-377-4950
• ID Theft Hotline at 1-877-438-4338
• TTY users call 1-866-653-4261

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Choosing a Medicare Drug Plan

• Coverage
• Formularies
• Cost
• Premium, deductible, copayments or coinsurance
• Convenience
• Pharmacy networks
• Mail-order

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Choosing a Plan

• Step 1 Collect information
• Any current prescription drug coverage
• Prescription drugs and doses
• Step 2 Compare Medicare drug plans
• Medicare You 2006
• Medicare Prescription Drug Plan Finder tool at
  www.medicare.gov
• 1-800-MEDICARE
• Step 3 Choose a plan
• For help, call the State Health Insurance
  Assistance Program (SHIP) in their state

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Joining a Plan

• Enroll directly with the plan sponsor
• Internet
• Plan website
• www.medicare.gov
• Telephone
• Paper form
• Mail or fax to plan sponsor

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For More Information

• Websites
• www.medicare.gov
• www.cms.hhs.gov
• www.socialsecurity.gov
• Publications
• Medicare You handbook
• Your Guide to Medicare Prescription Drug Coverage
• 1-800-MEDICARE (1-800-633-4227)
• Social Security Administration
• 1-800-772-1213
• Georgia Cares (1-800-669-8387)