Medicare Prescription Drug Coverage

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Medicare PrescriptionDrug Coverage
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Whats Different About Prescription Drug
Information?

• One size does not fit all, more than ever before
• Distinct messages and desired actions vary by
  audience
• More focus on segmenting information into
  bite-size chunks
• Useful materials needed for expanded local
  outreach efforts

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Target Audiences

• General Population
• Employer/Union Population
• Limited Income and Resources (LI/R) Population
• Long-term Care Population

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General Population

• Medicare Fee-For-Service
• AB only
• Medigap
• Private Fee-For-Service (PFFS)
• Medicare Managed Care
• Medicare Advantage Plans (HMO and PPO)
• Goal Engage and Enroll

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Meet the General Population
Original Medicare 13 million
Medigap A-K 6.35 million
Medigap H-J 1.9 million
Prestandardized plans/state 2.75 million
Medicare Advantage 4.1 million 3.2 million RX coverage (addl 800,000 in employer plans)
Cost Plans 326,000
Private Fee For Service 77,108
Medicare Savings Accounts
All numbers are estimates
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The Total General Population Needs to Know

• Coverage starts Jan 2006
• Enroll in a plan to get coverage
• Enroll now to pay lower premiums
• Waiting to enroll means you cant enroll until
  the next enrollment period
• Compare your current coverage with Medicare
  Prescription Drug Plans or Managed Care Plans
  with Prescription Drug Coverage

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The Fee-For-Service and Medigap Population
Needs to Know

• You can drop the prescription part of your policy
  and join a Medicare Prescription Drug Plan (PDP)
• You can enroll in a PDP and still have Medigap
  (or PFFS) without drug coverage
• Most Medigap coverage is not at least as good as
  Medicare Prescription Drug Coverage (not
  creditable)

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The Managed Care Population Needs to Know

• If you currently have drug coverage, you can stay
  in your plan and have Medicare Prescription Drug
  Coverage
• If you do not have drug coverage, you can stay in
  your plan and add Medicare Prescription Drug
  Coverage

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Key Dates

• RX Card Enrollee Letter (September)
• CMS Selects Plans (9/15/05)
• Medigap Plans Send Creditable Coverage Notice
  (9/15/05-11/15/05)
• Media Ads (Fall, 2005)
• Drug Plans Begin Marketing (10/1/05)
• Plan information on www.medicare.gov (10/13/05)
• Medicare You Premailing (TBD)
• Medicare You Handbook (10/15/05)
• Medicare Advantage Annual Notice of Change
  (10/31/05)
• Media Ads (Spring, 2006)

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Meet the E/U Population
11.4 million people (33 of the Medicare 65
population)

• This group
• Already has coverage and must make a decision
• Can be reached through their employers or unions
• Should be encouraged to check with their benefits
  administrator

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Meet the E/U Population

• Includes
• People covered by full Employer Subsidy
• People covered by plans that will supplement
  Medicare Prescription Drug Coverage
• SPAP members
• Crossover group who are eligible for both
  Employer Subsidy and extra help
• Crossover group who get coverage from an employer
  that works with an MA plan
• Active employees and spouses of active employees

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Meet the E/U Population
Employment-based retiree drug coverage 11.4 million
Coverage by a plan eligible for the Medicare retiree drug subsidy 9.8 million
Enrolling in a Medicare prescription drug plan and receiving additional coverage through employer or union 400,000
Enrolling in a Medicare prescription drug plan and receiving additional financial help through employer or union 1.3 million
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The E/U Population Needs to Know

• Contact your benefits administrator to see if
  your coverage is as good as Medicare Prescription
  Drug Coverage (creditable)
• What you do next depends on that answer
• You may be able to keep your current coverage
• If you dont enroll you may pay higher premiums
  later
• If you do enroll, you cant get coverage back
• If you want to stay in an MA plan, you must get
  drug coverage through that plan.

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If Coverage Is as Good They Need to Know

• You can keep current coverage and not worry about
  paying higher premiums for Medicare Prescription
  Drug Coverage in the future
• You can choose to enroll in Medicare Prescription
  Drug Coverage
• But, it is possible you wont be able to get back
  into your employer/union coverage

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If Coverage is NOT as Good They Need to Know

• You can enroll in Medicare Prescription Drug
  Coverage
• Same messages as for General Population

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Key Dates

• Creditable Coverage Notice from Employer/Unions
  (Now - 11/15/05)
• Fact sheets available on www.medicare.gov (April
  2005)

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Limited Income and Resources (LI/R) Population

• Full-benefit dual eligibles, MSP, SSI
• Income lt150 FPL
• Goal Engage, Encourage Application, Enroll

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Two Groups

• Those who automatically qualify for extra help
• Full-Duals with Drug Coverage, MSP, SSI
• Goal Engage, Enroll
• Those who must apply to receive extra help
• lt150 Federal Poverty Level
• Goal Engage, Encourage Application, Enroll

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Meet the LI/R Population
Eligible for assistance 14.4 million
Enroll for Assistance 10.9 million
Full-benefit dual eligibles 6.3 million
Medicare Savings Programs with income below 135 of FPL 3 million
Income under 150 of FPL 1.6 million
All numbers are estimates
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Those Who Automatically Qualify Need to Know

• Your Medicaid coverage ends 1/1/06
• Your coverage will come from a Medicare
  Prescription Drug Plan starting 1/1/06
• Youve been assigned to X plan
• You can switch plans to meet your needs

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Those Who Must Apply Need to Know

• Benefits of applying for extra help
• Apply for extra help (including how to apply)
• You must enroll in a plan to receive coverage
• If you dont enroll, youll be assigned to a plan
  in spring 2006
• How their SPAP (if they have one) works with
  Medicare Prescription Drug Coverage

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Key Dates

• Web tool www.medicare.gov (4/21/05)
• CMS notice to those who automatically qualify
  (full-benefit dual eligibles, MSP, except in FL,
  IL, MD, SC, VT, WI) (mid-May)
• SSA application to potential eligibles
  (5/27/05-8/16/05)
• CMS notice to SSI-only and other deemed in FL,
  IL, MD, SC, VT, WI (mid-June)

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Key Dates

• SSA application for extra help available online
  (7/1/05)
• SSA begins processing applications (7/1/05)
• CMS mails plan assignment notice to full-benefit
  dual eligibles
• (fall 2005 effective 1/1/06)

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Key Dates

• Medicaid drug coverage ends
• Medicare drug coverage begins (1/1/06)
• CMS mails plan assignment notice (spring 2006
  effective 6/1/06)
• SSA online help available now!
• http//www.ssa.gov/organizations/medicareoutre
  ach2/

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Meet the LTC Population

• 1.3 million people
• (4 of the Medicare 65 population)
• Short-term LTC residents
• from hospital or home to a LTC facility
• from a skilled nursing facility (Part A) stay to
  Medicaid
• or private stay from LTC facility to assisted
  living or home
• transition from hospice to Part A care
• continuity of care is a concern
• Long-term LTC residents
• full dual eligibles or deemed (inc. MSP,
  SSI/Medicaid)

All numbers are estimates
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The LTC Population Needs to Know
Key Beneficiary Messages Because LTC populations
encompass other populations (i.e., limited
income, retirees with employer plan benefits,
etc.), messages are derived from general/specific
population messages and targeted as
appropriate. Outreach Methods Are The
Difference
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Key Dates

• Release of Long-term Care and Transition Process
  Guidance (3/16/05)
• Nursing Home Resident Fact Sheet available at
  www.medicare.gov (May 2005)

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• Message Discipline
• Never deviate from tested, uniform message

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Messaging

• Overall Messages
• Drug coverage that helps you pay for the
  prescriptions you need.
• Medicare prescription drug coverage is available
  to all People with Medicare.
• There is additional help for those who need it
  most.
• The Medicare prescription drug coverage pays for
  brand name as well as generic drugs.

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Messaging

• Choice
• You can choose between at least two Medicare
  prescription drug plans and pick a plan that
  meets your needs.

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Current Terminology

• For Low-Income Subsidy
• Extra help with drug plan costs
• Limited income and resources
• Apply
• To get Medicare Prescription Drug Coverage
• Join, enroll, sign up

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Current Terminology

• Miscellaneous
• List of drugs the plan covers
• At least 1 more for every month you waited to
  get a Medicare prescription drug plan, or you
  will pay more, or higher premium
• People with Medicare and Medicaid
• Personalized Counseling
• 3600 out-of-pocket
• Long-term care facility, like a nursing home
• Complaint

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Terminology
Consistency Please Help Us! Visit often for
the most recent preferred terms
www.cms.hhs.gov/partnerships/tools/materials/prefe
rredterms.pdf
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Remember

• This isnt like traditional Medicare where they
  will get a Medicare card in the mail
• To get the new drug benefit, people with Medicare
  must enroll
• To get the best deal, they should enroll on time
• To enroll, theyll need to choose a plan