Medicare Drug Benefit: Part D in Minnesota

1
Medicare Drug Benefit Part D in Minnesota

• Minnesota Road Shows
• May and June 2005

Posted 6-14-05
2
Overview
MMA Overview

• Summary of the 2003 Medicare Prescription Drug
  and Modernization Act (MMA)
• Extra Help (LIS)
• Policy impacts in Minnesota
• Roles

3
MMA
MMA Overview

• Most dramatic changes to Medicare since its
  original passage in 1965
• 415 pages!
• Comprised of 12 Titles
• Signed into law December 8, 2003

4
MMA
MMA Overview

• Created
• New Medicare Advantage options
• New Medigap plans K L
• Established
• Medicare Prescription Drug Discount Card
• Transitional Assistance Program
• Established the Voluntary Prescription Drug
  Benefit Program (Medicare Part D)

5
MMA
MMA Overview

• Established subsidy for employers and unions that
  maintain retiree prescription drug coverage (28)
• Sets a new moratorium on implementation of the
  therapy caps through 2005
• Increased Medicare Part B deductible annually
  (110 in 2005)
• Applies higher Medicare Part B premiums to people
  above income thresholds as of 1/1/07

6
New Part B Preventive Care
MMA Overview

• Cardiovascular Screening Blood Tests
• Diabetes Screening Tests
• Welcome to Medicare physical

7
Medicare Drug Discount Cards
MMA Overview

• Offers discounts on prescription drugs
• Interim relief
• Transitional Assistance or the credit
• 600/yr (prorated beginning 4/1/05)
• Available to low-income Medicare beneficiaries
  (135 of FPL or less)
• Its not too late to sign up!

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Medicare Advantage
MMA Medicare Advantage

• New ways to integrate and package Part A and B
• May include new Part D drug benefit
• Replaces MedicareChoice and offers more health
  coverage choices

9
Medicare Advantage Options
MMA Medicare Advantage

• Managed Care Plans
• Preferred Provider Organization (PPO)
• Private Fee-for-Service Plans
• Special Needs Plans (new)
• Medical Savings Accounts

10

MMA Medicare Advantage
Current Minnesota Medicare Advantage Plans

• Medicare managed care health plans
• HealthPartners
• UCare
• Medicare Private Fee For Service plans
• Humana
• Sterling
• Unicare

11

MMA Medicare Advantage
Future Minnesota Medicare Advantage Plan
Possibilities

• Local Medicare Advantage plan (MA-PD) Part A, B
  and D
• Specialized MA plans for Special Needs
  Beneficiaries (MSHO, MnDHO)
• Medicare Advantage PFFS with Part D
• Regional MA-PD PPO like (Part A, B, and D)

12

MMA Medicare Advantage
Other Options (not Medicare Advantage) for Part D
Coverage

• Private Prescription Drug Plans (Part D only)
• Medicare Cost Plan (Part A, B and maybe D)

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Medicare Prescription Drug Benefit Part D
MMA Part D

• January 1, 2006
• A New Year,
• A New Medicare Benefit!

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Medicare Prescription Drug Benefit
MMA Part D

• Insurance coverage for prescription drugs
• Helps lower the out-of-pocket cost of drugs
• Voluntary benefit
• Medicare Part D drug coverage supplants Medicaid
  drug coverage for people with both benefits
• Beneficiaries must take action by choosing a plan
  (with some exceptions)
• Initial enrollment period
• November 15, 2005 through May 15, 2006

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Medicare Prescription Drug Benefit
MMA Part D

• Coverage is provided by a Medicare approved
• Prescription Drug Plan (PDP)
• Medicare Advantage plan with prescription drug
  coverage (MA-PD)
• Can also be provided by a Medicare Cost Plan
• Plans may offer more than one option
  alternative plans must be of at least equal value
  to the Part D standard benefit

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Medicare Prescription Drug Benefit
MMA Part D

• There must be at least 2 prescription drug plans
  available in every region
• One of these plans may be a MA-PD (regional
  Preferred Provider Organization)

17
Our Region
MMA Part D
Note A Medicare Advantage (MA) region is one
color. A difference in shading indicates that
there are multiple Prescription Drug Plan (PDP)
regions nested within the MA region No change
indicates that the MA and PDP regions are the
same. For example, Wisconsin and Illinois are
in one MA region they are each a separate PDP
region. Each territory is its own PDP region.
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Our Region (MA 19 and PDP 25)
MMA Part D

• 1.9 million Medicare beneficiaries
• 559,000 beneficiaries below 135 of FPG
• 157,000 beneficiaries below 150 of FPG
• 242,000 dual eligible beneficiaries
• 12 variation in drug spending across states
  within the region (nationally there is a 43
  difference)

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Medicare Prescription Drug Benefit
MMA Part D

• Beneficiaries who do not take action to choose a
  plan during their enrollment period
• AND
• Do not have other pharmacy coverage that is equal
  in value to the standard Part D benefit risk
  having to pay a higher drug plan premium

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Creditable Coverage
MMA Part D

• It is other pharmacy coverage that is at least
  equal in value to the standard Part D benefit is
  called creditable coverage
• Can be in employer or union retiree plans,
  Veterans benefits, Federal Employees Health
  Benefit Plan, TriCare.
• Plans must tell their enrollees if the coverage
  is creditable.
• If the coverage is creditable, then the
  beneficiary who keeps this coverage and does not
  enroll in Part D will not pay a higher premium as
  a result of delaying enrollment in Part D.
• If the coverage is not creditable, the
  beneficiary who decides to delay enrollment in
  Part D, may pay a higher premium.

21
Formulary

• List of drugs that will be covered by the plan
• Formularies will vary from plan to plan
• Required to provide a minimum of 2 drugs from
  every therapeutic class
• There are some excluded classes of drugs
• Appeal rights

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Medicare Part D Standard Benefit
MMA Part D

• An approved plan offers negotiated discount
  prices based on a formulary with cost sharing
• Cost-sharing for standard benefit in 2006
• Premium of 37 per month/444 per year
• Annual deductible of 250
• Coinsurance of
• 25 on first 1999 of drug costs
• 100 on next 2,850 in annual drug costs
• 5 or co-pays when drug costs reach 5,101
  annually

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Part D Standard Benefit No Subsidy
Beneficiary Costs
Part D Plan
100
75
25
250 Deductible
Premiums - est. 37/mo.
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Standard Benefit True out of pocket costs
(TROOP)
MMA LIS

• 250 annual deductible
• 500 (25 of drug costs 251-2250)
• Plan pays 1500
• 2,850 (100 of drug costs 2251-5100)
• Plan pays 0
• Reach 3,600 annual TROOP, catastrophic coverage
  begins
• Plan pays 95
• Beneficiary pays 5

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Extra Financial Help
MMA LIS

• Low-Income Subsidy (LIS)
• Provides help with Medicare Part D out-of-pocket
  costs
• Subsidy may be full or partial, depending on
  income, resources and family size
• Some will automatically get the full subsidy
• Medicare and full Medicaid benefits (Full Benefit
  Duals)
• Medicare and are enrolled in a Medicare Savings
  program (QMB,SLMB,QI)
• Medicare and supplemental security income (SSI)

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Extra Help Partial Subsidy
MMA LIS

• Beneficiaries (Non-Medicaid and Non-SSI) with
  income between 135 and 150 FPL
• Assets no more than 10,000 individual, 20,000
  couple
• Cost-sharing
• Premium on sliding fee scale
• 50 deductible
• 15 coinsurance on drug costs up to 5,100
• 2/5 copays on drug costs above 5,100
  (catastrophic level)

27

• Part D Partial Subsidy
• Lower Premiums
• Lower Deductible
• Lower Coinsurance
• No Doughnut Hole

Beneficiary Costs
Part D Plan
15
85
50 Deductible
Sliding Scale Premiums
will vary
28
Extra help Full Subsidy
MMA LIS

• Beneficiaries with income below 135 FPL
• Assets not greater than 6,000 single/9,000
  couple
• Cost-sharing
• No premiums
• No deductible or coinsurance
• No drug costs in doughnut hole except
  co-payments
• 1/3 for income at or below 100 FPL
• 2/5 for income above 100 FPL
• Help with Medicare Prescription Drug Plan Costs
• Does not enroll a beneficiary in a Medicare Drug
  Plan

29
Full benefit duals, Medicare Savings program
enrollees and SSI recipients
MMA LIS

• Automatic full subsidy
• No need to complete an application
• Cost-sharing
• No premiums
• No deductible
• Co-payments
• 1/3 for income at or below 100 FPL
• 2/5 for income above 100 FPL
• No co-payments above 5,100
• No co-payments for full benefit duals in nursing
  homes or ICF/MR

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• Part D Full Subsidy
• No Premiums
• No Deductible
• No Coinsurance
• No Doughnut Hole

Beneficiary Costs
Part D Plan
Drug Costs
Co-Pays 1/3 lt100 FPL 2/5 gt100 FPL
Co-Pays
No premiums No deductibles
31
Low-Income Subsidy Groups in MN No application
needed
MMA LIS

• Automatically eligible full subsidy
• SSI beneficiaries
• Medicare Savings group enrollees
• Qualified Medicare Beneficiaries (QMB)
• Service Limited Medicare Beneficiaries (SLMB)
• Qualified Individuals 1 (QI-1)
• QMB or SLMB on the MN Prescription Drug Program
• Medicaid full benefit duals including
• Elderly
• Disabled
• Employed disabled (MA-EPD)
• Elderly waiver enrollees
• Parents/caretakers
• Enrollees with a spenddown

32
Sliding Scale Premium Assistance
Numbers are for 2006
33

Current Monthly Federal Poverty Level (FPL)
Amounts

• Based on a household size of 1
• FPL amounts change each July

34
Why Connect to MSP?

• Medicare Part B monthly premium in 2006 will be
  89.20 (currently 78.20)
• Medicare Part B annual deductible in 2006 will be
  125.40 (currently 110)
• All MSPs will be eligible for Part D LIS/extra
  help (up to 135 of FPL)
• Not all LIS will be eligible for MSP, but many
  will be (LIS up to 150 of FPL)

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Why Connect to MSP?

• MSP helps pay for cost-sharing/premiums for Part
  B
• Part B includes physician services and some
  outpatient drugs not covered by Part D
• Prescription drug coverage under Part D will
  require a physician order (Part B)

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MMA Enrollment Timeline
MMA Part D
Start of Program Jan 1 2006
Nov 15 2005
May 15 2006
July 1 2005
Enrollment Period for Part D Plans
Application Period for Low-Income Subsidy (Deemed
- Automatically eligible)
July 1 2005
Full benefit dual eligibles lose coverage under
Medicaid for drugs that could be covered under
Part D
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The Timeline (subject to change)

• April November 15, 2005 Employers and unions
  notify retirees about creditable coverage
• May 27-August 15, 2005 SSA mailing to potential
  low income subsidy beneficiaries begins
• May 16, 2005 CMS mailing to deemed eligibles
  begins
• July 1, 2005 SSA begins processing low income
  subsidy applications and notifying beneficiaries
  about eligibility
• September 1, 2005 CMS mails out Medicare and You
  handbooks to all beneficiaries
• September 2005 Part D plans announced
• September 1-November 15 Medigap companies issue
  creditable coverage notices

38
The Timeline (subject to change)

• October 1, 2005 Marketing of Part D plans begin
• October 1, 2005 CMS begins mailing youve been
  enrolled notices to deemed beneficiaries
• October 13, 2005 CMS launches online enrollment
  center for drug coverage
• November 15,2005 - May 15, 2006 Initial
  Enrollment period for Part D
• December 31, 2005 Medicaid drug coverage for
  dual eligibles ends
• January 1, 2006 Medicare Part D coverage begins
• April 1, 2006 CMS enrollment reminder mailing
  Last chance to enroll without penalty
• May, 2006 Facilitated enrollment for MSP begins

39
The Timeline (subject to change)

• October, 2005 CMS begins ongoing routine
  mailings of deemed status to new MSP enrollees
• November 1, 2005 CMS begins ongoing routine
  monthly auto-enrollment for new full dual
  eligibles

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Decisions will depend on status
MMA Part D

• Find out if someone is
• Dual eligible?
• Medical AssistanceEmployed Persons with
  Disabilities (MA-EPD) enrollees?
• MSHO/MnDHO enrollee?
• State Pharmacy Assistance Program (SPAP)
  enrollee?
• HIV/AIDS beneficiary with Medigap coverage?
• Retiree with Rx coverage?
• Medicare Supp. policyholder with Rx Coverage?
• Medicare Cost Plan enrollee?
• Medicare Advantage Private Fee for Service
  enrollee?
• Local Medicare Advantage enrollee?
• No Rx coverage at all?

41
Medicare Part D Subsidy Overview
42
Medicare Prescription Drug, Improvement and
Modernization Act (MMA) of 2003

• Drug Discount Card
• 5/3/0412/31/05
• Part D Program
• Effective 1/1/06
• Voluntary
• Part D Subsidy
• Help for beneficiaries with low income and
  limited resources on premium, deductible, and
  co-payments

43
What is the subsidy?

• Extra help to pay for Medicare Prescription Drug
  Benefit
• Premiums
• Deductibles
• Co-payments

44
Who is eligible for the subsidy?

• Medicare beneficiaries with income and resources
  below 150 of Federal Poverty Level

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Deemed Population

• People who are automatically eligible for the
  subsidy
• Medicare and Medicaid
• Medicare Savings Programs (QMB, SLMB, QI)
• SSI and Medicare
• Do not have to complete an application
• States work with CMS to process subsidy for
  deemed population

46
Not Deemed Population

• Medicare beneficiaries who have limited resources
  and low income
• DO NOT have SSI or Medicaid or a Medicare
  Savings Program
• Must apply for a subsidy

47
Subsidy Application Process

• Scannable application
• Internet application July 1
• Phone with SSA
• At SSA office
• Offsite with SSA or other organization

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SSAs Mailing

• Begins May 27, ends mid-August
• Includes
• Cover letter
• Scannable application
• Pre-addressed, postage paid return envelope
• By terminal digits
• 360,000 packages in Minnesota

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Application Tips

• Do NOT photocopy application!
• Use 2 pencil or black ink.
• Keep numbers, letters, and Xs inside boxes.
• Fold only once, horizontally.

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Submitting the Application

• File early!
• Do not send proofs.
• Mail Social Security Administration
• Wilkes-Barre Data Operations Center
• P.O. Box 1020
• Wilkes-Barre, PA 18767-1020
• Internet beginning July 1, 2005
• Will receive a receipt

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Scannable Applications

• SSA will provide to SHIP through local office
• Request in advance
• Do not download from Internet!
• Internet application July 1

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For More Information

• Social Security Administration
• www.socialsecurity.gov
• 1-800-772-1213
• Center for Medicare and Medicaid Services
• www.medicare.gov
• 1-800-633-4227

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Policy Impacts in Minnesota
MMA Policy Impacts
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MMA Minnesotas Medicare Population
MMA Policy Impacts

• 677,000 Medicare beneficiaries in MN
• Of those
• 50 have no drug coverage
• 120,000 have income below 135 of federal
  poverty level (FPL)
• 93,000 are eligible for both Medical Assistance
  and Medicare (dual eligibles)
• 7,700 are enrolled in the states PDP program

55
Minnesota Medical Assistance
MMA Policy Impacts

• Coverage
• Starting 1/1/06 Medical Assistance will not cover
  Part D drugs for full benefit duals
• Some exceptions Medical Assistance will
  continue to cover over the counter,
  benzodiazapines, barbituates and a few others
• Cost-sharing
• All full benefit duals and MSP will be deemed
  eligible for LIS
• Duals will pay copays for drugs
• Medicare Drug Benefit does not have a monthly cap
  on copays
• No copays for full benefit duals in a medical
  institution, nursing facility or ICF/MR

56
Minnesota Medical Assistance
MMA Policy Impacts

• Automatic enrollment
• Full benefit dual eligibles, NOT including MSP
  enrollees will be randomly enrolled in a Part D
  plan before January 1, 2006 if they do not select
  a plan
• To PDP (if in FFS Medicare)
• To an MA-PD (if in Medicare Advantage plan)
• Ability to opt-out of the plan
• Can choose another plan at any time

57
Minnesota Medicare Saving Programs and MN PDP
MMA Policy Impacts

• Automatically eligible for LIS
• No need to complete SSA application
• Need to select a plan before 1/1/06 to continue
  drug coverage
• Goal plan selection by 12/31/05
• If no plan selection is made
• Facilitated enrollment in a Plan will be done in
  May, 2006

58
MSHO and MnDHO
MMA Policy Impacts

• MSHO MnDHO managed care plans will qualify as
  Medicare Advantage Special Needs Plans
• MSHO MnDHO enrollees
• will receive coordinated prescription drug
  benefits from one plan
• do not need to do anything before 1/1/06 because
  they automatically have coverage for the Medicare
  Prescription Drug Benefit through their
  MSHO/MnDHO plan.

59
Tribal Health Care
MMA Policy Impacts

• Tribes in Minnesota with their own pharmacies
  will no longer receive a payment from Medical
  Assistance for prescription drugs provided to
  their dual eligible members.
• MMA requires Medicare Part D plans to include
  tribal pharmacies in their network by offering
  them contracts.

60
MA-EPD
MMA Policy Impacts

• All MA-EPD enrollees will be deemed eligible for
  LIS, regardless of income
• MA-EPD enrollees must pay their MA-EPD premium
  but will not have to pay the Part D premium
• MA-EPD enrollees will have a 1-5 copay,
  depending on income

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Minnesotas Prescription Drug Program (PDP)
MMA Policy Impacts

• All enrollees qualify for Medicare Drug Benefit
• All enrollees will be deemed eligible for LIS
• All enrollees will need to choose a plan before
  the end of the year to continue their drug
  assistance after 1/1/06
• Facilitated plan enrollment begins
• May, 2006
• Proposed PDP ends on 12/31/05

62
Health Plans in Minnesota
MMA Policy Impacts

• Medicaid Managed Care Plans will no longer cover
  drugs for duals
• MSHO MnDHO managed care plans may qualify as
  Medicare Advantage Special Needs Plans and
  continue to offer coordinated pharmacy benefits
• Plans may offer new Medicare Advantage Plans as
  of 1/1/06

63
Medicare Products in Minnesota
MMA Policy Impacts

• Medicare Cost Plans and Medicare Advantage
  Private Fee For Service Plans may provide Part D,
  but it is not required.
• Medicare Cost Plan Contracts extended to 12/31/07
• In MN, BCBS of MN (formerly First Plan),
  HealthPartners and Medica offer Cost plans

64
Medicare Products in Minnesota
MMA Policy Impacts

• MMA prohibits the sale of new Medicare
  supplemental policies with drug coverage on or
  after 1/1/06
• In MN, applies to Extended Basic Medsupp and
  Medicare Select plans
• Plans must issue creditable coverage notices
• Beneficiaries enrolled in a Medsupp with drug
  coverage before 1/1/06, may keep coverage

65
Policy Impacts Key Points
MMA Policy Impacts

• Medical Assistance (Medicaid) will no longer
  cover drugs for dual eligibles (MA and Medicare)
  that are included in the Part D benefit
• Medicare product options will change for next year

66
Roles and Minnesota Partners
MMA Roles and Partners
67
Centers for Medicare Medicaid Services (CMS)
Responsibilities
MMA Roles and Partners

• Medicare Policy
• Beneficiary Assistance
• Marketing and Education
• Benefit and Low Income Subsidy deeming policy for
  duals and Medicare Savings Program enrollees
• Employer retiree policies and standards for
  creditable coverage
• Contract Standards for PDP and Medicare Advantage
  plans

68
CMS Tools
MMA Roles and Partners

• Letters to Beneficiaries
• Outreach education materials
• Regulations
• Contract Approvals
• 1-800-MEDICARE and www.Medicare.gov
• Regional Office participation
• SHIPs
• State Medicaid Agencies

69
Social Security Administration (SSA)
Responsibilities
MMA Roles and Partners

• Low Income Subsidy (LIS) application development
• LIS training
• LIS application assistance
• LIS eligibility determinations

70
SSA Tools
MMA Roles and Partners

• Low Income Subsidy (LIS) application
• Scannable paper application
• Over the phone application
• Web based application 7/1/05
• LIS sign up events
• SSA regional office staff
• 30 new hires in Minnesota

71
SHIP Responsibilities
MMA Roles and Partners

• Outreach Education
• Low Income Subsidy (LIS) application assistance
• Plan enrollment assistance

72
SHIP Tools
MMA Roles and Partners

• Senior LinkAge Line
• 1-800-333-2433
• Partners with Disability Linkage Line
• Train the Trainer events (Road Shows)
• Trained Volunteer force

73
Minnesota Department of Commerce Responsibilities
MMA Roles and Partners

• Conform state law to MMA changes
• Medicare supplement (Medigap) insurance
• No K and L in MN in 2006
• Licensing of Medicare Prescription Drug Plans

74
Minnesota Department of Human Services (DHS)
Responsibilities
MMA Roles and Partners

• Conform state Medicaid law to Medicare drug
  benefit requirements
• Change State Pharmacy Assistance Program (MN
  Prescription Drug Program-PDP) to reflect
  Medicare drug benefit changes
• Notify enrollees of policy changes
• Offer Low Income Subsidy (LIS) Enrollment
  Assistance
• Provide data to CMS
• Conduct Medicare Savings Program screenings
• Pay CMS the majority of costs for duals

75
Department of Human Services (DHS) Tools
MMA Roles and Partners

• DHS staff
• DHS outreach grants
• State Pharmacy Assistance Program
• Medical Assistance for Employed Persons with
  Disabilities
• County agencies

76
Employer Responsibilities
MMA Roles and Partners

• Notify their retirees of creditable coverage
• Make decision about continuing the drug benefit
• Make decision about Medicare drug subsidy for
  employers

77
Health Plan Responsibilities (MA)
MMA Roles and Partners

• Educate their enrollees (PMAP and Medicare),
  family members and representatives of changes
• Decide what to offer in 2006 (MA, SNP, etc.)
  submit application to CMS
• Provide a CMS approved product for at least one
  year
• Market to all eligible individuals

78
Health Plan Tools (MA)
MMA Policy Impacts

• Notices to enrollees about changes and options
• Marketing materials
• Provide Community Education sessions
• Provide other forms of communication about
  changes and options
• phone banks
• internet
• articles in newsletters

79
Medigap Responsibilities
MMA Roles and Partners

• Provide notice of creditable coverage
• Make decision about continuing Medigap drug
  coverage to existing beneficiaries

80
Beneficiary Responsibilities
MMA Roles and Partners

• Understand the benefit
• Make a decision about applying for Low Income
  Subsidy (LIS)
• Make a choice about a drug plan beginning in
  November

81
Resource Gaps
MMA Roles and Partners

• Education (for beneficiaries and their
  familiesadult children, conservators, etc.)
• Low Income Subsidy (LIS) application and Medicare
  drug plan enrollment assistance
• Assurance that eligible people take action

82
Minnesotas Collective Effort Call to Action
MMA Roles and Partners

• Broad based statewide outreach campaign
  Call to Action
• Organizational education and outreach to key
  stakeholder groups
• MN Tool Kit
• Statewide Part D e-mail exchange listserv
• Road Shows

83
MN Medicare Part D Road Shows
MMA Roles and Partners

• May and June 2005
• East Grand Forks
• Bemidji
• Brainerd
• Willmar
• Fergus Falls
• Duluth
• Marshall
• Mankato
• Rochester
• Fairmont
• Mora
• St. Cloud
• Minneapolis
• St. Paul
• ITV training for County Agencies

84
Plan forThe Future

• Round 2 of Medicare Part D Road Shows will begin
  in October, 2005
• Focus on Part D plan options in MN

85
What you can do
MMA Roles and Partners

• Make brochures available at your site
• Promote awareness amongst beneficiaries to take
  action!
• Host educational events
• Host sign-up events
• Train your staff to help with applications and
  Medicare drug plan enrollment assistance

86

MMA Roles and Partners
Where to turn for more information, answers and
help

• Subscribe to the MN Medicare Part D listserv
• Senior LinkAge Line
• 1-800-333-2433
• www.Medicare.gov
• 1-800-Medicare
• www.socialsecurity.gov
• 1-800-772-1213

87
Along the way, there may be some confusion about
Part D
88
But by working together, we can help MN Medicare
beneficiaries transition smoothly into Part D
89
Get Ready Get Set Go!!!!!

• 677,000 MN Medicare beneficiaries need to learn
  about Part D before 1/1/06
• You are key to MN Medicare beneficiaries
  receiving accurate, consistent information about
  Part D
• THANK YOU!