Medicare Part D Prescription Drug Coverage ??????????

1
Medicare Part D Prescription Drug
Coverage??????????

• Presented by Peter Lau R.Ph.
• Confucius Pharmacy
• ?? ???????????????

2
What is Medicare Part D Prescription Drug
Coverage? ??????????????

• Administered by different insurance companies or
  PDPs.
• ?????????????
• Most prescription drugs are covered.
• ?????????????
• Effective on 1/1/2006
• ?2006?1?1???

3
Who is eligible?? ? ? ? ? ??

• Person with Medicare Part A and/ or B
• ??????????

4
What is Donut Coverage?
Drug cost from Part D pays Patient pays
0 - 250 (250) 0 Up to 250
251 - 2,250 ( 2,000) Up to 1,500(75 of 2,000) Up to 500(25 of 2,000)
2,251 - 5,100( 2,850) 0 Up to 2,850
( 5,100)Castastrophic Coverage 1,500 3,600TROOP
TROOP TRue Out Of Pocket (Cash, EPIC, FSA, Charity, etc.) TROOP TRue Out Of Pocket (Cash, EPIC, FSA, Charity, etc.) TROOP TRue Out Of Pocket (Cash, EPIC, FSA, Charity, etc.)
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? ? ? ? ? ? ? (Donut Coverage)
???? ??????? ????
0 - 250 (250) 0 ?? 250
251 - 2,250 ( 2,000) ?? 1,500(75 of 2,000) ?? 500(25 of 2,000)
2,251 - 5,100( 2,850) 0 ?? 2,850
( 5,100)Catastrophic Coverage 1,500 3,600TROOP
TROOP TRue Out Of Pocket (Cash, EPIC, FSA, Charity, etc.)?????? TROOP TRue Out Of Pocket (Cash, EPIC, FSA, Charity, etc.)?????? TROOP TRue Out Of Pocket (Cash, EPIC, FSA, Charity, etc.)??????
6
Prescription Drug Plans(PDP)? ? ? ? ? ?

• Formularies ????????
• Enrollment Change ??????

7
What should you do when you have the following
plan(s) ??????, ??????

• Medicare Only ???
• Medicare Medicaid ??????
• Medicare EPIC ????????????
• Medicare Advantage Plans ??????
• Other Prescription Plans ??????

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Medicare Only? ? ?

• 11/15/2005 ??
• Choose an insurance company for the Medicare Part
  D Prescription Drug Plan
• ?????????????
• Have monthly fees, deductibles and copays
• ????, ?????????

9
Medicare Medicaid? ? ? ? ? ?

• 11/2005
• Automatically enrolled and assigned a PDP
• ??????????????????
• Consult with your pharmacists to select/change
  the best PDP for your needs
• ??????????????????

10
Medicare Medicaid? ? ? ? ? ?

• No monthly fee or deductible
• ???????

11
Medicare EPIC????????????

• EPIC available in 2006
• 2006??????
• Join Medicare Part D Prescription Plan can save
  more
• ?????????????????

12
Medicare EPIC????????????

• Further notice from New York State Government
• ???????????
• Enrollment fees and copays
• ???????????

13
Medicare Advantage Plans? ? ? ? ? ?
Oxford ??
UHC ??

• Fees and benefits are set by the insurance
  companies
• ??????????????

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Other Prescription Plans? ? ? ? ? ?

• Examples Employment/Retirement Drug Plans
• ?? ?????????????
• Letter from your insurance plan to tell whether
  it is a Creditable Plan
• ??????????????????Medicare ???????

15
Beware of Scams! ? ?! ? ? ? ?!
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Automatic Extra Help
Medicare Premium Deductible Co-payPreferred Co-payNon-Preferred
Medicaidlt( 9,570 S, 12,830 M) 0 0 1 3
Medicaidgt( 9,570 S, 12,830 M) 0 0 2 5
QMB/ SLIMB/QI-1 0 0 2 5
SSI 0 0 2 5
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????????Extra Help
??? ?? ??? ???Preferred ???Non-Preferred
???????????? 9,570 (??), 12,830 (??) 0 0 1 3
???????????? 9,570 (??), 12,830 (??) 0 0 2 5
QMB/ SLIMB/QI-1 0 0 2 5
??? (SSI) 0 0 2 5
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65 ??????????????
??????? 78.20 ????? ??????? 78.20 ????? ??????? 78.20 ????? Single Couple
ResourceMA QMB Medicaid/Part B Fee Asset/Monthly Income 4,000 667 5,850 975
ResourceQMB Part B Fee Asset/Monthly Income 4,000 794 6,000 1,065
ResourceSLIMB Part B Fee Asset/Monthly Income 4,000 952 5,850 1,278
No Resource Test QI-1 Part B Fee No Asset Test/Monthly Income 1,071 1,438
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65 ??????????????
??????? 78.20 ????? ??????? 78.20 ????? ??????? 78.20 ????? ? ? ? ?
ResourceMA QMB ?????/Part B ?? ??/???? 4,000 667 5,850 975
ResourceQMB Part B ?? ??/???? 4,000 794 6,000 1,065
ResourceSLIMB Part B ?? ??/???? 4,000 952 5,850 1,278
No Resource Test QI-1 Part B ?? ???/???? 1,071 1,438
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• 11?15???????
• ?????????????
• ??????????????? (SSA, EPIC)
• Extra Help ????????
• ???Medicaid
• ??????? 14,355 (??) ? 19,245 (??)

21
? ? ? ? ?
Confucius Surgicals 7 Bowery, New
York ?????7? [phone]
Confucius Pharmacy Inc. 25 Bowery, New
York ?????25? [phone]
Mannings Pharmacy Corp. 13 Elizabeth St, New
York ???????13? [phone]
Mannings 8th Ave Pharmacy 64-02 Eighth Ave,
Brooklyn ?????? 64-02? [phone]