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Medicare Prescription Drug Plans

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Auto-enrolled unless plan chosen before January 1, 2006 ... Drugs for weight gain or loss. Barbituates. Benzodiazpines. The Auto-Assignment Process ... – PowerPoint PPT presentation

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Title: Medicare Prescription Drug Plans


1
Medicare Prescription Drug Plans
  • What Do You Need To Know?

2
Medicare Basics
  • Part A
  • Hospital Insurance
  • Part B
  • Medical Insurance (doctor visits)
  • Part C
  • Medicare Advantage
  • Part D
  • NEW Prescription Drug Benefit

3
Eligibility and Enrollment
  • Entitled to Part A and/or enrolled in Part B
  • Must reside in the plans service area
  • Program voluntary (for most)
  • Must enroll with the drug plan
  • Monthly fees apply (for most)

4
Prescription Drug Benefit
  • Available to everyone with Medicare
  • Medicare contracts with private companies
  • Benefits begin as early as January 2006
  • Financial aid is available through the Social
    Security Administration
  • Income and resource limits apply

5
Example of Standard Prescription Drug Coverage
  • Estimated 32 monthly premium
  • 250 deductible
  • Co-insurance of 25 of drug costs from 250 to
    2,250 (total drug spending)

6
Example of Standard Prescription Drug Coverage
  • Coverage gap from 2,250 to 5,100
  • Beneficiary pays 100 of drug costs
  • Catastrophic coverage after 5,100 (3,600 in
    out-of-pocket costs)
  • Beneficiary pays only 5 of drug costs

7
Five Main Groups
  • No Prescription Drug Coverage
  • Consider the current costs of your medications
  • Do you qualify for extra help?

8
Five Main Groups
  • Employer/union coverage (including VA, TRICARE,
    and FEHB)
  • Is your current coverage as good as the standard
    Medicare prescription coverage?
  • Contact your plan administrator

9
Five Main Groups
  • Medicare and Medicaid
  • Auto-enrolled unless plan chosen before January
    1, 2006
  • Automatically qualify for the extra help
  • Do not need to complete the application for extra
    help

10
Five Groups
  • Medicare Advantage Plan or other Medicare Health
    Plan
  • Provide medical and drug coverage
  • Similar to HMO or PPO, required to use doctors in
    plan

11
Five Groups
  • Medigap Policy with Prescription Drug Coverage
  • In general, the Medicare prescription drug
    coverage will offer savings
  • If you join a Medicare drug plan, contact your
    Medigap insurer

12
Need Help?
  • Call 1-800-MEDICARE
    (1-800-633-4227)
  • Visit www.medicare.gov
  • For extra help
  • - Social Security Administration
  • - 1-800-772-1213
  • - www.socialsecurity.gov
  • - 1-800-AGELINE (1-800-243-5463)

13
Resources
  • For enrollment
  • 1-800-MEDICARE (1-800-633-4227)
  • www.medicare.gov
  • For extra help
  • Social Security Administration
  • 1-800-772-1213
  • www.socialsecurity.gov
  • 1-800-AGELINE (1-800-243-5463)

14
Resources
  • Alabama Medicaid Agency
  • www.medicaid.state.al.us

15
  • This presentation made possible by support from
    the American Pharmacy Cooperative, Inc.

16
Enrolling in Medicare Part D
17
Initial Enrollment Period
  • If you have Medicare and Medicaid, choose a drug
    plan before January 1, 2006
  • If you fall in one of the other four groups you
    have until May 15, 2006, to enroll

18
Initial Enrollment Period
  • Penalty of 1 per month added to monthly fee if
  • Enrollment is delayed and
  • Beneficiary is without creditable coverage

19
You Have Responsibilities
  • Decide if you should participate
  • Apply for extra help with Social Security
  • Choose a plan that best meets your needs
  • Enroll in a Prescription Drug Plan
  • Change plans, if necessary
  • Pay your premiums, co-pays and deductibles

20
Applying for Extra Help
  • For those with limited income and resources
  • Contact Social Security at 1-800-772-1213

21
Applying for Medicare Savings Program
  • For those with limited income
  • Contact Medicaid at 1-800-362-1504

22
What You Need To Do To Prepare
  • You have time. Sign up ends May 15, 2006. Choose
    wisely.
  • Find out if you qualify for extra help from
    Social Security.
  • Think of the three Cs
  • Cost
  • Coverage
  • Convenience

23
Cost
  • What do you currently pay for your medications?
  • True out-of-pocket costs
  • How much do you want to pay?
  • Deductible?
  • Co-pay?
  • Premium?
  • Medication costs?

24
Coverage
  • Make a list of the drugs you currently take
  • Name of the medicine
  • Dosage
  • How often you take it
  • Cost (not just your co-pay)

25
Convenience
  • Write down the names of the pharmacies you use.
  • Find out what plans they accept.
  • Do you want to use a mail order pharmacy?
  • How much do you travel?

26
Protect Your Personal Information
  • Dont pay cash, write a check
  • Only plans that are approved by Medicare can
    offer a Medicare prescription drug plan
  • Social Security is making follow-up calls to
    people

27
Protect Your Personal Information
  • You do not HAVE to join or else lose benefits
  • Cannot enroll over the phone, only promote the
    plan
  • Keep your personal information safe!

28
Protect Your Personal Information
  • Dont give your personal information out
  • Never give your bank account, credit card or
    social security number out over the phone
  • Never pay cash or send enrollment payments over
    the internet
  • Persons working with Medicare will never show up
    uninvited at your home

29
Need Help?
  • Call 1-800-MEDICARE
    (1-800-633-4227)
  • Visit www.medicare.gov
  • For extra help
  • - Social Security Administration
  • - 1-800-772-1213
  • - www.socialsecurity.gov
  • - 1-800-AGELINE (1-800-243-5463)

30
Resources
  • For enrollment
  • 1-800-MEDICARE (1-800-633-4227)
  • www.medicare.gov
  • For extra help
  • Social Security Administration
  • 1-800-772-1213
  • www.socialsecurity.gov
  • 1-800-AGELINE (1-800-243-5463)

31
Resources
  • Alabama Medicaid Agency
  • www.medicaid.state.al.us

32
  • This presentation made possible by support from
    the American Pharmacy Cooperative, Inc.

33
Special Information For People Now On Medicaid
and Medicare
34
What Will be Different Under Part D
  • Full Dual Eligibles
  • Previously had drug coverage under Medicaid
  • Medicaid drug coverage ends 12/31/05
  • Auto-assigned to a Part D plan
  • Can change plans monthly
  • Automatically qualify for extra help

35
What Drugs are not Covered and How Medicaid Will
Help
  • Full Dual Eligibles
  • Will continue to receive coverage for certain
    excluded drugs by Medicaid
  • Still subject to Medicaid approval (PA) or other
    requirements

36
Part D Excluded Drugs Covered by Medicaid
  • Over-the-counter drugs
  • Cough and Cold medicines
  • Most vitamin and mineral products
  • Drugs for weight gain or loss
  • Barbituates
  • Benzodiazpines

37
The Auto-Assignment Process
  • How assignments made
  • Recent changes
  • Changing plans
  • What to do if you have other insurance for your
    medicine now

38
Medicare Savings Program
  • QMB, SLMB, Q1 recipients
  • Can choose to participate
  • Participants must choose a plan
  • Auto-assigned to a Part D plan
  • Automatically qualify for extra help

39
Need Help?
  • Call 1-800-MEDICARE
    (1-800-633-4227)
  • Visit www.medicare.gov
  • For extra help
  • - Social Security Administration
  • - 1-800-772-1213
  • - www.socialsecurity.gov
  • - 1-800-AGELINE (1-800-243-5463)

40
Resources
  • For enrollment
  • 1-800-MEDICARE (1-800-633-4227)
  • www.medicare.gov
  • For extra help
  • Social Security Administration
  • 1-800-772-1213
  • www.socialsecurity.gov
  • 1-800-AGELINE (1-800-243-5463)

41
Resources
  • Alabama Medicaid Agency
  • www.medicaid.state.al.us

42
  • This presentation made possible by support from
    the American Pharmacy Cooperative, Inc.

43
Special Information forHealth Care Providers
44
Identifying Recipients with a Part D Plan
  • Yellow recipient letter
  • Medicare Pharmacy Line
  • 1-866-835-7595
  • E1 eligibility transaction to the TrOOP
    facilitator

45
Dual Eligibles If Not Auto Enrolled
  • Point of Sale Facilitated Enrollment
  • CMS Contractor (WellPointe)
  • Pharmacist to bill special account that will
    engage in a series of steps
  • CMS website has instructional video on this
    process

46
Identifying PDPs for Nursing Home Patients
  • Procedure for up to 100 recipients
  • Procedure for over 100 recipients
  • Questions about these procedures, contact
  • Michele Ramirez 215-861-4159

47
Identifying PDPs for Nursing Home Patients
  • Fax number
  • 1-785-830-2593
  • Mailing information
  • Medicare Nursing Home Requests
  • 3383 Greenway Drive
  • Lawrence, KS 66046-5504
  • 785-838-2107 (delivery only)

48
Options for Full Dual Eligibles
  • One time fill
  • Switch to a therapeutic equivalent drug
  • Appeals process
  • Change PDP

49
What Drugs are not Covered and How Medicaid Will
Help?
  • Full Dual Eligibles
  • Will continue to receive coverage for certain
    excluded drugs by Medicaid
  • Still subject to Medicaid approval (PA) or other
    requirements

50
Part D Excluded Drugs Covered by Medicaid
  • Over-the-counter drugs
  • Cough and Cold medicines
  • Most vitamin and mineral products
  • Drugs for weight gain or loss
  • Barbituates
  • Benzodiazpines

51
Information on PDPs
  • CMS website www.medicare.gov
  • Medicare 1-800-633-4227
  • Medicare and You 2006 Handbook
  • Alabama Medicaid website www.medicaid.state.al.u
    s

52
Need Help?
  • Call 1-800-MEDICARE
    (1-800-633-4227)
  • Visit www.medicare.gov
  • For extra help
  • - Social Security Administration
  • - 1-800-772-1213
  • - www.socialsecurity.gov
  • - 1-800-AGELINE (1-800-243-5463)

53
Resources
  • For enrollment
  • 1-800-MEDICARE (1-800-633-4227)
  • www.medicare.gov
  • For extra help
  • Social Security Administration
  • 1-800-772-1213
  • www.socialsecurity.gov
  • 1-800-AGELINE (1-800-243-5463)

54
Resources
  • Alabama Medicaid Agency
  • www.medicaid.state.al.us

55
  • This presentation made possible by support from
    the American Pharmacy Cooperative, Inc.

56
Using the Medicare Website to Find a
PrescriptionDrug Plan
57
www.medicare.gov
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Need Help?
  • Call 1-800-MEDICARE
    (1-800-633-4227)
  • Visit www.medicare.gov
  • For extra help
  • - Social Security Administration
  • - 1-800-772-1213
  • - www.socialsecurity.gov
  • - 1-800-AGELINE (1-800-243-5463)

83
Resources
  • For enrollment
  • 1-800-MEDICARE (1-800-633-4227)
  • www.medicare.gov
  • For extra help
  • Social Security Administration
  • 1-800-772-1213
  • www.socialsecurity.gov
  • 1-800-AGELINE (1-800-243-5463)

84
Resources
  • Alabama Medicaid Agency
  • www.medicaid.state.al.us

85
  • This presentation made possible by support from
    the American Pharmacy Cooperative, Inc.
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