Medicare Prescription Drug Plans - PowerPoint PPT Presentation

Loading...

PPT – Medicare Prescription Drug Plans PowerPoint presentation | free to view - id: 1678e3-OTA3Y



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Medicare Prescription Drug Plans

Description:

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

Number of Views:51
Avg rating:3.0/5.0
Slides: 86
Provided by: khea2
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

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
58
(No Transcript)
59
(No Transcript)
60
(No Transcript)
61
(No Transcript)
62
(No Transcript)
63
(No Transcript)
64
(No Transcript)
65
(No Transcript)
66
(No Transcript)
67
(No Transcript)
68
(No Transcript)
69
(No Transcript)
70
(No Transcript)
71
(No Transcript)
72
(No Transcript)
73
(No Transcript)
74
(No Transcript)
75
(No Transcript)
76
(No Transcript)
77
(No Transcript)
78
(No Transcript)
79
(No Transcript)
80
(No Transcript)
81
(No Transcript)
82
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.
About PowerShow.com