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Medicare

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Medicare's New Prescription Drug Program. Mike Klug, J.D. Program Consultant ... Iowa Stand-Alone Prescription Drug Plans. Comparison of 3 Plans. N/A / 30% N/A / 30 ... – PowerPoint PPT presentation

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Title: Medicare


1
Medicares New Prescription Drug Program
  • Mike Klug, J.D.
  • Program Consultant
  • Univ. of Iowa Center on Aging

2
Goals
  • Provide background on the new Medicare program
  • Identify key factors in making enrollment and
    plan selection decisions
  • Identify information resources

3
Background Medicare Part D
  • Open to all people with Medicare Parts A and/or B
  • People with Medicare and Medicaid and/or
    Supplemental Security Income (SSI) will be
    enrolled automatically
  • Low income individuals will qualify for extra
    help
  • Social Security sent applications

4
Background Medicare Part D
  • Do seniors plan to enroll in a drug plan?
  • 43 percent dont yet know
  • 37 percent do not plan to enroll
  • 20 percent plan to enroll
  • Kaiser Family Foundation Survey, November 10,
    2005
  • About 50 percent plan to enroll
  • Wall Street Journal, November 2005

5
Key Factors in Making Decisions
  • Extra Help Program
  • Current Insurance Coverage for Drugs
  • Enrolling in a Medicare Drug Plan
  • Selecting a Medicare Drug Plan

6
Extra Help Program
  • For those with limited financial means
  • Monthly Income up to 1,196 (1) 1,604 (2)
  • Assets up to 10,000 (1) 20,000 (2)
  • Helps with premiums, deductibles, co-payments or
    coinsurance
  • Social Security accepts applications
  • www.ssa.gov

7
Extra Help Program
  • Covers dual eligibles
  • People with Medicaid, SSI, or Medicare Savings
    Programs (QMB, SLMB, QI)
  • Covers others with limited means
  • No premiums, low co-payments for people with
    Medicaid
  • Lower premiums and co-payments for others

8
Current Insurance Coverage?
  • Retiree plans
  • VA benefits or TRICARE-for-Life
  • Medicare Supplement Insurance
  • Medicare Advantage (MA) plans
  • Medicaid
  • Drug coverage ends for dual eligible people on
    December 31, 2005

9
Approved Part D Drug Plans
  • Medicare approved drug plans must provide
  • Coverage equal to the standard benefit, or extra
    coverage to enhance it
  • Access to medically necessary drugs
  • Formulary standards for drug selection
  • Access to convenient retail pharmacies
  • Drugs to nursing homes
  • Medication Therapy Management

10
Medicare Part D Standard Benefit
  • Covers brand name and generic drugs
  • Annual deductible of 250
  • Covers 75 of next 2,000 in drug costs (up to
    2,250 in total drug costs)
  • No coverage of the next 2,850 in drug costs
    until out-of-pocket costs reach 3,600
  • Catastrophic benefit Medicare pays 95 after
    drug costs reach 5,100
  • Average monthly premium estimated at 32

11
Medicare Part D Standard Benefit Drug Plan
You could pay 5 of anything over 5,100 in
drug costs ___3600 out of pocket__ The next
2850 The next 500 The first 250
12
Covered Drugs
  • Cancer medications
  • Antidepressants
  • Antipsychotics
  • Anticonvulsive treatments for epilepsy and other
    conditions
  • Immunosuppressants
  • HIV/AIDS treatments

13
Excluded Drugs
  • Benzodiazepines, i.e. minor tranquilizers
  • Barbiturates
  • Drugs for weight loss or gain
  • Drugs for relief of colds
  • Over-the-counter drugs
  • They may be provided at no cost
  • Drugs covered by Medicare Part B

14
Enroll in a Drug Plan?
  • People without prescription drug coverage
  • People whose coverage is less than equivalent to
    Medicares standard plan
  • The issue of creditable coverage
  • Penalties for late enrollment

15
Enroll in a Drug Plan?
  • Initial Enrollment Period November 15, 2005 to
    May 15, 2006
  • Coverage Starts January 1, 2006
  • Next Enrollment Period November 15, 2006 to
    December 31, 2006
  • Auto-enrollment for Medicaid patients

16
Penalty for Delay
  • For those without creditable coverage
  • Next open enrollment period (Nov.15 Dec. 31,
    2006)
  • Coverage effective on Jan. 1, 2007
  • Premium goes up AT LEAST 1 per month for every
    month delayed
  • Premium remains in effect for the entire time the
    benefit is used

17
Which Drug Plan to Select?
  • Prescription Drug Plans (PDP)
  • Stand alone work with Original Medicare
  • 41 plans from18 plan sponsors
  • Premiums 1.87 to 99.90 per month
  • Medicare Advantage Drug Plans (MA-PD)
  • Medicare HMOs, Regional PPOs, PFFS plans
  • 22 plans from 8 plan sponsors
  • Premiums 0 to 53.90 per month

18
Which Drug Plan to Select?
  • Monthly Premiums
  • Annual Deductible
  • Medications on Plan Formulary?
  • Coinsurance or Co-payment Levels (Tiers)
  • Network Pharmacies
  • Drug Utilization Management Protocols

19
Plans Need Not Cover All Prescribed Medications
  • Access to all medically necessary drugs
  • At least two drugs in each treatment class
  • Review formularies to see if drug plan covers
    your drug(s)
  • Medicare drug plans must provide a transition
    period while trying alternatives
  • Exceptions may be requested denials appealed

20
Iowa Stand-Alone Prescription Drug Plans
21
Comparison of 3 Plans
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Comparing Plans Tips
  • Make list of medications
  • Check the drug plans formulary to make sure your
    drugs are covered
  • Check the drug plans pharmacy network
  • Compare out-of-pocket costs in light of your
    budget
  • Consider cost-benefit of enhancements

38
Drug Plan Marketing
  • Medicare Drug Plans can market by
  • Direct mail
  • Phone calls
  • TV and radio
  • Distributing information at health fairs
  • Providing lunch at informational meetings
  • Offering incentives/gifts up to 15.00 in value

39
Drug Plan Marketing
  • Medicare drug plans cannot
  • Sell door-to-door, unless invited.
  • Ask for personal information during marketing
    activities.
  • Ignore the National Do-not-Call Registry.
  • Compare one plan to another by name.
  • Use the words Medicare Endorsed.

40
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41
Resources
  • Medicare
  • 1-800-MEDICARE
  • www.medicare.gov (Drug plan and formulary finder
    tools, fact sheets, QA)
  • www.cms.hhs.gov (Outreach and public education
    tools provider and partner ListServs)

42
Resources
  • Iowa Senior Health Insurance Information Program
    (SHIIP)
  • 1-800-351-4664 (statewide)
  • www.shiip.state.ia.us
  • Free, objective, one-on-one counseling
  • University of Iowa Center on Aging
  • www.centeronaging.uiowa.edu
  • Free Brochure, Educational programs

43
Resources
  • Iowa Insurance Division Consumer Hotline
  • 877-955-1212
  • HHS Office of Inspector General (Medicare Fraud
    and Abuse)
  • 800-447-8477

44
Resources Health CareProviders
  • Educate (avoid recommending a plan)
  • Make information materials available
  • Refer to appropriate information sources
  • Key messages
  • Dont rush!
  • Seek help from family, friends, objective helpers

45
Special Thanks
  • Lori Benz Center on Aging
  • Steve Maravetz Health Sciences Public Relations
  • Greg Jensen, Vika Pecherskikh, UIHC Social
    Services Staff
  • Jay Currie, Michael Kelly and Julie Urmie
    College of Pharmacy
  • Health Assistance Partnership
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