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Medicare Prescription Drug Plans

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Medicare Prescription Drug Plans ... How to Apply for Extra Help ... For as long as they are enrolled in a Medicare prescription drug plan ... – PowerPoint PPT presentation

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Title: Medicare Prescription Drug Plans


1
2005 National Medicare You Training Program
CMS Congressman Bishop Medicare Information
Meetings 2005
2
What You Need to Know
  • General Overview
  • Medicare Prescription Drug Coverage

3
Medicare Prescription Drug Coverage
  • Begins January 1, 2006
  • Available for all people with Medicare
  • Part A, Part B, or both
  • Cannot be incarcerated or live outside the U.S.
  • Must join a Medicare drug plan to get coverage
  • Initial enrollment period November 15, 2005,
    through May 15, 2006
  • Join by December 31, 2005, for coverage beginning
    January 1, 2006

4
Plan Choices
  • Two types of Medicare drug plans
  • Medicare Prescription Drug Plans
  • Medicare Advantage Plans and other Medicare
    Health Plans with prescription drug coverage

5
Rx Drug Coverage Enrollment
  • Coverage is not automatic
  • Except people who qualify for extra help
  • Initial Enrollment Period (IEP)

6
Annual Coordinated Election Period (AEP)
  • November 15 December 31 every year
  • People who dont have a Medicare drug plan can
    enroll
  • People who currently have a Medicare drug plan
    can switch
  • Change effective January 1
  • Special Enrollment Period (SEP) may apply in
    special circumstances

7
Standard Coverage
  • Standard coverage in 2006
  • Minimum coverage drug plans must provide
  • In 2006, person with Medicare pays
  • A monthly premium
  • 250 deductible
  • 25 of yearly drug costs from 250 to 2,250
  • Person pays 25 500 plan pays 75 1,500
  • 100 of next 2,850 in drug costs
  • 5 of drug costs (or a small copayment) after
    3,600 out of pocket
  • 250 500 2,850 3,600

8
Extra Help With Drug Costs
  • Available for many people with limited income and
    resources
  • Those below Federal poverty level save over 95
    on average
  • People with lowest income and resources
  • Pay no premiums or deductibles
  • Have small or no copayments
  • Those with slightly higher income and resources
  • Have a reduced deductible
  • Pay a little more out of pocket

9
Eligibility for Extra Help
  • Income
  • Below 150 Federal poverty level
  • 1,197 per month for an individual or
  • 1,604 per month for a married couple
  • Based on family size
  • Resources
  • Up to 11,500 (individual)
  • Up to 23,000 (married couple)
  • Includes 1,500/person funeral or burial expenses
  • Counts savings and stocks
  • Does not count home the person lives in
  • Higher amounts for Alaska and Hawaii

2005 amounts
10
Automatic Eligibility for Extra Help
  • Some people may automatically qualify
  • People with Medicare who
  • Get full Medicaid benefits
  • Get Supplemental Security Income (SSI)
  • Get help from Medicaid paying their Medicare
    premiums
  • All others must apply

11
How to Apply for Extra Help
  • Social Security Administration (SSA) sent
    applications to people who may be eligible
  • Those who think they may qualify can
  • Call the Social Security Administration,
    1-800-772-1213
  • Visit www.socialsecurity.gov
  • Apply at their State Medical Assistance office.
  • People who are not sure should still apply
  • Even if they did not get an application
  • www.socialsecurity.gov can help people decide
  • There is no risk or cost to apply

12
Things to Consider
  • What is current health insurance coverage?
  • Is there currently prescription drug coverage?
  • Even those with current drug coverage should ask
  • Is Medicare prescription drug coverage right for
    me?

13
Coverage on Average at Least as Good as Medicares
  • People with other coverage
  • Will not pay a penalty if they wait to enroll
  • If coverage is at least as good as Medicare
    prescription drug coverage
  • Possible examples
  • Some group health plans (GHP)
  • Some Medigap policies
  • VA coverage
  • Military coverage including TRICARE

14
Late Enrollment
  • Most people will have to pay a penalty if they
    wait to enroll
  • Additional 1 of base premium for every month
    they were eligible but not enrolled
  • For as long as they are enrolled in a Medicare
    prescription drug plan
  • Unless they have other coverage that, on average,
    is at least as good as Medicare prescription drug
    coverage

15
Special Enrollment Period
  • Change in residence
  • Move out of plans service area
  • Move into or out of a long-term care facility
  • People with Medicare and
  • Full Medicaid benefits
  • Medicare Savings Programs
  • People Medicare enrolled in a plan
  • Involuntary loss of coverage
  • Others

16
Which Drugs Are Covered?
  • Drugs, biologicals, insulin
  • Available only by prescription
  • Medical supplies associated with injection of
    insulin
  • Syringes, needles, alcohol swabs, gauze
  • Brand-name and generic drugs

17
Which Drugs Are Not Covered?
  • Drugs excluded by MMA law
  • But some plans may choose to cover
  • Non-prescription drugs
  • Drugs that are covered for a person under
    Medicare Part A or Part B

18
Plan Marketing
  • Plans began marketing October 1, 2005
  • Medicare prescription drug plans may
  • Use the Medicare Rx seal
  • Send information or call people with Medicare

19
Protecting Against Fraud and Identity Theft
  • Medicare prescription drug plans may not
  • Contact people with Medicare before October 1,
    2005
  • Sell door-to-door
  • Enroll people by phone
  • Unless the person calls them OR
  • The person is adding drug coverage to their
    Medicare Advantage or other Medicare Health Plan

20
Protecting Against Fraud and Identity Theft
  • Those who think someone is using their personal
    information should call
  • 1-800-MEDICARE (1-800-633-4227)
  • TTY users call 1-877-486-2048
  • Fraud Hotline at 1-800-447-8477
  • TTY users call 1-800-377-4950
  • ID Theft Hotline at 1-877-438-4338
  • TTY users call 1-866-653-4261

21
Choosing a Medicare Drug Plan
  • Coverage
  • Formularies
  • Cost
  • Premium, deductible, copayments or coinsurance
  • Convenience
  • Pharmacy networks
  • Mail-order

22
Choosing a Plan
  • Step 1 Collect information
  • Any current prescription drug coverage
  • Prescription drugs and doses
  • Step 2 Compare Medicare drug plans
  • Medicare You 2006
  • Medicare Prescription Drug Plan Finder tool at
    www.medicare.gov
  • 1-800-MEDICARE
  • Step 3 Choose a plan
  • For help, call the State Health Insurance
    Assistance Program (SHIP) in their state

23
Joining a Plan
  • Enroll directly with the plan sponsor
  • Internet
  • Plan website
  • www.medicare.gov
  • Telephone
  • Paper form
  • Mail or fax to plan sponsor

24
For More Information
  • Websites
  • www.medicare.gov
  • www.cms.hhs.gov
  • www.socialsecurity.gov
  • Publications
  • Medicare You handbook
  • Your Guide to Medicare Prescription Drug Coverage
  • 1-800-MEDICARE (1-800-633-4227)
  • Social Security Administration
  • 1-800-772-1213
  • Georgia Cares (1-800-669-8387)
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