Medicare Part D: The Basics for LowIncome Beneficiaries and How to Get the Extra Help

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Medicare Part D The Basics for Low-Income
Beneficiaries and How to Get the Extra Help

• Meeting at which you are speaking
• City, State/Organization
• Month, Day, 2005
• Your Name
• Your organization

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What is Part D?

• A new part of Medicare to help you pay for
  prescription drugs
• Part D begins January 1, 2006
• Part D plans offered through private companies

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Can I get Part D?

• You are eligible for Part D if you have either
  Medicare Part A or Part B.
• You CAN have both Part D and Medicaid
• If Medicaid currently pays for your medicine, you
  will now get most of your prescription drugs from
  Part D.

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What is Part D extra help?

• People without extra help pay premiums, co-pays
  and deductibles for Part D.
• Extra help is money the government pays to
  private plans to cover Part D costs for people
  who have low-incomes.
• The amount of help each person receives depends
  on their income and savings.

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What does the extra help do for me?

• With extra help you will have
• No premium or a very small premium
• No deductible or one that is 50 or less
• Small or no co-pays for each prescription

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Who can get extra help with Part D?

• Extra help is available for people who
• Have countable income below 1217/month for
  single people, 1624/month for married couples
• AND
• Have resources (usually savings) that are less
  than 11,500 for single people, 23,000 for
  married couples

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Who can get extra help with Part D? (contd)

• If you are working, the amount of income you are
  allowed to have may be higher than the numbers
  listed here.
• The home you live in and the car you drive do not
  count as savings.
• You are allowed to have up to 1500 set aside per
  person as funds for burial. This will not count
  against you. It is included in the 11,500 and
  23,000.

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How do I get extra help?

• There are some groups of people who will receive
  extra help without applying
• People who have Medicare AND Medicaid helps them
  pay for other health care costs (including
  medicines)
• People who get help paying for their Medicare
  premiums through Medicaid (QMB, SLMB and QI
  programs)
• SSI recipients who do not automatically get
  Medicaid (remove this bullet if your state
  automatically gives Medicaid to SSI recipients)

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How do I get extra help? (contd)

• If you do not have any Medicaid at all, you may
  still qualify for extra help for Part D.
• You will have to apply for extra help.
• You can apply through either your local Medicaid
  office or the Social Security Administration.

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Medicaid pays for my prescription drugs now.
What does Part D mean to me?
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If you currently get your prescriptions through
Medicaid

• You should have received a letter from Medicare
  telling you that you qualify for extra help.
  Keep this letter.
• In October, Medicare chooses a prescription drug
  plan for you and lets you know what it is. (You
  will get a letter about this. Keep this letter.)
• You may not like the plan. If you dont,
  starting November 15, 2005, you can change plans
  at any time.

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If you currently get your prescriptions through
Medicaid

• After December 31, 2005, Medicaid will no longer
  pay for most of your prescription drugs.
• Medicare will begin paying for most of your
  prescription drugs on January 1, 2006.
• You will have co-pays of up to either 1 and 3
  or 2 and 5, depending on your income. (Some
  drugs will be free.)
• Medicaid will still cover your other health care
  costs.

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Questions?
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Medicaid doesnt pay for my medicine, but the
state helps me pay for my Medicare costs. What
does Part D mean to me?
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If you currently get help paying Medicare costs

• You should have received a letter from Medicare
  telling you that you qualify for extra help.
  Keep this letter.
• You can join a Medicare prescription drug plan
  anytime between November 15, 2005 and May 15,
  2006.

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If you currently get help paying Medicare costs

• If you join by December 31, 2005, your benefits
  will begin on January 1, 2006.
• It is generally better for you to sign up for a
  plan as soon as possible to make sure you dont
  miss any drug coverage.

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If you currently get help paying Medicare costs

• If you have not joined a plan by May 15, 2006,
  Medicare will choose a plan for you and enroll
  you in that plan effective June 1, 2006.
• You will receive a letter in the spring telling
  you what plan you will be put in. Keep this
  letter.
• You will be able to switch plans anytime.
• If you join a Medicare prescription drug plan,
  you will have co-pays of up to 2 or 5.

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Questions?
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I dont get any help from Medicaid but I dont
have a lot of money. Can I get help paying for
Part D?
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If you dont get any help from Medicaid but dont
have much money

• You may get extra help if
• Your countable income is less than 1217/month
  for a single person, 1624/month for a married
  couple
• AND
• Your savings are less than 11,500 for a single
  person, 23,000 for a married couple

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If you dont get any help from Medicaid but dont
have much money

• You will need to apply for extra help.
• You can apply through either
• your local Medicaid office
• OR
• the Social Security Administration (SSA).

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Does it matter where I apply?

• If you apply through your local Medicaid office,
  you may also get help paying for your other
  Medicare premiums.
• If you apply through SSA, you will be considered
  only for the Part D extra help. (This process may
  be quicker because there will be less paperwork.)

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Ive already applied for extra help at SSA. Can
I still apply for help with Part A and B premiums?

• YES
• You can apply for help paying for your other
  Medicare costs through your local Medicaid
  office.
• This application is separate from your SSA
  application for Part D extra help.

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Ive applied and will get extra help. Now what?

• You will now have to choose and sign up for a
  Medicare prescription drug plan.
• You can join a plan anytime between November 15,
  2005 and May 15, 2006.
• If you join before December 31, 2005, your
  coverage will begin on January 1, 2006.
  Otherwise, coverage will begin the month after
  you enroll.

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Ive applied and will get extra help. Now what?
(contd)

• If you have not enrolled in a plan by May 15,
  2006, Medicare will pick a plan for you.
• You will receive a letter telling you what plan
  Medicare picked for you.
• Unless you change plans prior to then, you will
  be enrolled in that plan as of June 1, 2006.
• You will not be able to switch plans until Nov.
  15, 2006 except in certain circumstances.

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I applied for extra help and was turned down.
Now what?

• If you were turned down because you have too much
  income or savings, remember you can reapply
  anytime your financial situation changes.
• Be sure to double check that the information used
  to make the decision was correct.

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I applied for extra help and was turned down.
Now what? (contd)

• If the denial was due to incorrect information
  about your income or savings, you should appeal
  the decision.
• If you applied through your local Medicaid
  office, follow its appeal process.
• If you applied through SSA, they have a separate
  appeal process.
• Contact your local SHIP or a Legal Services
  Provider for more information.

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Questions?
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• Questions everyone can and should be asking

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What if I already have other drug coverage?

• If you already have other drug coverage, you will
  have to find out if it is creditable.
• Creditable means as good or better than the
  Part D coverage.
• Programs through the federal government (VA,
  TRICARE, FEHBP) are generally considered
  creditable.
• Health plans are required to tell you if your
  current coverage is creditable.

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What if I already have other drug coverage?
(contd)

• If your current drug plan is not creditable,
  you will need to join a Part D plan.
• If your current drug plan is creditable you may
  not need to enroll in Part D.

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What should I think about when choosing a plan?

• There are many things to think about when
  choosing a Part D plan
• Does it cover the medicines I need?
• Is there a pharmacy I can use in the plans
  network? Is it a preferred pharmacy?
• If I get extra help Will I pay premiums, co-pays
  and deductibles?
• What type of plan is it?- PDP or MA-PD?

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Where can I get this information?

• Some local community service agencies (such as
  SHIPs) can help you figure out the best plan for
  you. (customize for place/audience-include
  contact info)
• There will be a Prescription Drug Plan Finder
  available through www.medicare.gov that will let
  you to search for plans in your local area that
  cover the drugs you need.

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Where can I get this information? (contd)

• In October, you will receive a Medicare You
  2006 booklet. This booklet will contain a list
  of the plans available in your area.
• Companies sponsoring plans will begin advertising
  their plans starting in October. You can get
  pricing information and a list of covered drugs
  from the plan sponsors.

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Medicare put me in a plan. What should I do?

• Check to see that all the prescriptions you need
  are on the plans drug list.
• Make sure a pharmacy you can use is in the plans
  network.
• Check what co-pays, premiums, and deductibles are
  part of the plan costs.

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The plan I was assigned to doesnt work for me.
What should I do?

• You will need to find a new plan that does work
  for you.
• Then you will need to enroll in the new plan.
• This change will take effect the month after you
  switch plans.

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I cant find a plan that covers all my
prescriptions. What can I do?

• You can talk to your doctor about switching to a
  different drug or dosage for your condition that
  is covered by a plan and will work for you.
• You can ask your doctor to help you ask a plan
  for a formulary exception.
• You can see if another program or community
  service agency can help you get the drug.

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What if one of my drugs is not covered by Part D?

• Certain drugs will not be covered by any Part D
  plan.
• You may be able to get help paying for non-Part D
  drugs through the following
• A State Pharmaceutical Assistance Program
• Medicaid (if you get your medicines through them
  now)
• A Pharmaceutical company Patient Assistance
  Program
• Other community service agency or program

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I found a plan thats right for me. Now what?

• You will need to sign up for that plan. (Keep a
  record of your enrollment.)
• Starting November 15, 2005 you can enroll in a
  plan in any of the following ways
• The Prescription Drug Plan Finder available at
  www.medicare.gov
• 1-800-MEDICARE
• Directly through your selected drug plans
  sponsor

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Where can I go to get help?

• Local SHIP/Other consumer health assistance
  program