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Title:

New Medicare Prescription Drug Coverage

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For the first time in history, Medicare will help. pay for prescription drugs in various drug ... Limited Income Help (if eligible) SSA accepting applications ... – PowerPoint PPT presentation

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Title: New Medicare Prescription Drug Coverage


1
New Medicare Prescription Drug Coverage
  • Presented by Benefits Assistance Program of the
    Area Agency on Aging, Region One

2
PRESCRIPTION DRUG COVERAGE PART D
  • For the first time in history, Medicare will help
  • pay for prescription drugs in various drug
  • categories
  • Coverage begins January 1, 2006
  • Will be delivered by Prescription Drug Plans
  • Available for all Medicare beneficiaries

3
Eligibility and Enrollment
  • Entitled to Part A and/or enrolled in Part B
  • Reside in plans service area
  • Must enroll in a Medicare prescription drug plan
    to get Medicare prescription drug coverage
  • Stand-alone Prescription Drug Plan (PDP)
  • Medicare Advantage Prescription Drug Plan (MA-PD)

4
What it CostsHow it Works
  • Average monthly premium for AZ is 28 per month
  • 250 deductible
  • Coinsurance of 25 of drug costs from 250 to
    2,250
  • Medicare pays 75
  • 100 of drug costs from 2,250 to 5,100
  • Coinsurance of 5 of drug costs after true
    out-of-pocket drug costs reach 3,600

5
Prescription Drug Plans Available in AZ
  • AZ is an individual region for PDPs
  • 18 companies offering PDPs in AZ
  • 43 stand-alone plans available
  • 10 companies offer National plans

6
TROOP (2006)
  • The amount of money to reach catastrophic
    coverage. Consists of
  • Deductible 250
  • 25 coinsurance 500
  • Coverage Gap 2,850

  • 3,600
  • Medicare prescription drug plan premium
    wrap-around coverage are not part of
    out-of-pocket threshold

7
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8
Medicare Prescription Drug Plans
  • Must offer basic drug benefit
  • May offer supplemental benefits
  • Can be flexible in benefit design
  • Will have formulary
  • Must follow marketing guidelines

9
Initial Enrollment Period
  • Nov 15, 2005 to May 15, 2006
  • Are currently eligible or
  • Will become eligible in November, December 2005,
    and January 2006
  • Coverage will be effective January 1, 2006 or
  • First day of the month after PDP selection

10
Postponing Enrollment
  • Higher premiums for people who wait to enroll
  • Exception for those with creditable drug coverage
  • Assessed 1 of base premium for every month you
    are
  • Eligible to enroll in a Medicare prescription
    drug plan but not enrolled
  • No creditable drug coverage for 63 consecutive
    days or longer

11
Possible Examples of Creditable Coverage
  • Some Group Health Plans (GHP)
  • Active employer GHP
  • Retirement GHP
  • VA coverage
  • Military coverage including TRICARE
  • Note The source of the current drug coverage
    will send a notice telling the person if it is at
    least as good as Medicare prescription drug
    coverage

12
How it How it Works for Retirees
  • If current coverage is creditable, keep current
    coverage
  • Can join a PDP but not necessary
  • Enrollment in PDP may end all retiree-health
    coverage
  • If current coverage is not creditable
  • Join a Medicare PDP to replace current coverage
  • Former employers or unions must provide letter
    of creditable or non-creditable coverage prior to
    November 15

13
Options for Retiree Health Plans
  • Offer coverage in place of Medicare drug coverage
    and receive a tax-free subsidy for each member
  • Offer or contract with a Medicare PDP to provide
    drug coverage
  • Provide coverage that supplements the Medicare
    drug coverage
  • Pay all or part of Medicare drug premiums

14
I am enrolled in a Medicare Health plan.
  • Individuals will be passively enrolled in their
    Medicare Advantage plans drug plan
  • Drug benefits will be covered directly through
    plan
  • Not able to have a separate
  • prescription drug plan

15
What About Medigap Coverage?
  • Some Medigap plans have a drug benefit
  • Must decide to keep current plan with
    prescription coverage
  • or
  • enroll in Part D modify current plan
  • If the Medigap plan does not have drug benefits
  • The Medigap coverage will not change
  • Should enroll in a Prescription Drug Plan

16
How do I Choose a Plan?
  • Know what drugs are on the plans formulary
  • Know what pharmacy you can use to purchase drugs
  • Does plan have mail-order option

17
Are all drugs covered?
  • NO!
  • Must check PDPs formulary before choosing a
    plan!

18
Excluded Drugs
  • Drugs for
  • Anorexia, weight loss, or weight gain
  • Fertility
  • Cosmetic purposes or hair growth
  • Symptomatic relief of cough and colds
  • Prescription vitamins and mineral products
  • Except prenatal vitamins and fluoride
    preparations
  • Non-prescription drugs
  • Barbiturates
  • Benzodiazepines

19
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20
Can plans change their drug formularies?
  • Drug plan sponsors may change their list of
    covered drugs but must give 60 day notice to
    beneficiaries if using a drug that will be
  • dropped drug from formulary
  • moved to a to different tier level

21
My drug is not on the formulary What do I do?
  • Urgently needed drugs may be covered while a
    prompt exception process is completed
  • Appeal process if a physician determines that an
    alternate medication is not in the best interest
    of the patient

22
Is there a limit to the number of prescriptions?
  • Unlimited prescriptions can be filled
  • Plans will not limit number of prescriptions
    filled in a certain time period, for example, a
    month

23
Can I fill my prescriptions at any pharmacy?
  • NO
  • Each plan will have their own pharmacy network
  • Must have prescription filled at a pharmacy in
    the plans network

24
Can I Change My Drug Plan?
  • Generally, a person is locked into their PDP for
    the calendar year. They may change their PDP
    only during
  • The Annual Coordinated Election Period, or
  • A Special Enrollment Period if applicable

25
Extra Help for Some People
  • Those with lowest incomes (
  • Pay no premiums or deductibles
  • Pay small or no copayments
  • Those with slightly higher incomes (2005) and resources
  • Pay reduced premium
  • Pay reduced deductible
  • Pay reduced coinsurance

26
Qualifying for Extra Help
  • Resources
  • Single less than 11,500
  • Couple less than 23,000
  • Income
  • Single less than 14,355
  • Couple less than 19,245

27
To Get This Help
  • Person does not have to do anything
  • If currently receiving benefits from both AHCCCS
    and Medicare
    or
  • Receiving Supplemental Security Income benefits
    and Medicare

28
To Get This Help(if not on AHCCCS or receiving
SSI)
  • Application should have come in the mail from SSA
  • Mail completed application to SSA or complete
    on-line at www.socialsecurity.gov
  • Will need to enroll in a PDP starting November 15

29
How is Income Counted?
  • Includes income of applicant and spouse
  • Income is compared to family size standard
  • Family includes dependent relatives who reside
    with the applicant and who rely on them for at
    least half their support

30
How Are Resources Counted?
  • Includes resources of applicant and spouse
  • Will only consider
  • Liquid assets can be converted to cash within 20
    days
  • Real estate Does not include applicants primary
    residence

31
Part Application Process
  • Separate application process for
  • Limited Income Help (if eligible)
  • SSA accepting applications now
  • Prescription Drug Plan
  • Enrollment begins 11-15-05

32
How To Enroll
  • Paper application through drug plan
  • On the Medicare website www.medicare.gov
  • On the drug plans website
  • 1-800-MEDICARE (1-800-633-4227)

33
Important Dates
  • If you have limited income and resources, watch
    your mail for information from Social Security
    about applying for extra help paying for
    prescription drugs

May-August 2005
34
Important Dates
  • If you receive AHCCCS, SSI, or are in a MSP,
    watch your mail for a letter from Medicare

May 2005
35
Important Dates
  • Watch your mail for the Medicare You handbook,
    which will have information about the plans in
    your area

October/ November 2005
36
Important Dates
  • You can begin to compare Medicare prescription
    drug plans
  • www.medicare.gov
  • 1-800-MEDICARE
  • BAP (602-264-2255)

October 13 2005
37
Important Dates
  • You can begin to enroll in Medicare prescription
    drug plans

November 15 2005
38
Important Dates
  • Medicare prescription drug coverage begins for
    those who are enrolled

January 1 2006
39
Important Dates
  • Need to enroll in a Medicare prescription drug
    plan by

May 15 2006
40
Thank You for Watching!
  • If you have questions or want more information,
    please call
  • Benefits Assistance Program
  • at the Area Agency on Aging
  • 602-264-2255
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