Making Medicare Work in Illinois and Beyond Effective Strategies to Assist Individuals to Transition to Medicare Part D

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Making Medicare Work in Illinois and
BeyondEffective Strategies to Assist Individuals
to Transition to Medicare Part D

• John Coburn
• Health Disability Advocates
• November 2, 2005

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Make Medicare Work Coalition in IL(MMW
Coalition)

• Marries public policy advocacy with education and
  outreach in the community
• 3 Partners lead a coalition of aging disability
  groups Progress Center for Independent Living,
  Suburban Area Agency on Aging, and Health
  Disability Advocates
• Provide person-centered outreach that covers ALL
  public programs (federal and state) that
  individuals access and their interaction with
  Medicare Part D

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HealthCare Choices Resource Centerwww.makemedicar
ework.org
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Make Medicare Work Policy Group

• A neutral table for coalition partners to discuss
  federal and state policy initiatives
• Source of accurate, credible policy analysis on
  MMA regulations and impacts on Illinois
• Develop proposed policy changes at federal levels
  regarding implementation of MMA components
• Work collaboratively with state agencies and
  policymakers on development of state programs

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Make Medicare Work Policy Group

• Comprised of policy, advocacy and provider
  groups, state agency representatives,
  policymakers
• Informed by experiences relayed to education and
  outreach team
• Recent activities include advocacy around
  Illinois SPAP (IL Rx), comments on Low Income
  Subsidy Rules and impact on working individuals,
  advocacy on AIDS Drug Assistance Program issues

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Medicare Consumer Profiles in Midwest

• Geographic and demographic profile of Medicare
  Consumers in IL, IN, MI, OH, WI
• Goals
• Target education outreach efforts to vulnerable
  populations
• Create effective policy solutions

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Make Medicare Work Policy Group

• Upcoming policy issues include Medicare Part Ds
  interaction with those who already have drug
  coverage.
• Examples Medicaid, AIDs Drug Assistance
  Program, Retiree coverage, Illinois Comprehensive
  Insurance Program (I-CHIPhigh risk pool)
• Education and outreach IS a policy issue because
  programs need effective education and outreach
  plans to effectuate a smooth transition.

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Current HDA/MMW Work with Other Insurance Programs

• ADAPs, I-CHIP and Illinois Rx (SPAP) have made or
  still must make several decisions on how they
  will continue to cover individuals eligible for
  Part D.
• Similar to Medicaid Buy-In, concern about how
  Part D coverage compares to current coverage and
  what education tools to use to help individuals
  to make the transition.
• I Dont Need Medicare Part D Myth

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Phase 1 Gearing Up for Medicare Part D

• Combating the I Dont Need Medicare Part D
  Myth.
• Enrollment in Extra Help or assuring Dual
  Eligible/Deemed Eligible Status.
• At this point, Phase 1 should be up and
  running.

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Phase 1 Deliverables

• Beneficiaries understand their Medicare Part D
  status (dual eligible, extra help eligible,
  etc).
• Beneficiaries have confirmed deemed eligible
  status or applied for extra help.
• Beneficiaries understand that they will no longer
  access most or all of their medications from
  Medicaid or other applicable program.
• Beneficiaries understand the Medicare Part D
  timeline of events.

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Phase 2 Its All About the Plans and
Transition!

• Once beneficiaries understand the basics, the
  biggest concern is the plans. Will I have the
  same coverage?
• Phase 2 must entail helping to navigate through
  unbelievable amounts of information to settle on
  a plan that will meet an individuals needs.

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Phase 2 Sifting through the Plans

• It is next to impossible to weigh all of the
  variables to come to the best plan.
• Narrow it down to three questions for dual
  eligibles
• Are all my medications on the formulary?
• What benefit management tools are attached to my
  medications?
• What does the plan I want cost?

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Phase 2 Education Around Assuring Continued
Coverage

• Medicaid Buy-In Participants can change plans
  every month. Do they know HOW to do this?
• Someone may need to file for an exception if they
  cannot find a plan with all of their needed
  medications. Do they have the tools to do this?

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Phase 2 Deliverables for Dual Eligibles

• Beneficiary has tools to make an informed
  decision on plans.
• Beneficiary has chosen a plan that meets his or
  her needs.
• Beneficiary is equipped to deal with future
  changes in coverage by understanding how to
  choose a different plan or file an exception.

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Questions?

• John Coburn
• Health Disability Advocates
• 312-218-0941
• jcoburn_at_hdadvocates.org