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1 Medicare Part D The New Prescription Drug Benefit and Implications for CARE Act Clients Mary Vienna Division of Training and Technical Assistance HIV/AIDS.

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Presentation on theme: "1 Medicare Part D The New Prescription Drug Benefit and Implications for CARE Act Clients Mary Vienna Division of Training and Technical Assistance HIV/AIDS."— Presentation transcript:

1 1 Medicare Part D The New Prescription Drug Benefit and Implications for CARE Act Clients Mary Vienna Division of Training and Technical Assistance HIV/AIDS Bureau Health Resources and Services Administration Department of Health and Human Services

2 2 Medicare Part D and Ryan White Overview  The new Medicare benefit called Medicare Part D  How that will change care for our clients on Medicare  How it will impact grantees

3 3 Medicaid versus Medicare  Medicaid Federal and State program with State flexibility Federal and State program with State flexibility Means-tested Means-tested Takes into account financial resourcesTakes into account financial resources Poor AND Poor AND Disabled on SSIDisabled on SSI Parents, children, pregnant womenParents, children, pregnant women Medically NeedyMedically Needy Prescription drug benefit Prescription drug benefit 200,000 with HIV/AIDS 200,000 with HIV/AIDS (44% of those in care) $10.4 billion (Federal and State) in 2005 $10.4 billion (Federal and State) in 2005  Medicare Federal program No means testing 65 or older OR Permanently disabled Under 65 and receiving SSDI for 2 years No prescription drug benefit Approx 80,000 with HIV/AIDS (19% of those in care) More likely to have AIDS diagnosis and T4 count 0-199* $2.9 billion in 2005 SOURCE: Bozzette, et al. “The Care of HIV-Infected Adults in the United States.” NEJM, Vol. 339, No. 26. December, 1998

4 4 What is Dual Eligible?  70-85% of Medicare beneficiaries with HIV/AIDS also qualify for Medicaid  Disabled, poor and at end-stage illness  Use Medicaid for access to medications Medicaid 200,000 Medicare 60, ,000 Dual Eligible 50,000 – 60,000 People Living with HIV/AIDS

5 5 Medicare Modernization Act  Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003 signed into law on December 8, 2003  Biggest change to Medicare in 40 years  Adds a prescription drug benefit to Medicare called Medicare Part D  Benefit starts January 1, 2006

6 6 Basic Prescription Drug Benefit  Enrollment period from November 15, 2005 to May 15, 2006 Medicare beneficiary chooses to enroll in Medicare Part D Medicare beneficiary chooses to enroll in Medicare Part D Medicare beneficiary then chooses either: Medicare beneficiary then chooses either: A stand-alone prescription drug plan [PDP] for those in traditional fee- for-service (Part A and B) MedicareA stand-alone prescription drug plan [PDP] for those in traditional fee- for-service (Part A and B) Medicare A managed care plan (Medicare Advantage) that includes a prescription drug plan [MA-PD] for those in Part CA managed care plan (Medicare Advantage) that includes a prescription drug plan [MA-PD] for those in Part C Beneficiaries will have a choice of at least two prescription drug plans Beneficiaries will have a choice of at least two prescription drug plans Choices and plans will vary between regions Choices and plans will vary between regions  Plans have flexibility (subject to certain constraints) to establish varying features: Levels of cost-sharing requirements and coverage limits other than “standard” coverage Levels of cost-sharing requirements and coverage limits other than “standard” coverage Lists of drugs to include on their formulary, and on which tier Lists of drugs to include on their formulary, and on which tier Cost management tools Cost management tools

7 7 Basic Prescription Drug Benefit  Generally, people are enrolled in a plan for a year. In special circumstances people can change plans. Dual eligibles can change plans at any time.  Expected premium in 2006 of $32.20 per month but will vary by plan  Basic benefit will have deductibles, coinsurance and co- pays  People with limited resources will receive low-income subsidies (LIS) for these costs Most Medicare beneficiaries with HIV/AIDS will qualify for some type of LIS Most Medicare beneficiaries with HIV/AIDS will qualify for some type of LIS CMS pays subsidies directly to the plan CMS pays subsidies directly to the plan  All beneficiary costs and subsidy eligibility will be adjusted annually

8 8 Basic Prescription Drug Benefit  This benefit is different for Medicare Subsidies are means tested Subsidies are means tested Benefit will vary by region Benefit will vary by region Implementation requires coordination between CMS, the Social Security Administration and State Medicaid Agencies Implementation requires coordination between CMS, the Social Security Administration and State Medicaid Agencies Many Medicare beneficiaries have other drug coverage--requires coordination (e.g., retiree plans, VA, Tricare) Many Medicare beneficiaries have other drug coverage--requires coordination (e.g., retiree plans, VA, Tricare)

9 9 Medicare Part D and Dual Eligibles  As of January 1, 2006, Medicaid will no longer provide federal matching funds for Medicare beneficiaries’ prescription drug coverage  Dual eligibles will be switched to Medicare for drug coverage  Impact dependent on differences between previous State Medicaid plan and Medicare drug plans available in the area

10 10 Medicare Part D and Dual Eligibles  The switch from Medicaid to Medicare will take place on January 1, 2006 No transitional period No transitional period  To ensure continuity of drug coverage, CMS will auto-enroll all dual eligibles and notify them of their plan assignment in October  Dual eligibles can choose another plan at any time – no annual election period

11 11 Ensuring a Smoother Transition  PDPs must have a transition process for new enrollees, with outreach efforts and a transition timeframe to introduce formulary requirements

12 12 Standard Benefit: Beneficiary Cost Per Year (for 2006), Excluding LIS  Expected monthly premium of $32.20  $250 deductible  25% coinsurance from $251 to $2,250*  100% coinsurance from $2,251 to $5,100 (coverage gap commonly referred to as the “donut hole”)  Catastrophic coverage level: co-pay of 5% or $2/$5 (whichever is greater) after total drug costs reach $5,100 AND beneficiary has paid $3,600 in true out-of-pocket costs (TrOOP) Coinsurance is a term used in Medicare Part D that refers to the beneficiary’s contribution toward prescription drug costs until the catastrophic coverage limit has been reached

13 13 Standard Benefit in 2006 $250$2250$5100 $ + Beneficiary Liability Deductible Coverage Gap Total Spending ≈ 95% 80% Reinsurance 15% Plan Pays Catastrophic Coverage 5% Coinsurance Medicare Pays Reinsurance 75% Plan Pays 25% Coinsurance Out-of-pocket Threshold Direct Subsidy/ Beneficiary Premium $750$3600 TrOOP Total Beneficiary Out-Of-Pocket $250

14 14 Case Study: Peter Jones  65 years old, HIV positive, aged into Medicare  Income $1,600 per month (200% FPL)  Antiretroviral regimen is Efavirenz (Sustiva) + FTC/TDF (Truvada)  Drugs cost $1,300 per month  Peter pays: $32.20 per month in premiums $32.20 per month in premiums Month 1: $250 deductible plus $262 (25% coinsurance) towards $1050 balance Month 1: $250 deductible plus $262 (25% coinsurance) towards $1050 balance Month 2: $237 coinsurance (25% of $950 balance to reach $2250 co-insurance limit) plus $350 (100% coinsurance for balance of $1300 pharmacy cost) Month 2: $237 coinsurance (25% of $950 balance to reach $2250 co-insurance limit) plus $350 (100% coinsurance for balance of $1300 pharmacy cost) Month 3: $1,300 prescription cost (100% coinsurance) [Peter has now paid $2,399 out-of-pocket towards his drugs] Month 3: $1,300 prescription cost (100% coinsurance) [Peter has now paid $2,399 out-of-pocket towards his drugs] Month 4: $1,201 prescription cost (100% coinsurance for a total of $3,600 in out- of-pocket costs). Total drug costs are also $5,200 (above the $5,100 limit) so the catastrophic coverage level has been reached. Month 4: $1,201 prescription cost (100% coinsurance for a total of $3,600 in out- of-pocket costs). Total drug costs are also $5,200 (above the $5,100 limit) so the catastrophic coverage level has been reached. Months 5-12: $65 per month (5% co-pay) Months 5-12: $65 per month (5% co-pay)  Peter pays $4, for the year [$ in premiums, $3600 out-of- pocket and $520 in co-pays]

15 15 Who Qualifies for a Low Income Subsidy (LIS)?  Medicare beneficiaries who are automatically qualified for a full subsidy (known as “deemed eligible”) are : Dual eligible (receive full Medicaid benefits) Dual eligible (receive full Medicaid benefits) 70-85% of Medicare beneficiaries living with HIV/AIDS70-85% of Medicare beneficiaries living with HIV/AIDS In a Medicare Savings Program In a Medicare Savings Program Qualified Medicare Beneficiary (QMB)Qualified Medicare Beneficiary (QMB) Specified Low-Income Medicare Beneficiary (SLMB)Specified Low-Income Medicare Beneficiary (SLMB) Qualifying Individual (QI)Qualifying Individual (QI) Receiving SSI benefits Receiving SSI benefits  Medicare will notify them May-June Dual eligibles will be auto-enrolled in October and may choose a different plan Dual eligibles will be auto-enrolled in October and may choose a different plan

16 16 Who Qualifies for a Low Income Subsidy (LIS)?  Other Medicare beneficiaries who qualify for a full or partial subsidy, but not automatically, are: Single with an annual income below $14,355 and resources less than $11,500 in 2005* Single with an annual income below $14,355 and resources less than $11,500 in 2005* Married with a combined annual income below $19,245 and resources less than $23,000 in 2005* Married with a combined annual income below $19,245 and resources less than $23,000 in 2005*  These individuals must apply to the Social Security Administration or Medicaid State Agency to qualify  SSA sending nearly 19 million letters and applications this summer. Can apply by mail, SSA’s 1-800, online, or in person.  Medicaid State Agencies who qualify Medicare beneficiaries for LIS must also screen them for eligibility for Medicaid and Medicare Savings Programs  Medicare will enroll those who don’t choose a plan by May 15 * Higher in Alaska, Hawaii and for certain reasons

17 17 LIS for Dual Eligibles  No premiums unless beneficiary chooses an above-average cost PDP Then pay balance of premium cost Then pay balance of premium cost  No deductible or coinsurance  Prescription co-pay Below 100% FPL: $1 generic/$3 brand drug co-payBelow 100% FPL: $1 generic/$3 brand drug co-pay Above 100% FPL: $2 generic/$5 brand drug co-payAbove 100% FPL: $2 generic/$5 brand drug co-pay  No cost after total drug costs of $5,100 and $3,600 out-of-pocket limit is reached  Subsidy counts toward out-of-pocket costs What someone pays out-of-pocket + what Medicare pays as the extra help = $3,600 What someone pays out-of-pocket + what Medicare pays as the extra help = $3,600

18 18 Case Study: Jane Matthews  On SSDI, Medicare and Medicaid (dual eligible)  SSDI benefit $780/month (less than100% FPL)  Antiretroviral regimen is Sustiva + Truvada  Drugs cost $1,300 per month  Jane pays $6 in co-pays per month for two scripts (income < 100% FPL so $3 brand name co-pay applies) for three months  By 4 th month, total drug costs of $5,200 exceeds $5,100 catastrophic coverage level ($1,300 x 4)  No cost to Jane after that  Jane pays $18 for the year [3 months of $6 co-pay]

19 19 Full Low-Income Subsidy  Those eligible for this subsidy include Medicare beneficiaries who are: In a Medicare Savings Program (QMB, SLMB, QI) In a Medicare Savings Program (QMB, SLMB, QI) Receiving SSI benefits Receiving SSI benefits Have an income below 135% FPL and resources of no more than $7,500 single/$12,000 per couple* Have an income below 135% FPL and resources of no more than $7,500 single/$12,000 per couple*  No premiums unless beneficiary chooses an above-average cost PDP  No deductible or coinsurance  Prescription co-pay $2 generic/$5 brand drug co-pay$2 generic/$5 brand drug co-pay  No cost after total drug costs of $5,100 and $3,600 out-of-pocket limit is reached  Subsidy counts toward out-of-pocket costs and reaching catastrophic level Adjusted annually; resources include burial exclusion of $1500 for individual, $3,000 per couple.

20 20 Case Study: Joseph Black  On SSDI and Medicare  SSDI benefit is $950/month (less than120% FPL)  Antiretroviral regimen is Sustiva + Truvada  Drugs cost $1,300 per month  Joseph pays $10 in co-pays per month for two scripts ($5 brand name co-pay times two) for three months  By 4 th month, total drug costs of $5,200 exceeds $5,100 catastrophic coverage level ($1,300 x 4)  No cost to Joseph after that  Joseph pays $30 for the year [3 months of $10 co-pay]

21 21 Partial Low Income Subsidy (2006)*  Those eligible for this subsidy include Medicare beneficiaries who are: Below 150% FPL and with resources of no more $11,500 (individuals) and $23,000 (couples) Below 150% FPL and with resources of no more $11,500 (individuals) and $23,000 (couples)  Benefit Sliding scale premium Sliding scale premium $50 deductible $50 deductible 15% coinsurance up to catastrophic coverage level 15% coinsurance up to catastrophic coverage level $2 generic/$5 brand name drug co-pay after total drug costs of $5,100 and $3,600 out-of-pocket limit is reached $2 generic/$5 brand name drug co-pay after total drug costs of $5,100 and $3,600 out-of-pocket limit is reached  Subsidy counts toward out-of-pocket costs and reaching catastrophic coverage level * Adjusted annually

22 22 Sliding Scale Premium Assistance FPL & Assets % of Premium Subsidy Amount Income at or below 135% FPL, and with assets that do not exceed $11,500 (individuals) or $23,000 (couples) 100% Income above 135% FPL but at or below 140% FPL, and with assets that do not exceed $11,500 (individuals) or $23,000 (couples) 75% Income above 140% FPL but at or below 145% FPL, and with assets that do not exceed $11,500 (individuals) or $23,000 (couples) 50% Income above 145% FPL but below 150% FPL, and with assets that do not exceed $11,500 (individuals) or $23,000 (couples) 25% *Numbers are for 2006

23 23 Case Study: Jason Smith  On SSDI, Medicare and small private disability insurance benefit  Income $1,100 per month (138% FPL)  Antiviral regimen is Sustiva + Truvada  Drugs cost $1,300 per month  Jason pays: About $8 per month in premiums (75% subsidy of $32.20) About $8 per month in premiums (75% subsidy of $32.20) Month 1: $50 deductible plus $ (15% coinsurance of $1,250 balance) Month 1: $50 deductible plus $ (15% coinsurance of $1,250 balance) Month 2: $195 coinsurance (15% coinsurance of $1,300) Month 2: $195 coinsurance (15% coinsurance of $1,300) Month 3: $195 coinsurance (total drug costs $3,900) Month 3: $195 coinsurance (total drug costs $3,900) Month 4: $180 coinsurance (on $1200 balance of $5100 total drug cost limit for catastrophic coverage level) Month 4: $180 coinsurance (on $1200 balance of $5100 total drug cost limit for catastrophic coverage level) Months 5-12: $10 per month ($5 brand name co-pay on two scripts) Months 5-12: $10 per month ($5 brand name co-pay on two scripts)  Jason pays $983 for the year [$96 in premiums, $ in deductible and coinsurance, $80 in co-pays]

24 24 Standard Drug Benefit for beneficiaries with income >150% FPL or less than 150% FPL but more than the resource limit $32.20 monthly estimated premium Beneficiary Pays Plan Pays Full-benefit dual eligibles with income  100% FPL* $0 monthly premium and no deductible $5100 $ % $1 - $3 co-pays apply *Cost sharing is $0 if the beneficiary is a full-benefit dual eligible and institutionalized. Full-benefit dual eligibles with income >100% FPL $0 monthly premium and no deductible $250$2250$5100 $ + 75 % About 95% $5100 $ + $2 - $5 co-pays apply 100 % Numbers are for 2006

25 25 SSI Recipients, Medicare Savings Programs Groups, Applicants with income < 135% FPL who also meet resource test ($7,500 individual / $12,000 couple) $0 monthly premium and no deductible Applicants with income <150% FPL who also meet resource test ($11,500 individual / $23,000 couple) Sliding scale premium assistance $ % $50 $2 - $5 co-pays apply Numbers are for 2006 Beneficiary Pays Plan Pays $5100 $ + $2 - $5 co-pays apply 100 %

26 26 How to Apply for Help  The Social Security Administration (SSA) will mail applications to people who may qualify Those who think they may qualify should Those who think they may qualify should Complete the application formComplete the application form Mail it to the address on the back of the form Mail it to the address on the back of the form Use the enclosed postage-paid envelope Use the enclosed postage-paid envelope Use original forms only Use original forms only Do not photocopy the application Do not photocopy the application Photocopying the application could delay timely processing Photocopying the application could delay timely processing Apply--even if they’re not sure they qualifyApply--even if they’re not sure they qualify

27 27 Other Ways to Apply for Extra Help  Apply on the Social Security website at  Apply at a Social Security sponsored event  Apply by phone by calling Social Security at  Apply at a State Medicaid Office  Apply at a community event that will offer opportunities to apply  State Health Insurance Program (SHIP) counselors will offer free personalized counseling starting in the fall of 2005

28 28 Further Help With Costs  AIDS Drug Assistance Programs (ADAP), in accordance with State program policy, can pay: Premiums Premiums Deductible Deductible Coinsurance (15%, 25% and 100%) Coinsurance (15%, 25% and 100%) Co-pays Co-pays  ADAP contributions do not count toward the $3,600 in TrOOP costs needed to reach the catastrophic coverage level

29 29 What Counts Toward TrOOP?  Payments made by: The beneficiary The beneficiary Another individual (e.g. family or friends) Another individual (e.g. family or friends) Certain charities Certain charities A State Pharmacy Assistance Program (SPAP) A State Pharmacy Assistance Program (SPAP) A personal health savings vehicle (Flexible Spending Accounts, Health Savings Accounts, and Medical Savings Accounts) A personal health savings vehicle (Flexible Spending Accounts, Health Savings Accounts, and Medical Savings Accounts) Co-pays waived by a pharmacy Co-pays waived by a pharmacy CMS to the plan as low income subsidies CMS to the plan as low income subsidies

30 30 What Doesn’t Counts Toward TrOOP?  Premiums  Payments made by: AIDS Drug Assistance Programs (ADAP) AIDS Drug Assistance Programs (ADAP) Group health plans (employer/retiree plans) Group health plans (employer/retiree plans) Federal government programs (e.g., Indian Health, Medicaid,Tricare, VA, FQHCs) Federal government programs (e.g., Indian Health, Medicaid,Tricare, VA, FQHCs) State-run programs that are not SPAPs State-run programs that are not SPAPs Workman’s CompensationWorkman’s Compensation Automobile/No-Fault/Liability Automobile/No-Fault/Liability Part D plans’ supplemental or enhanced benefits Part D plans’ supplemental or enhanced benefits

31 31 What Doesn’t Count Toward TrOOP?  Payments never count toward TrOOP when made for: Non-covered drugs that are not obtained through an exceptions or appeal process Non-covered drugs that are not obtained through an exceptions or appeal process Drugs purchased outside the U.S. Drugs purchased outside the U.S. Non-Part D drugs Non-Part D drugs Part B drugsPart B drugs Drugs excluded in the Part D benefit (e.g. benzodiazepines, barbiturates)Drugs excluded in the Part D benefit (e.g. benzodiazepines, barbiturates)

32 32 Access to Drugs: Formulary Issues  PDPs have the flexibility (within certain constraints) to establish: Different levels of cost-sharing requirements and coverage limits other than “standard” coverage Different levels of cost-sharing requirements and coverage limits other than “standard” coverage Lists of drugs to include on their formulary Lists of drugs to include on their formulary Tiers of drug co-payments Tiers of drug co-payments Cost management tools Cost management tools  If a plan uses a formulary, it must include at least two drugs in each therapeutic category and class  The U.S. Pharmacopoeia (USP) has designed a model guideline of therapeutic categories and classes of drugs. Medicare drug plans can use the USP model but they are not required to do so.  CMS will review formularies to assure that prescription drugs for HIV/AIDS are included  CMS will review formularies to assure that prescription drugs for HIV/AIDS are included  A prescription drug plan will not be approved if the formulary design would discourage enrollment of certain groups

33 33 58Antivirals Anti-CMV Agents 59 Anti-HIV Agents, Fusion Inhibitors 60 Anti-HIV Agents, Protease Inhibitors 61 Anti-HIV Agents, Non-nucleoside Reverse Transcriptase Inhibitors 62 Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors 63 Anti-HIV Agents, Other 64 Antihepatitis Agents, Interferons 65 Antihepatitis Agents, Vaccines 66 Antihepatitis Agents, Other HIV Drug Categories in USP Model Formulary

34 34 Access to Drugs: Formulary Issues  In order to protect against discrimination, CMS will review six drug classes in the formulary to ensure there is access to all drugs in that class: Antidepressants Antidepressants Antipsychotics Antipsychotics Anticonvulsants Anticonvulsants Antiretrovirals Antiretrovirals Antineoplastics Antineoplastics Immunosuppressants Immunosuppressants

35 35 Issues for HIV/AIDS Care  Access to medications Two drugs in each therapeutic class or category with six exceptions Two drugs in each therapeutic class or category with six exceptions True drug benefit will be determined by plan formulary True drug benefit will be determined by plan formulary Plan can change drugs in formulary while the non-dual beneficiary must remain in plan for one year Plan can change drugs in formulary while the non-dual beneficiary must remain in plan for one year Reliance on exceptions and appeals process Reliance on exceptions and appeals process  Costs Prevents ADAP from contributing toward TrOOP costs Prevents ADAP from contributing toward TrOOP costs Drugs not covered by plan do not count towards catastrophic coverage level Drugs not covered by plan do not count towards catastrophic coverage level Unlike Medicaid, no access to medication for failure to pay co-pay Unlike Medicaid, no access to medication for failure to pay co-pay Pharmacy can waive co-payPharmacy can waive co-pay 60 and 90 day prescriptions lower co-pay costs60 and 90 day prescriptions lower co-pay costs Requires those eligible for full low-income subsidies to pay premium balance for above-average cost plans Requires those eligible for full low-income subsidies to pay premium balance for above-average cost plans

36 36 Issues and Challenges for Beneficiaries  Deciding whether to enroll in Part D in 2006 if they have a choice Financial penalties for delayed enrollment Financial penalties for delayed enrollment  Enrolling in low-income subsidy program Will beneficiaries know they are eligible? Will beneficiaries know they are eligible? Will they sign up? Will they sign up?  Comparing plans and deciding which to join Could face wide variations in premiums, benefit design, formularies and preferred drug lists each year. Could face wide variations in premiums, benefit design, formularies and preferred drug lists each year.  Facing potential consequences of a poor plan choice Annual enrollment period for non-duals Annual enrollment period for non-duals  While the plan is responsible for tracking TrOOP costs, the beneficiary is expected to inform the plan of other prescription drug benefits

37 37 Challenges for Beneficiaries with HIV/AIDS are Obligations and Opportunities for Ryan White  Initial transition period raises unique challenges How to educate ourselves How to educate ourselves How to educate dual eligibles and enrollees How to educate dual eligibles and enrollees How to ensure a smooth transition for individual health and public health reasons How to ensure a smooth transition for individual health and public health reasons  Clients will need information and assistance in: Applying for subsidy programs Applying for subsidy programs Enrolling in Medicare Part D Enrolling in Medicare Part D Choosing a plan that works for them Choosing a plan that works for them  Providers and case managers must know resources available for help  Once enrolled, clients will look to providers for help with appeals and exceptions  Non-dual Medicare clients comfortable on ADAP programs will need to be encouraged to enroll in Medicare Part D

38 38 It’s Happening Fast  May-June 2005 CMS mails notices to people with Medicare who automatically qualify for the low income subsidy and do not need to apply CMS mails notices to people with Medicare who automatically qualify for the low income subsidy and do not need to apply Applications for subsidies accepted Applications for subsidies accepted  Summer SSA mails applications to potential eligibles who don’t automatically qualify SSA mails applications to potential eligibles who don’t automatically qualify  October “Medicare and You” handbook with comparative drug plan information mailed to every beneficiary 2006 “Medicare and You” handbook with comparative drug plan information mailed to every beneficiary Online tool to help select plan on Online tool to help select plan on CMS notifies dual eligibles of the plan Medicare will enroll them in if they do not choose one on their own by December 31, 2005 CMS notifies dual eligibles of the plan Medicare will enroll them in if they do not choose one on their own by December 31, 2005  November 15, 2005 Beneficiaries can begin enrollment in Medicare Part D by choosing and enrolling in a Medicare plan Beneficiaries can begin enrollment in Medicare Part D by choosing and enrolling in a Medicare plan  January 1, 2006 All dual eligibles switched to Medicare All dual eligibles switched to Medicare  April 2006 CMS notifies other people who qualify for the low-income subsidy that if they do not choose a plan by April 2006, CMS will facilitate their enrollment in a plan on their behalf, with coverage effective June 1, 2006 CMS notifies other people who qualify for the low-income subsidy that if they do not choose a plan by April 2006, CMS will facilitate their enrollment in a plan on their behalf, with coverage effective June 1, 2006  May 15, 2006 Initial enrollment period for Medicare Part D complete Initial enrollment period for Medicare Part D complete

39 39 What’s HAB Doing?  HAB Medicare Workgroup Expertise and resource to programs and project officers on Medicare Part D Expertise and resource to programs and project officers on Medicare Part D  Technical assistance and outreach plan  Venues to reach grantees  HAB project officer training  HAB website information  Qs & As

40 40 Who Do I Go To For Answers? HAB Project Officers HAB Project Officers CMS Regional Office CMS Regional Office Medicaid State Agency Medicaid State Agency Social Security Administration Social Security Administration State Health Insurance Program State Health Insurance Program State ADAP State ADAP Title I and II programs Title I and II programs HIV and Professional Organizations HIV and Professional Organizations

41 41 Website Resources  Medicare Part D webpage Medicare Part D webpage Qs & As Qs & As Links Links  Information about Medicare Part D Information about Medicare Part D  Medicare HIV/AIDS Fact Sheet Medicare HIV/AIDS Fact Sheet  Click on “Learn About Your Medicare Prescription Coverage Options” Click on “Learn About Your Medicare Prescription Coverage Options” Information for Medicare beneficiaries Information for Medicare beneficiaries


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