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August 2005 1 2005 National Medicare & You Training Program Speaker Name Group Name Date.

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Presentation on theme: "August 2005 1 2005 National Medicare & You Training Program Speaker Name Group Name Date."— Presentation transcript:

1 August National Medicare & You Training Program Speaker Name Group Name Date

2 August Changes in Medicare Keeping up with Todays Health Care Promoting a healthy lifestyle Covering preventive services Offering prescription drug coverage Expanding coordinated care options Including care for chronic conditions Helping people with Medicare live longer, healthier lives

3 August What You Need to Know Now Medicare Prescription Drug Coverage

4 August Important Information For All People With Medicare Medicare prescription drug coverage is available to all people with Medicare There is additional help for those who need it most Medicare prescription drug coverage pays for brand-name as well as generic drugs Look for a Medicare prescription drug plan that meets your needs Medicare prescription drug coverage helps you pay for the prescriptions you need

5 August Important Information For All People With Medicare Medicare prescription drug coverage is available to all people with Medicare There is additional help for those who need it most Medicare prescription drug coverage pays for brand-name as well as generic drugs Look for a Medicare prescription drug plan that meets your needs Medicare prescription drug coverage helps you pay for the prescriptions you need

6 August Medicare Prescription Drug Coverage Begins January 1, 2006 Available for all people with Medicare Part A, Part B, or both For minimum standard coverage in 2006, enrollees would pay Average monthly premium of about $32 First $250 per year for prescriptions (deductible) Part of the cost of prescriptions after $250 5% of drug costs (or small copayment) after paying $3,600 out of pocket

7 August Savings in 2006 On average, for a person with Medicare and no drug coverage now Total drug spending will go down by about 50% Over $1,100 per year saved People with other drug coverage that, on average, is at least as good as Medicares also may save money These estimates do not include the extra help for people with limited incomes

8 August Important Information For All People With Medicare Medicare prescription drug coverage is available to all people with Medicare There is additional help for those who need it most Medicare prescription drug coverage pays for brand-name as well as generic drugs Look for a Medicare prescription drug plan that meets your needs Medicare prescription drug coverage helps you pay for the prescriptions you need

9 August 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

10 August 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

11 August 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

12 August How to Apply for Extra Help Social Security Administration (SSA) is mailing applications to those who may be eligible Throughout the summer of 2005 Those who think they may qualify should Complete this application Mail it to the address on the back Use the enclosed postage-paid envelope Use original forms only (do not photocopy) People who are not sure should still apply can help people decide

13 August Extra Help and Other Drug Coverage People with other drug coverage Should apply for extra help, even if covered by Employer or union group health plan Indian Health Service VA health benefits Should ask how Medicare drug coverage with extra help will work with the current coverage Could save money with Medicare prescription drug coverage

14 August Important Information For All People With Medicare Medicare prescription drug coverage is available to all people with Medicare There is additional help for those who need it most Medicare prescription drug coverage pays for brand-name as well as generic drugs Look for a Medicare prescription drug plan that meets your needs Medicare prescription drug coverage helps you pay for the prescriptions you need

15 August Which Drugs Are Covered? Medicare-covered drugs Drugs available only by prescription Drugs, biologicals, insulin Medical supplies associated with injection of insulin Brand-name and generic drugs Drugs not covered Drugs excluded by MMA law Non-prescription drugs Drugs that are covered for a person under Medicare Part A or Part B

16 August Coverage Varies by Plan Plan may not cover all drugs Formularies must include more than one drug in each classification Centers for Medicare & Medicaid Services (CMS) will review formularies Plan must give 60-day notice of many changes Plan must have exception process Gives enrollees access to medically necessary drugs Decision can be appealed

17 August Important Information For All People With Medicare Medicare prescription drug coverage is available to all people with Medicare There is additional help for those who need it most Medicare prescription drug coverage pays for brand-name as well as generic drugs Look for a Medicare prescription drug plan that meets your needs Medicare prescription drug coverage helps you pay for the prescriptions you need

18 August Ways to Get Coverage Medicare prescription drug coverage is provided through Medicare Prescription Drug Plans Medicare Advantage and other Medicare Health Plans Some employers and unions to retirees Coverage is NOT automatic People need to understand their options

19 August Joining a Plan Enroll directly with the plan sponsor Can get help in enrolling Legal representative Spouse, other relative, friend, or advocate Initial Enrollment Period For people entitled to Medicare before February 2006 November 15, 2005, through May 15, 2006 For people entitled to Medicare on February 1, 2006, or later 7-month period

20 August Late Enrollment Most people will have to pay a penalty if they wait to enroll Additional 1% of base premium for every month the person was eligible but not enrolled For as long as the person is 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

21 August Coverage on Average at Least as Good as Medicares People with other coverage Will receive information from the other plan 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) State Pharmacy Assistance Program (SPAP) VA coverage Military coverage including TRICARE

22 August Annual Coordinated Election Period November 15 – December 31 every year Person who does not have a Medicare drug plan can enroll Person who currently has a Medicare drug plan can switch Change effective January 1 Special Enrollment Period may apply at other times in special circumstances

23 August Example of Late Enrollment Mrs. Jones has Medicare Part A and Part B, and she has no prescription drug coverage. She does not enroll in a Medicare prescription drug plan by May 15, 2006, the end of the Initial Enrollment Period. When will she have another opportunity to enroll in a Medicare prescription drug plan? What are the consequences of waiting to enroll later?

24 August Example of Late Enrollment When will Mrs. Jones have another opportunity to enroll in a Medicare prescription drug plan? She can enroll during the next Annual Coordinated Election Period, November 15 – December 31, 2006, with coverage effective January 1, What are the consequences of waiting to enroll later? Since Mrs. Jones does not have coverage at least as good as Medicare drug coverage, she will pay a penalty.

25 August Medicare Advantage Open Enrollment Person can join a Medicare Advantage Plan or other Medicare Health Plan In 2006: January 1 – June 30, 2006 In 2007 and beyond: January 1 – March 31, each year Change effective the first of the month after the month person joined

26 August Open Enrollment Limit During Medicare Advantage Open Enrollment Person who has a Medicare plan with prescription drug coverage May only switch to another plan with prescription drug coverage Person who has a Medicare plan without prescription drug coverage May only switch to a plan that does not have drug coverage

27 August Important Information For All People With Medicare Medicare prescription drug coverage is available to all people with Medicare There is additional help for those who need it most Medicare prescription drug coverage pays for brand-name as well as generic drugs Look for a Medicare prescription drug plan that meets your needs Medicare prescription drug coverage helps you pay for the prescriptions you need

28 August Things to Consider What is current health insurance coverage? Original Medicare Plan without drug policy Original Medicare Plan with Medigap drug policy Medicare and employer/union, including military Medicare Advantage and other Medicare Health Plans HMO, PPO, PFFS Medicare Cost Plans Medicare and Medicaid Is there currently prescription drug coverage? Even those with current drug coverage should ask Is Medicare prescription drug coverage right for me?

29 August Original Medicare Plan 1) Without Drug Coverage or 2) With Medigap Drug Policy Medicare and Employer/Union Coverage, including the Military Medicare Advantage and Other Medicare Health Plans Medicare and Medicaid or Other State/Federal Assistance Programs Current Insurance Coverage* Which box describes the health insurance you have now? *Does NOT include doctor samples, discount cards, Medicare-approved drug discount cards with or without the $600 credit, free clinics, or drug discount websites

30 August Original Medicare Plan Without Medigap or With Medigap Plans A - G I have Original Medicare only, or Original Medicare and a Medigap (Supplement) Policy without drug coverage.

31 August Original Medicare Plan What to do –Watch the mail this fall for the Medicare & You handbook Choices to make –Join a Medicare Prescription Drug Plan –Join a Medicare Advantage or other Medicare Health Plan with prescription drug coverage –Dont enroll in Medicare prescription drug coverage But you may pay a penalty if you join later

32 August Original Medicare Plan and Medigap With Drug Coverage I have Original Medicare and a Medigap (Supplement) Policy with drug coverage.

33 August Original Medicare And Medigap With Drug Coverage What to do –Watch the mail this fall for important information from the insurance company on Medigap coverage Choices to make –Keep coverage through the Medigap policy –Join a Medicare Prescription Drug Plan after you Modify the Medigap policy to remove drug coverage, or Change to a Medigap policy with no drug coverage –Drop Medigap policy and join a Medicare Advantage or other Medicare Health Plan with prescription drug coverage

34 August Medicare and Employer/Union Coverage, including the Military I am a retiree and I have drug coverage through my (or my spouses) employer or union.

35 August Employer/Union Coverage Medicare is working with employers to help people with Medicare keep their current coverage Employer options –Offer coverage in place of Medicare prescription drug coverage and receive a tax-free subsidy –Offer or contract with a Medicare drug plan to provide prescription drug coverage –Provide coverage that supplements the Medicare prescription drug coverage –Pay all or part of Medicare drug plan premiums

36 August Employer/Union Coverage What to do –Watch the mail this fall for important coverage information from the plan sponsor –Contact the benefits administrator before you make any changes Choices to make –Keep coverage offered by employer/union –Join a Medicare Prescription Drug Plan –Join a Medicare Advantage or other Medicare Health Plan with prescription drug coverage CAUTION: If you drop or lose your employer/union coverage, you may not be able to get it back

37 August Medicare Advantage and Other Medicare Health Plans I have a Medicare Advantage Plan (like an HMO or PPO) or other Medicare Health Plan.

38 August Medicare Advantage Plans (HMO, PPO, and PFFS) What to do –Watch for a notice from your plan –Call the plan for details Choices to make –If plan will offer drug coverage Stay in plan and get Medicare prescription drug coverage –If plan wont offer drug coverage Switch to another Medicare Advantage or other Medicare Health Plan with prescription drug coverage Switch to the Original Medicare Plan and join a Medicare Prescription Drug Plan Dont enroll in Medicare prescription drug coverage –But you may pay a penalty if you join later

39 August Medicare Cost or PACE Plan What to do –Call the plan for details Choices to make –If Cost Plan with drug coverage Get Medicare prescription drug coverage from the plan or Join a Medicare Prescription Drug Plan –If Cost Plan with no drug coverage Join a Medicare Prescription Drug Plan –If PACE plan, will get coverage through that plan

40 August Medicare and Medicaid or Other State/Federal Assistance Programs I have Medicare and Medicaid, and I get my drug coverage from Medicaid.

41 August Medicare and Medicaid What to do –You automatically qualify for the extra help –Watch the mail this fall Letter about choosing a Medicare prescription drug plan Medicare & You 2006 handbook Choices to make –Compare drug plan options and enroll in a plan If not, Medicare will enroll you in one by December 31, 2005 Starting January 1, 2006, Medicare will pay for your prescription drugs –Can switch to another plan at any time

42 August Other State/Federal Assistance Programs What to do –You automatically qualify for the extra help if you Get help from Medicaid paying your Medicare premiums Get Medicare and Supplemental Security Income (SSI) benefits –Watch the mail for Medicare & You 2006 handbook Choices to make –Compare drug plan options –Find a plan that meets your needs –If no choice made by May 15, 2006, you will be enrolled on June 1, 2006 Also applies to people who applied and qualify for extra help Can switch once to another plan (if you get help from Medicaid paying your Medicare premiums, you can switch at any time)

43 August Special Populations State Pharmacy Assistance Program participants People in long-term care facilities Residents of the U.S. territories

44 August State Pharmacy Assistance Programs Provide wraparound coverage Provide same or better coverage and save money Reduce state costs or expand population served Costs incurred by SPAP may or may not be counted toward out-of- pocket limit

45 August Long-Term Care Facilities Residents Usually obtain drugs from pharmacy chosen by the facility Can change plans at any time Will have convenient access Those with Medicare and full Medicaid coverage have no premiums, deductibles, or copayments

46 August U.S. Territories Each territory has its own prescription drug plan region Each territory can develop its own extra help Help with premiums, coinsurance, copayments, deductibles or Provide supplemental coverage

47 August Choosing a Plan See Medicare & You 2006 handbook To be mailed October 2005 Read about prescription drug plans in the area For help in choosing a plan Visit To get personalized information Call MEDICARE ( ) TTY users call Call the local State Health Insurance Assistance Program Attend local community events

48 August Important Dates May 2005 Medicare mailed notices to people who automatically qualify for extra help Summer 2005 Social Security Administration mails applications to people who may be eligible for the extra help July 1, 2005 Social Security application for the extra help available online

49 August Important Dates September 16 – November 15, 2005 Medigap plans with drug coverage mail information to policy holders October 13, 2005 Begin comparing plans MEDICARE ( )

50 August Important Dates October 2005 Medicare & You 2006 handbook mailed Medicare notifies people with Medicare and Medicaid of the plan they will be automatically enrolled in on January 1, 2006, if they do not enroll on their own Employer plans send coverage information to enrollees November 15, 2005 Initial Enrollment Period begins

51 August Important Dates January 1, 2006 Medicare prescription drug plan coverage begins for those enrolled May 15, 2006 Last day of Initial Enrollment Period June 1, 2006 Facilitated enrollment of people entitled to extra help who did not enroll by May 15

52 August For More Information Websites Publications Medicare & You handbook Facts About Medicare Prescription Drug Plans MEDICARE ( ) Social Security Administration


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