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Medicare Prescription Drug Coverage. 06/08/20102 Medicare Prescription Drug Coverage Referred to as Medicare Part DReferred to as Medicare Part D Available.

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Presentation on theme: "Medicare Prescription Drug Coverage. 06/08/20102 Medicare Prescription Drug Coverage Referred to as Medicare Part DReferred to as Medicare Part D Available."— Presentation transcript:

1 Medicare Prescription Drug Coverage

2 06/08/20102 Medicare Prescription Drug Coverage Referred to as Medicare Part DReferred to as Medicare Part D Available to everyone with MedicareAvailable to everyone with Medicare Drug plans approved by MedicareDrug plans approved by Medicare –Run by private companies Must be enrolled in a plan to get coverageMust be enrolled in a plan to get coverage Coverage provided throughCoverage provided through –Medicare Prescription Drug Plans (PDPs) –Medicare Advantage with Prescription Drugs (MA-PDs) Understanding Medicare Prescription Drug Coverage

3 06/08/20103 Part D Eligibility Requirements To be eligible to join a Prescription Drug PlanTo be eligible to join a Prescription Drug Plan –You must have Medicare Part A and/or Part B To be eligible to join Medicare Advantage plan with drug coverageTo be eligible to join Medicare Advantage plan with drug coverage –You must have Part A and Part B –You must live in plans service area –You cannot be incarcerated –You must be enrolled in a plan Understanding Medicare Prescription Drug Coverage

4 06/01/20104 Covered Drugs Prescription brand-name and generic drugsPrescription brand-name and generic drugs Approved by FDAApproved by FDA Used and sold in U.S.Used and sold in U.S. Used for medically-accepted indicationsUsed for medically-accepted indications Includes drugs, biological products, and insulinIncludes drugs, biological products, and insulin – Supplies associated with injection or inhalation Medicare Drug Coverage Under Part A, Part B and Part D

5 06/08/20105 Required Coverage All drugs in 6 categories must be coveredAll drugs in 6 categories must be covered –Cancer medications –HIV/AIDS treatments –Antidepressants –Antipsychotic medications –Anticonvulsive treatments for epilepsy and other conditions –Immunosuppressants Understanding Medicare Prescription Drug Coverage

6 06/01/20106 Vaccines All Part D drug plans must cover:All Part D drug plans must cover: –All commercially available vaccines e.g., shingles vaccinee.g., shingles vaccine Note: Except those covered under Part B e.g., flu shote.g., flu shot Contact drug plan for more informationContact drug plan for more information Medicare Drug Coverage Under Part A, Part B and Part D

7 06/01/20107 Drugs Not Covered by Part D Excluded by law from Medicare coverageExcluded by law from Medicare coverage – Anorexia, weight loss or weight gain drugs – Erectile dysfunction drugs – Fertility drugs – Drugs for cosmetic or lifestyle purposes – e.g., hair growth – Drugs for symptomatic relief of coughs and colds – Prescription vitamin and mineral products – except prenatal vitamins and fluoride preparations – Non-prescription drugs – Barbiturates and benzodiazepines – To be covered in 2013 Medicare Drug Coverage Under Part A, Part B and Part D

8 06/08/20108 Drugs Not Covered by Part D (continued) Medicare Part A or Part B covered drugsMedicare Part A or Part B covered drugs –Unless you dont meet Part A or B coverage requirements Plan may choose to cover excluded drugsPlan may choose to cover excluded drugs – At their own cost, or – Share the cost with members Understanding Medicare Prescription Drug Coverage

9 06/08/20109 Access to Covered Drugs Plans must cover at least two drugs in each categoryPlans must cover at least two drugs in each category Coverage and rules vary by planCoverage and rules vary by plan Plans can manage access to drug coverage throughPlans can manage access to drug coverage through –Formularies (list of covered drugs) –Prior authorization (doctor requests before service) –Step therapy (type of prior authorization) –Quantity limits (limits quantity for period of time) Understanding Medicare Prescription Drug Coverage

10 Formulary A list of prescription drugs covered by the planA list of prescription drugs covered by the plan May have tiers that cost different amountsMay have tiers that cost different amounts 06/08/2010Understanding Medicare Prescription Drug Coverage10 Example of Tiers (Plans can form tiers in different ways) Tier You Pay Prescription Drugs Covered 1 Lowest copayment Most generics 2 Medium copayment Preferred, brand-name 3 Highest copayment Non-preferred, brand-name Specialty Highest copayment or coinsurance Unique, very high-cost

11 06/08/201011 Prior Authorization Doctor must contact plan for prior authorizationDoctor must contact plan for prior authorization – Before prescription will be covered – Must show medical necessity for that particular drug Ask plan for prior authorization requirementsAsk plan for prior authorization requirements –Process for requests may vary by plan Understanding Medicare Prescription Drug Coverage

12 06/08/201012 Step Therapy Type of prior authorizationType of prior authorization Person must try a similar, less- expensive drug that has been proven effectivePerson must try a similar, less- expensive drug that has been proven effective Doctor can request an exception ifDoctor can request an exception if –Tried similar, less expensive drug and it didnt work, or –Step-therapy drug is medically necessary Understanding Medicare Prescription Drug Coverage

13 06/08/201013 Quantity Limits Plans may limit the quantity of drugs they coverPlans may limit the quantity of drugs they cover –Over a certain period of time –For reasons of safety and/or cost Understanding Medicare Prescription Drug Coverage

14 06/08/201014 If Your Prescription Changes Get up-to-date information from planGet up-to-date information from plan –By phone or on plans website Give doctor copy of plans formularyGive doctor copy of plans formulary If the new drug is not on plans formularyIf the new drug is not on plans formulary –Can request a coverage determination from plan –May have to pay full price if plan still wont cover drug Understanding Medicare Prescription Drug Coverage

15 06/08/201015 Formulary Changes Plans may change categories and classesPlans may change categories and classes –Only at beginning of each plan year (Plan year is January through December) –May make maintenance changes during year Plan usually must notify you 60 days before changesPlan usually must notify you 60 days before changes –May be able to use your drug until end of calendar year –May ask for exception if other drugs dont work Plans may remove drugs withdrawn from marketPlans may remove drugs withdrawn from market –By the manufacturer or the Food and Drug Administration, without 60 day notification Understanding Medicare Prescription Drug Coverage

16 06/08/201016 Medicare Drug Plan Can be flexible in benefit designCan be flexible in benefit design Must offer at least a standard level of coverageMust offer at least a standard level of coverage May offer enhanced benefitsMay offer enhanced benefits Benefits & costs can change from year to yearBenefits & costs can change from year to year –Monthly premium varies by plan Some plans have no premiumSome plans have no premium –Possible yearly deductible No more than $320 in 2012No more than $320 in 2012 –Copayments or coinsurance May depend on how much spent that yearMay depend on how much spent that year Understanding Medicare Prescription Drug Coverage

17 2012 Standard Coverage and Cost Benefit Stage Coverage Range Plan Pays Beneficiary Pays Annual Deductible $0-$3200%$0100%$320 Initial Coverage $320-$2930 (Next $2610) 75%$1957.5025%$652.50 Coverage Gap $2930-6657.50 (Next $3727.50) 50% - Brand-name 14% - Generics 50% - Brand-name 86% - Generic Catastrophic Coverage $6657.50 and up 95% No Maximum 5%

18 Monthly Premiums Starting January 1, 2011 part D monthly premiums may be higher based on incomeStarting January 1, 2011 part D monthly premiums may be higher based on income –Includes PDP and MA-PD plans If income is aboveIf income is above –$85,000 filing individual tax return –$170,000 filing a joint tax return Additional monthly adjustments will be charged in addition to part D premiums SSA will be contacting those who have to pay higher premiums in NovemberSSA will be contacting those who have to pay higher premiums in November

19 06/08/201019 True Out-of-Pocket Costs (TrOOP) TrOOP is the amount of money (out-of-pocket) that can be used to reach catastrophic coverage Payment sources that countPayment sources that count –Plan member –Family members or other individuals –Illinois Cares Rx payments –SSA Extra Help (low-income subsidy) –Charities Not if established/controlled by current/former employer or unionNot if established/controlled by current/former employer or union –Indian Health Services and AIDS Drug Assistance Programs – Part D manufacturerdiscount for covered Brand-name drugs during coverage gap – Part D manufacturer discount for covered Brand-name drugs during coverage gap Understanding Medicare Prescription Drug Coverage

20 06/08/201020 Out-of-Pocket Costs that Do Not Count Payment sources that do not countPayment sources that do not count –Monthly drug premium payments –Group health plans Including employer or union retiree coverageIncluding employer or union retiree coverage –Government-funded programs including TRICARE and VA –Manufacturer Patient Assistance Programs –Other third-party payment arrangements –Part D plan discounts for covered drugs during coverage gap Understanding Medicare Prescription Drug Coverage

21 Coverage Gap Discount If you reach the coverage gap in 2012 you may receive discounts on both brand-name and generic drugs If you reach the coverage gap in 2012 you may receive discounts on both brand-name and generic drugs – 50% discount on brand-name prescription drugs in 2012 – 14% discount on generic drugs in 2012 Additional savings in coverage gap each year Additional savings in coverage gap each year –Gap to be closed in 2020 06/08/201021Understanding Medicare Prescription Drug Coverage

22 Cost Sharing for Brand-name Drugs in the Medicare Part D Coverage Gap, 2010-2020

23 Cost Sharing for Generic Drugs in the Medicare Part D Coverage Gap, 2010-2020

24 06/08/2010Understanding Medicare Prescription Drug Coverage24 When you can Join or Switch Medicare Prescription Drug Plans Initial Coverage Election Period (IEP) 7 month period7 month period Starts 3 months before month of eligibilityStarts 3 months before month of eligibility Annual Open Enrollment Period (AOEP) October 15 – December 7 October 15 – December 7

25 06/08/2010Understanding Medicare Prescription Drug Coverage25 When You Can Join or Switch Medicare Prescription Drug Plans (continued) Medicare Advantage Disenrollment Period (MADP) January 1–February 14, you can leave an MA plan and switch to Original Medicare. If you make this change, you may also join a Medicare Prescription Drug Plan to add drug coverage. Coverage begins the first of the month after the plan gets enrollment form.

26 When you can Join or Switch Medicare Prescription Drug Plans (continued) 5-star Special Enrollment Period (5-star SEP) December 8, 2011 – December 31, 2012 Beneficiaries will have a one-time enrollment into any 5-star plan. This will include both the Stand-alone prescription drug plan (PDP) or Medicare Advantage with drug coverage (MA-PD). Beneficiaries will have a one-time enrollment into any 5-star plan. This will include both the Stand-alone prescription drug plan (PDP) or Medicare Advantage with drug coverage (MA-PD).

27 06/08/2010Understanding Medicare Prescription Drug Coverage27 When you can Join or Switch Medicare Prescription Drug Plans (continued) Special Enrollment Periods (SEP) You permanently move out of your plans service areaYou permanently move out of your plans service area You lose other creditable Rx coverageYou lose other creditable Rx coverage You werent adequately informed your other coverage was not creditable/was reduced and no longer creditableYou werent adequately informed your other coverage was not creditable/was reduced and no longer creditable You enter, live in or leave a long- term care facilityYou enter, live in or leave a long- term care facility You have a continuous SEP if you qualify for Extra HelpYou have a continuous SEP if you qualify for Extra Help Or in exceptional circumstancesOr in exceptional circumstances

28 06/08/201028 Creditable Drug Coverage If you have other drug coverageIf you have other drug coverage –It may or may not be creditable –If creditable, it meets or exceeds Medicares minimum standards With creditable coverageWith creditable coverage –Will not have to pay a late-enrollment penalty Plans inform yearly about whether creditablePlans inform yearly about whether creditable –e.g.; employer group plans, retiree plans, VA, TRICARE and FEHB Understanding Medicare Prescription Drug Coverage

29 06/08/201029 Penalty Calculation Late Enrollment National base beneficiary premium –$30.23 in 2012 –Can change each year Pay 1% (of $30.23 in 2012) for every month eligible but not enrolledPay 1% (of $30.23 in 2012) for every month eligible but not enrolled –Unless person has creditable coverage –Penalty added to premium payment Understanding Medicare Prescription Drug Coverage

30 06/08/201030 Extra Help with Drug Cost Sometimes called the Low-Income Subsidy (LIS)Sometimes called the Low-Income Subsidy (LIS) For people with lowest income and resourcesFor people with lowest income and resources –Pay no premiums or deductibles & small or no copayments Those with slightly higher income and resourcesThose with slightly higher income and resources –Pay reduced deductible and a little more out of pocket No coverage gap for people who qualify for LISNo coverage gap for people who qualify for LIS Understanding Medicare Prescription Drug Coverage

31 06/08/201031 Qualifying for Extra Help Some will automatically qualify if they have Medicare and; Some will automatically qualify if they have Medicare and; –Get full Medicaid benefits –Supplemental Security Income (SSI) –Medicare Savings Program Medicaid help with some Medicare costMedicaid help with some Medicare cost All others must apply with Social SecurityAll others must apply with Social Security –Online at www.socialsecurity.gov, or www.socialsecurity.gov –Call 1-800-772-1213 (TTY 1-800-325-0778) Ask for Application for Help with Medicare Prescription Drug Plan Costs (SSA-1020)Ask for Application for Help with Medicare Prescription Drug Plan Costs (SSA-1020) Understanding Medicare Prescription Drug Coverage

32 06/08/201032 Income and Resource Limits Income Income –Below 150% Federal poverty level $16,335 per year for a single person* or$16,335 per year for a single person* or $22,065 per year for a married couple*$22,065 per year for a married couple* Based on family sizeBased on family size Resources Resources –Up to $12,640 (individual) –Up to $25,260 (married couple) Includes $1,500/person funeral or burial expensesIncludes $1,500/person funeral or burial expenses Counts savings and stocksCounts savings and stocks Does not count home you live inDoes not count home you live in 2011 amounts *Higher amounts for Alaska and Hawaii Understanding Medicare Prescription Drug Coverage

33 06/08/201033 Auto- and Facilitated Enrollment CMS identifies and enrolls people each month –Randomly assigned to plans Premiums at or below regional low-income premium subsidy amountPremiums at or below regional low-income premium subsidy amount May join MA plan meeting special needsMay join MA plan meeting special needs If you are already enrolled in an MA plan If you are already enrolled in an MA plan –Youll be enrolled in the same plan with Rx coverage (MA-PD) –If offered by your current plan Understanding Medicare Prescription Drug Coverage

34 06/08/201034 Medicare and Full Medicaid You are auto-enrolled in a plan unlessYou are auto-enrolled in a plan unless –You are already in a Part D plan –You choose and join a plan on your own –You call the plan or 1-800-MEDICARE to opt out You are covered 1st month you are covered byYou are covered 1st month you are covered by –Medicaid and are entitled to Medicare Will get auto-enrollment letter on yellow paperWill get auto-enrollment letter on yellow paper You have a continuous Special Enrollment PeriodYou have a continuous Special Enrollment Period Understanding Medicare Prescription Drug Coverage

35 06/08/201035 Others Qualified for Extra Help Facilitated into a plan unlessFacilitated into a plan unless –You already are in a Part D plan –You choose and join own plan –Youre enrolled in employer/union plan receiving subsidy –You call the plan or 1-800-MEDICARE to opt out Coverage is effective 2 months after CMS notifiesCoverage is effective 2 months after CMS notifies Will get facilitated enrollment letter on green paperWill get facilitated enrollment letter on green paper Have continuous Special Enrollment PeriodHave continuous Special Enrollment Period Understanding Medicare Prescription Drug Coverage

36 06/08/201036 People New to Extra Help You can apply for Extra Help any timeYou can apply for Extra Help any time –If denied, can reapply if circumstances change If in a Medicare drug plan and later qualifyIf in a Medicare drug plan and later qualify –Plan is notified you qualify for Extra Help –Plan refunds costs back to effective date of Extra Help Deductibles/PremiumsDeductibles/Premiums Cost-sharing assistanceCost-sharing assistance Understanding Medicare Prescription Drug Coverage

37 06/08/201037 Enrollment Notices CMS notifies people of enrollment in a PDPCMS notifies people of enrollment in a PDP –Auto-enrollment letter on yellow paper –Facilitated enrollment letter on green paper Denotes either full or partial subsidyDenotes either full or partial subsidy Includes list of area plans at/below regional low-income premium subsidy amountIncludes list of area plans at/below regional low-income premium subsidy amount MA plan sends notice if enrollment in MA-PDMA plan sends notice if enrollment in MA-PD Understanding Medicare Prescription Drug Coverage

38 06/08/201038 Re-establishing Eligibility for People Who Automatically Qualify CMS re-establishes eligibility in the FallCMS re-establishes eligibility in the Fall –For next calendar year –If you no longer automatically qualify CMS sends letter in September on gray paperCMS sends letter in September on gray paper –Includes SSA application – If you automatically qualify & your copayment changed CMS sends letter In early October on orange paperCMS sends letter In early October on orange paper Understanding Medicare Prescription Drug Coverage

39 06/08/201039 Extra Help – What You Pay Group 1 100% FPL Group 2 100-135% FPL Group 3 135-150% FPL Premium$0*$0 Sliding scale based on income Yearly deductible $310/year $0*$0$60 Coinsurance up to $4,700 out of pocket $1.10/$3.30 copay $2.60/$6.50 copay Up to 15% coinsurance Catastrophic coverage $0$0 $2.60/$6.50 copay Understanding Medicare Prescription Drug Coverage *If you join a basic plan with a premium at or below the regional low-income premium subsidy amount.

40 LI-NET Limited Income Newly Eligible Transition Program (LI-NET)Limited Income Newly Eligible Transition Program (LI-NET) –Combined auto-enrollment and Point-of-Sale Facilitated Enrollment For full duals and SSI-only beneficiariesFor full duals and SSI-only beneficiaries Provides Part D coverage for all uncoveredProvides Part D coverage for all uncovered –Full duals and SSI-only beneficiaries retroactively –LIS eligible beneficiaries on a current basis 06/08/2010Understanding Medicare Prescription Drug Coverage40

41 LI-NET Coverage and Enrollment CoverageCoverage –Full Dual/SSI-only up to 36 months –Partial Dual/LIS Applicants up to 30 days –Unconfirmed up to 7 days Enrolled in LI NET for temporary coverageEnrolled in LI NET for temporary coverage –In Standard PDP for future coverage Open Formulary, No Prior Authorization, No Pharmacy RestrictionsOpen Formulary, No Prior Authorization, No Pharmacy Restrictions Standard PDP Rights for Enrollees, Eligibility Reviews for Non-EnrolleesStandard PDP Rights for Enrollees, Eligibility Reviews for Non-Enrollees 06/08/2010Understanding Medicare Prescription Drug Coverage41

42 Access to LI-Net Three ways to access the LI-NET programThree ways to access the LI-NET program –Auto: Enrollment by CMS –Point of Service (POS) –Submitting a receipt for drugs already paid out-of-pocket During eligible periodsDuring eligible periods

43 State Pharmacy Assistant Program (SPAP) In Illinois, SPAP is Illinois Cares RxIn Illinois, SPAP is Illinois Cares Rx Two types of coverageTwo types of coverage –Illinois Cares Rx Basic formerly Pharmaceutical Assistance Programformerly Pharmaceutical Assistance Program –Illinois Cares Rx Plus formerly SeniorCareformerly SeniorCare Can also assist individuals not on Medicare Can also assist individuals not on Medicare

44 Illinois Cares Rx for those on Medicare Will assist with some cost sharing with a coordinating planWill assist with some cost sharing with a coordinating plan –Deductible up to $320 of total drug cost –Initial coverage up to $2,930 of total drug cost –Coverage gap from $2,930- $6,657.50 of total drug cost –Catastrophic coverage begins at $6,657.50 – provides NO wrap coverage NOTE: Applicants must apply for LIS through Social Security at least once and follow instructions from SSA if qualify for any portion of assistance

45 State Pharmacy Assistance Program Medicare and Illinois Cares Rx –Provides wrap-around coverage –Must be enrolled in a coordinating PDP or MA-PD plan in order to get the wrap –Pays the premium for a coordinating Part D plan, or –Expands greatly the population served by the state of Illinois Costs incurred by IL Cares Rx can count toward out-of-pocket limitCosts incurred by IL Cares Rx can count toward out-of-pocket limit Applications can be filed on line at www.cbrx.il.gov/Applications can be filed on line at www.cbrx.il.gov/

46 Medicare and Illinois Cares Rx Must meet annual income requirement ofMust meet annual income requirement of –$21,780* for a household of 1 –$29,420* for a household of 2 –$37,060* for a household of 3 Must follow Part D plan rules for coverageMust follow Part D plan rules for coverage Must Apply for SSA Extra HelpMust Apply for SSA Extra Help –At least once, even if you do not meet requirements * Income amounts are based on an application filed in 2010 using 2009 income

47 Illinois Cares Rx For individuals who need drug assistance but are not on Medicare will have toFor individuals who need drug assistance but are not on Medicare will have to –Meet income requirements For Plus or Basic coverageFor Plus or Basic coverage –Be 65yrs or older; or –Persons with disability –Follow Illinois Cares Rx formulary list

48 Illinois Cares Rx Basic Must be without Medicare coverage and eitherMust be without Medicare coverage and either –Age 65 or older, or –A person with disabilities Annual income of no more thanAnnual income of no more than –$21,780* for a household of 1 –$29,420* for a household of 2 –$37,060* for a household of 3 IL Cares Rx Basic Drug Coverage for 11 Disease Categories Alzheimers Disease Arthritis CancerDiabetes Glaucoma Heart and blood pressure problems HIV/AIDS (if not eligible for Medicare) Multiple Sclerosis Osteoporosis Parkinsons Disease Lung Disease and smoking related illnesses * Income amounts are based on an application filed in 2010 using 2009 income

49 Illinois Cares Rx Plus Illinois Cares Rx Plus provides coverage for almost all prescription drugsIllinois Cares Rx Plus provides coverage for almost all prescription drugs Must be a citizen or qualified non- citizen 65 or older without MedicareMust be a citizen or qualified non- citizen 65 or older without Medicare Annual income of no more than $21,780* (single) or $29,420* (married couple)Annual income of no more than $21,780* (single) or $29,420* (married couple) * Income amounts are based on an application filed in 2010 using 2009 income

50 06/08/201050 Things to Consider Before Joining a Plan Important questions to ask Important questions to ask –Do you have other current health insurance coverage? –What about current prescription drug coverage? –Is any prescription drug coverage you might have as good as Medicare drug coverage? –How does your current coverage work with Medicare? –Could joining a plan affect your current coverage? –Could joining a plan affect a family members coverage? Understanding Medicare Prescription Drug Coverage

51 06/08/201051 Annual Notice of Change All Part D plans send to all members by September 30 All Part D plans send to all members by September 30 –May arrive with Evidence of Coverage Will include information for upcoming year Will include information for upcoming year –Summary of Benefits –Formulary –Changes New premiumNew premium Cost sharing – copayments and coinsuranceCost sharing – copayments and coinsurance OtherOther Understanding Medicare Prescription Drug Coverage

52 06/08/201052 Residents of Long-Term Care Facilities Get drugs from pharmacy chosen by facility Get drugs from pharmacy chosen by facility Will have convenient access Will have convenient access Can change plans at any time Can change plans at any time With Medicare and full Medicaid benefits With Medicare and full Medicaid benefits –Have no deductible and no copayments Understanding Medicare Prescription Drug Coverage

53 06/08/201053 Coverage Determination Initial decision by plan Initial decision by plan –Benefits a member is entitled to receive –Amount member is required to pay for a benefit May be standard May be standard May be expedited May be expedited –Life or health seriously jeopardized Understanding Medicare Prescription Drug Coverage

54 06/01/201054 Part D Exception Requests Two types of exceptions Two types of exceptions –Tiers e.g., getting Tier 2 drug at Tier 1 coste.g., getting Tier 2 drug at Tier 1 cost –Formulary Drug not on plans formulary orDrug not on plans formulary or Access requirementsAccess requirements Requests can be made only by you, your appointed representative, or the prescriber Requests can be made only by you, your appointed representative, or the prescriber Requires supporting statement from physician Requires supporting statement from physician Medicare Drug Coverage Under Part A, Part B and Part D

55 06/08/201055 Approved Exceptions Exception valid for refills for remainder of year if Exception valid for refills for remainder of year if –Person remains enrolled in the plan and –Physician continues to prescribe drug, and –Drug stays safe to treat persons condition Plan may extend coverage into new plan year Plan may extend coverage into new plan year –If not, must send written notice – At least 60 days before plan year ends Understanding Medicare Prescription Drug Coverage

56 06/08/201056 Coverage Determination Timefram Coverage Determination Timefram e Plan must notify of coverage determination Plan must notify of coverage determination –Standard request within 72 hours –Expedited request within 24 hours –Exception involved – Time clock starts when plan receives physician statement –Missed timeframe – Goes to independent review entity (IRE) –MAXIMUS – www.medicarepartdappeals.com www.medicarepartdappeals.com – Skip 1 st level of appeal Understanding Medicare Prescription Drug Coverage

57 06/08/201057 Requesting Appeals In general, appeal requests must be written In general, appeal requests must be written –Plans must accept expedited requests orally An appeal can be requested by An appeal can be requested by –Plan member –Appointed representative 5 levels of appeals 5 levels of appeals Understanding Medicare Prescription Drug Coverage

58 Resources Illinois Senior Health Insurance ProgramIllinois Senior Health Insurance Program –www.insurance.illinois.gov –(800) 548-9034 MedicareMedicare –www.medicare.gov –(800) 633-4227 –Medicare and You 2012 handbook Social Security AdministrationSocial Security Administration –www.socialsecurity.gov


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