Introducing the Medicare Prescription Drug Benefit This is a presentation created by GeorgiaCares. This is not an official document. The official Medicare program provisions are contained in the relevant laws, regulations, and rulings.

Medicare Drug Plans For anyone who has Medicare Plan info in October Sign-up in November Starts January 1, 2006

What medications can I get? The new Medicare plan will pay for prescription meds, insulin, and supplies Plans will cover brand and generics A plan may not cover all of your meds

What if I my plan doesn't cover all of my meds? You have 2 ways of making sure you get all of your meds: –If you have Medicaid, then you can change plans monthly –You or your doctor can ask the plan to make an “exception” to cover a medication because it’s best for you, or

Example of a Plan (minimum standard) $33.15 monthly premium $250 deductible Coinsurance of 25% from $250 to $2,250 of drug costs ($500 oop; $1500 plan) 100% of drug costs from $2,250 to $5,100 ($2850 out of pocket) After $3,600 in out-of-pocket costs, Medicare pays approximately 95% Overview

What if Medicaid pays for my medicines right now? Medicaid stops paying for prescriptions for people on Medicare on December 31, 2005 –Will automatically get extra help to pay for a drug plan and be enrolled in a plan

If you have Medicaid

What will I pay if I have both Medicaid and Medicare? *Monthly Payment$0 Co-payment$1/generic $3/brand *The extra help will only pay for an” average” plan premium/payment. If a higher cost plan is chosen, then you have to pay that extra amount.

What if Medicaid helps pay for my Medicare? You will get extra help to pay for a drug plan if you have QMB, SLMB, or QI Choose a plan by May 15, 2006, or Medicare will pick one for you June 1, 2006 –This is also true for anyone who applies and gets the extra-help through Social Security

What will I pay if I have QMB, SLMB or QI-1? Deductible$0 *Monthly Premium$0 Co-payment$2/generic $5/brand The extra help will only pay an average monthly premium. If a higher premium plan is needed, the extra amount will be owed by the person with Medicare.

Do you have limited income but do not qualify for Medicaid coverage for your prescription drugs? You may still qualify for extra help with your prescriptions if your income is no more than $14,355 as a single or $19,245 as a couple Premium $37/month Sliding scale based on income Deductible $250/year $50 Coinsurance up to $3,600 out of pocket 15% coinsurance After $3600: 5% or $2/$5 copay $2/$5 copay

Extra Help Group 1 –Full-benefit dual eligibles with incomes at or below 100% Federal poverty level (FPL) Group 2 –QMB, SLMB, QI, or non-dual eligible beneficiaries with incomes below 135% FPL and limited resources ($7,500 per individual and $12,000 married couple) Group 3 –Beneficiaries with incomes below 150% FPL and limited resources ($11,500 individual and $23,000 married couple) Extra Help

Group 1 <$9570/ind <$12,830/cpl Group 2 <$12,920/ind <$17,321/cpl Group 3 <$14,355 ind <$19,245 cpl Premium $33.15/month $0 Sliding scale based on income Deductible $250/year $0 $50 Coinsurance up to $3,600 out of pocket $1/$3 copay$2/$5 copay15% coinsurance Catastrophic 5% or $2/$5 copay $0 $2/$5 copay Extra Help

Maximum Monthly Income Maximum resources Annual Deductible Monthly Premium* Co- Payments until out-of- pocket costs reach $3600 Catastrophic Benefit After Total Out-of-Pocket Costs Reach $3,600 Single: $ $1, Married: $1, $1, Single: < $6,000 Married: <$9,000 $0 $0 $2 generic or preferred $5 per prescription for all other drugs Free prescriptions Single: $ $1, Married: $1, $1, Single: $6,000 - $10,000 Married: $9,000 - $20,000 $50 $0 15% co-pay per prescription $2 generic or preferred multi-brand prescription drug $5 per prescription for all other drugs Single: $1,077- $1, Married: $1,444- $1, Single: < $11,500 Married: < $23,000 $50 Based on income 15% co- insurance for each prescription drug $2 generic or preferred multi-brand prescription drug $5 for all other drugs Extra Help

How the Extra Help Works CMS notifies the plan if you get the help The plan figures out who pays what Extra Help

Applying for Extra Help Apply with Social Security or at DFACS – – You can do it yourself Someone you trust can do it for you – GeorgiaCares

Application for Extra Help

What if I have a Medicare- approved drug-discount card? Apply for the extra help, and Enroll in a Medicare prescription drug plan

What if I don’t have Medicaid, but I get other benefits? You may see your food stamp benefits go down as you spend less on drugs If you get the $10 minimum food stamp benefit, your benefit may end Your rent may be increased as your prescription drug spending decreases. BUT, you will end up with extra cash.

When do I choose a plan? In 2005: –November 15 – May 15, 2006 In 2006 and every year after: –November 15 – December 31

What if I wait? You may have to pay more for a plan later if you don’t take one now People who get extra help will also get help paying the penalty

Special Sign-up If/when you: –Move out of the plan’s service area –Go in or out of a long term care facility –Lose your “at least as good” as coverage –Other exceptional circumstances

How do I choose a plan? Medicare & You 2005 handbook – –1-800-MEDICARE –Call the plan/s Call GeorgiaCares for help –

Each plan is different Prices will vary Pharmacy networks All your drugs may not be covered

If you have Medicaid or a Medicare Savings Program you will automatically get a drug plan and help in paying for it. If you have limited income, you must apply for the extra help with Social Security first and then enroll in a plan. You need to choose a plan that meets YOUR needs.

For More Information MEDICARE GeorgiaCares

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