1. Medicare Prescription Drug Coverage Patrick Hamilton Rural Health Coordinator Centers for Medicare & Medicaid Services Philadelphia Regional Office 2005 Maryland Rural Summit October 28, 2005

2. 10/28/05 2Medicare Prescription Drug Coverage Session Topics Overview Overview Eligibility and enrollment Eligibility and enrollment Extra help Extra help Out-of-pocket threshold Out-of-pocket threshold Medicare prescription drug coverage Medicare prescription drug coverage Medicare prescription drug plan finder web tool Medicare prescription drug plan finder web tool Partnering with CMS Partnering with CMS

3. 10/28/05 3Medicare Prescription Drug Coverage Session Topics Overview Overview Eligibility and enrollment Eligibility and enrollment Extra help Extra help Out-of-pocket threshold Out-of-pocket threshold Medicare prescription drug coverage Medicare prescription drug coverage Medicare prescription drug plan finder web tool Medicare prescription drug plan finder web tool Partnering with CMS Partnering with CMS

4. 10/28/05 4Medicare Prescription Drug Coverage Impact: Beneficiaries 42 million Medicare beneficiaries nationwide (about 675,000 in Maryland) 42 million Medicare beneficiaries nationwide (about 675,000 in Maryland) ALL 42 million are eligible for Medicare Prescription Drug Coverage ALL 42 million are eligible for Medicare Prescription Drug Coverage 23% do not currently have drug coverage 23% do not currently have drug coverage Beneficiary population will double in 30 years Beneficiary population will double in 30 years 14 million Medicare beneficiaries 14 million Medicare beneficiaries Eligible for extra help with drug costs Eligible for extra help with drug costs 96% of drug costs will be covered 96% of drug costs will be covered Overview

5. 10/28/05 5Medicare Prescription Drug Coverage Important Dates January 1, 2006: Drug coverage begins January 1, 2006: Drug coverage begins November 15, 2005: Enrollment begins, continues through May 15, 2006 November 15, 2005: Enrollment begins, continues through May 15, 2006 October 2005: Plan marketing begins October 2005: Plan marketing begins September 2005: Plans announced September 2005: Plans announced Summer 2005: Formulary and bid reviews, extra help applications Summer 2005: Formulary and bid reviews, extra help applications Winter/Spring 2005: Final regulation was released; bids were submitted Winter/Spring 2005: Final regulation was released; bids were submitted Overview

6. 10/28/05 6Medicare Prescription Drug Coverage Coverage begins January 1, 2006 Coverage begins January 1, 2006 Available for all people with Medicare Available for all people with Medicare Provided through Provided through Prescription drug plans (PDPs) Prescription drug plans (PDPs) Medicare Advantage Plans (MA-PDs) Medicare Advantage Plans (MA-PDs) Some employers and unions to retirees Some employers and unions to retirees Overview

7. 10/28/05 7Medicare Prescription Drug Coverage PDP and MA-PD Regions 34 PDP regions (DE, DC & MD= Region 5) 34 PDP regions (DE, DC & MD= Region 5) In MD, 19 PDP organizations offering 47 plans In MD, 19 PDP organizations offering 47 plans 26 MA-PD regions (DE, DC & MD= Region 5) 26 MA-PD regions (DE, DC & MD= Region 5) In MD, 17 of 26 counties have access to MA plans In MD, 17 of 26 counties have access to MA plans Key factors in establishing regions Key factors in establishing regions Eligibility population and capacity Eligibility population and capacity Beneficiary consideration Beneficiary consideration Limited variation in prescription drug spending Limited variation in prescription drug spending Overview

8. 10/28/05 8Medicare Prescription Drug Coverage Overview

9. 10/28/05 9Medicare Prescription Drug Coverage Overview

10. 10/28/05 10Medicare Prescription Drug Coverage Medicare Prescription Drug Plans Must offer basic drug benefit Must offer basic drug benefit Standard benefit Standard benefit May offer supplemental benefits May offer supplemental benefits Enhanced benefit Enhanced benefit Can be flexible in benefit design Can be flexible in benefit design Must follow marketing guidelines Must follow marketing guidelines Overview

11. 10/28/05 11Medicare Prescription Drug Coverage Example of Standard Prescription Drug Coverage $32 average monthly premium $32 average monthly premium $250 deductible $250 deductible Up to $2,250: Beneficiary pays 25% drug costs and Medicare pays 75% drug costs Up to $2,250: Beneficiary pays 25% drug costs and Medicare pays 75% drug costs Between $2,250 and $5,100: Beneficiary pays 100% drug costs (coverage gap) Between $2,250 and $5,100: Beneficiary pays 100% drug costs (coverage gap) After $3,600 in out-of-pocket spending: Medicare pays approximately 95% and beneficiary pays greater of $2/$5 copay or 5% coinsurance After $3,600 in out-of-pocket spending: Medicare pays approximately 95% and beneficiary pays greater of $2/$5 copay or 5% coinsurance Overview

12. 10/28/05 12Medicare Prescription Drug Coverage Standard Benefit 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

13. 10/28/05 13Medicare Prescription Drug Coverage Session Topics Overview Overview Eligibility and enrollment Eligibility and enrollment Extra help Extra help Out-of-pocket threshold Out-of-pocket threshold Medicare prescription drug coverage Medicare prescription drug coverage Medicare prescription drug plan finder web tool Medicare prescription drug plan finder web tool Partnering with CMS Partnering with CMS

14. 10/28/05 14Medicare Prescription Drug Coverage Eligibility and Enrollment Entitled to Part A and/or enrolled in Part B Entitled to Part A and/or enrolled in Part B Reside in plans service area Reside in plans service area Must enroll in a Medicare prescription drug plan to get Medicare prescription drug coverage Must enroll in a Medicare prescription drug plan to get Medicare prescription drug coverage Eligibility and Enrollment

15. 10/28/05 15Medicare Prescription Drug Coverage Enrolling in a Plan People with Medicare can enroll People with Medicare can enroll Directly with the plan sponsor Directly with the plan sponsor Through a personal representative Through a personal representative Stands in the shoes of a person with Medicare and has authority to act on his or her behalf Stands in the shoes of a person with Medicare and has authority to act on his or her behalf This authority comes from state law (e.g., Power of Attorney, guardian) or other applicable law (e.g., tribal or military law) This authority comes from state law (e.g., Power of Attorney, guardian) or other applicable law (e.g., tribal or military law) By enlisting the assistance of others By enlisting the assistance of others Spouse, relative, friend, caregiver, or advocacy group volunteer Spouse, relative, friend, caregiver, or advocacy group volunteer Eligibility and Enrollment

16. 10/28/05 16Medicare Prescription Drug Coverage Enrollment Options People eligible for Medicare prescription drug coverage may enroll in a People eligible for Medicare prescription drug coverage may enroll in a Prescription Drug Plan (PDP) or Prescription Drug Plan (PDP) or Medicare Advantage Prescription Drug plan (MA-PD plan) Medicare Advantage Prescription Drug plan (MA-PD plan) People enrolled in an MA plan must receive Medicare prescription drug coverage from the MA-PD plan except if People enrolled in an MA plan must receive Medicare prescription drug coverage from the MA-PD plan except if Enrolled in a PFFS plan without drug coverage; or Enrolled in a PFFS plan without drug coverage; or Enrolled in an MSA plan Enrolled in an MSA plan People enrolled in a cost plan can elect to receive Medicare prescription drug coverage from the cost plan or enroll in a PDP People enrolled in a cost plan can elect to receive Medicare prescription drug coverage from the cost plan or enroll in a PDP People must obtain Medicare prescription drug coverage from their PACE organization if it is offered People must obtain Medicare prescription drug coverage from their PACE organization if it is offered Eligibility and Enrollment

17. 10/28/05 17Medicare Prescription Drug Coverage Enrollment Periods In general, the enrollment periods for PDPs and MA- PDs are similar In general, the enrollment periods for PDPs and MA- PDs are similar There are three enrollment periods for PDPs There are three enrollment periods for PDPs Initial Enrollment Period (IEP) Initial Enrollment Period (IEP) November 15, 2005 – May 15, 2006 for beneficiaries eligible for Medicare by January 2006 November 15, 2005 – May 15, 2006 for beneficiaries eligible for Medicare by January 2006 For newly eligible, coordinates with Part B enrollment For newly eligible, coordinates with Part B enrollment Annual Coordinated Election Period (AEP) Annual Coordinated Election Period (AEP) For the first year: November 15, 2005 – May 15, 2006 For the first year: November 15, 2005 – May 15, 2006 2006 and beyond: November 15 – December 31 2006 and beyond: November 15 – December 31 Special Enrollment Period (SEP) Special Enrollment Period (SEP) Eligibility and Enrollment

18. 10/28/05 18Medicare Prescription Drug Coverage Postponing Enrollment Higher premiums for people who wait to enroll Higher premiums for people who wait to enroll Exception for those with prescription drug coverage at least as good as a Medicare prescription drug plan Exception for those with prescription drug coverage at least as good as a Medicare prescription drug plan Assessed 1% of base premium for every month Assessed 1% of base premium for every month Eligible to enroll in a Medicare prescription drug plan but not enrolled Eligible to enroll in a Medicare prescription drug plan but not enrolled No drug coverage as good as a Medicare prescription drug coverage for 63 consecutive days or longer No drug coverage as good as a Medicare prescription drug coverage for 63 consecutive days or longer Eligibility and Enrollment

19. 10/28/05 19Medicare Prescription Drug Coverage Possible Examples of Coverage at Least as Good as Medicares Coverage under a PDP or MA-PD Coverage under a PDP or MA-PD Some Group Health Plans (GHP) Some Group Health Plans (GHP) State Pharmacy Assistance Program (SPAP) State Pharmacy Assistance Program (SPAP) VA coverage VA coverage Military coverage including TRICARE Military coverage including TRICARE * Note: The source of the current drug coverage will send a notice telling the person if it is at least as good as Medicare prescription drug coverage Eligibility and Enrollment

20. 10/28/05 20Medicare Prescription Drug Coverage Enrolling in a Plan Look at Medicare & You 2006 handbook Look at Medicare & You 2006 handbook Read about the prescription drug plans available in the area Read about the prescription drug plans available in the area Contact the plan to enroll Contact the plan to enroll Need help choosing and enrolling in a plan? Need help choosing and enrolling in a plan? Medicare Prescription Drug Plan Finder Tool Medicare Prescription Drug Plan Finder Tool www.medicare.gov www.medicare.gov 1-800-MEDICARE (TTY 1-877-486-2048) 1-800-MEDICARE (TTY 1-877-486-2048) Local SHIP Local SHIP Maryland 1-800-243-3425 Maryland 1-800-243-3425 CMS and partner-sponsored enrollment fairs CMS and partner-sponsored enrollment fairs Eligibility and Enrollment

21. 10/28/05 21Medicare Prescription Drug Coverage Auto-Enrollment Medicaid prescription drug coverage for full-benefit dual eligibles ends 12/31/05 Medicaid prescription drug coverage for full-benefit dual eligibles ends 12/31/05 Full-benefit dual eligibles who do not enroll in a plan by 12/31/05 Full-benefit dual eligibles who do not enroll in a plan by 12/31/05 CMS will enroll them in a prescription drug plan with a premium covered by the low-income premium assistance CMS will enroll them in a prescription drug plan with a premium covered by the low-income premium assistance Their Medicare prescription drug coverage will begin 1/1/06 Their Medicare prescription drug coverage will begin 1/1/06 Will receive letter in October with auto-assignment information Will receive letter in October with auto-assignment information Full-benefit dual eligibles have a SEP Full-benefit dual eligibles have a SEP Can change plans any time Can change plans any time Eligibility and Enrollment

22. 10/28/05 22Medicare Prescription Drug Coverage Facilitated Enrollment CMS is facilitating the enrollment CMS is facilitating the enrollment MSP, SSI-only, and people who apply and qualify for extra help (but do not choose a plan) MSP, SSI-only, and people who apply and qualify for extra help (but do not choose a plan) Enrollment facilitated if they do not choose a plan by May 15, 2006 Enrollment facilitated if they do not choose a plan by May 15, 2006 Coverage effective June 1, 2006 Coverage effective June 1, 2006 SEP – may change plans SEP – may change plans MSP/SSI: Continuous SEP MSP/SSI: Continuous SEP LIS: SEP through 12/31/06 LIS: SEP through 12/31/06 Eligibility and Enrollment

23. 10/28/05 23Medicare Prescription Drug Coverage Session Topics Overview Overview Eligibility and enrollment Eligibility and enrollment Extra help Extra help Out-of-pocket threshold Out-of-pocket threshold Medicare prescription drug coverage Medicare prescription drug coverage Medicare prescription drug plan finder web tool Medicare prescription drug plan finder web tool Partnering with CMS Partnering with CMS

24. 10/28/05 24Medicare Prescription Drug Coverage Extra Help Assistance with premium and cost sharing Assistance with premium and cost sharing Eligibility determined by SSA or state Eligibility determined by SSA or state Income and resource tests Income and resource tests Some groups are deemed eligible Some groups are deemed eligible Apply with paper form or at ssa.gov Apply with paper form or at ssa.gov Applications accepted on a rolling basis Applications accepted on a rolling basis Extra Help

25. 10/28/05 25Medicare Prescription Drug Coverage Deemed Eligible Full-benefit dual eligibles Full-benefit dual eligibles SSI recipients SSI recipients Medicare Savings Program groups, e.g., QMBs, SLMBs, QIs Medicare Savings Program groups, e.g., QMBs, SLMBs, QIs Received letters this summer Received letters this summer All others must file an application All others must file an application Extra Help

26. 10/28/05 26Medicare Prescription Drug Coverage Applying for Extra Help People with Medicare can apply People with Medicare can apply Personal representatives can apply Personal representatives can apply Who has authority to act on behalf of a person with Medicare under state law (e.g., Power of Attorney, guardian) or other applicable law (e.g., tribal or military) Who has authority to act on behalf of a person with Medicare under state law (e.g., Power of Attorney, guardian) or other applicable law (e.g., tribal or military) Representative payee appointed by SSA Representative payee appointed by SSA People with Medicare and personal representatives may enlist others to apply People with Medicare and personal representatives may enlist others to apply Spouse, child, caregiver, advocacy group volunteer Spouse, child, caregiver, advocacy group volunteer Extra Help

27. 10/28/05 27Medicare Prescription Drug Coverage Extra Help Group 1 (about 76,000 in MD) Group 1 (about 76,000 in MD) Full-benefit dual eligibles with incomes at or below 100% Federal poverty level (FPL) Full-benefit dual eligibles with incomes at or below 100% Federal poverty level (FPL) Group 2 (about 200,000 in MD) Group 2 (about 200,000 in MD) Full-benefit dual eligibles above 100% of FPL; QMB, SLMB, QI, SSI-only, or non-dual eligible beneficiaries with incomes below 135% FPL and limited resources ($6,000 per individual and $9,000 married couple) Full-benefit dual eligibles above 100% of FPL; QMB, SLMB, QI, SSI-only, or non-dual eligible beneficiaries with incomes below 135% FPL and limited resources ($6,000 per individual and $9,000 married couple) Group 3 (about 40,000 in MD) Group 3 (about 40,000 in MD) Beneficiaries with incomes below 150% FPL and limited resources ($10,000 individual and $20,000 married couple) Beneficiaries with incomes below 150% FPL and limited resources ($10,000 individual and $20,000 married couple) Extra Help

28. 10/28/05 28Medicare Prescription Drug Coverage Federal Poverty Level – 2005* 2005 FPLOne PersonCouple 2005 FPLOne PersonCouple 100%$9,570$12,830 100%$9,570$12,830 $797.50/mo$1,069.17/mo $797.50/mo$1,069.17/mo 135%$12,919$17,320 135%$12,919$17,320 $1,076.58/mo $1,443.37/mo $1,076.58/mo $1,443.37/mo 150%$14,355$19,245 150%$14,355$19,245 $1,196.25/mo $1,603.75/mo $1,196.25/mo $1,603.75/mo *Levels revised annually in February *Levels revised annually in February Extra Help

29. 10/28/05 29Medicare Prescription Drug Coverage Extra Help Group 1 Group 2 Group 3 Premium $32/month $0$0 Sliding scale based on income Deductible $250/year $0$0$50 Coinsurance up to $3,600 out of pocket $1/$3 copay $2/$5 copay 15% coinsurance Catastrophic 5% or $2/$5 copay $0$0 $2/$5 copay Extra Help

30. 10/28/05 30Medicare Prescription Drug Coverage Session Topics Overview Overview Eligibility and enrollment Eligibility and enrollment Extra help Extra help Out-of-pocket threshold Out-of-pocket threshold Medicare prescription drug coverage Medicare prescription drug coverage Medicare prescription drug plan finder web tool Medicare prescription drug plan finder web tool Partnering with CMS Partnering with CMS

31. 10/28/05 31Medicare Prescription Drug Coverage Out-of-Pocket Threshold The amount of money to reach catastrophic coverage The amount of money to reach catastrophic coverage Consists of Consists of Deductible - $250 in 2006 Deductible - $250 in 2006 25% coinsurance - $500 in 2006 25% coinsurance - $500 in 2006 100% between $2,250 and $5,100 - $2,850 in 2006 100% between $2,250 and $5,100 - $2,850 in 2006 Medicare prescription drug plan premium is not part of out-of-pocket threshold Medicare prescription drug plan premium is not part of out-of-pocket threshold Out-of-Pocket Threshold

32. 10/28/05 32Medicare Prescription Drug Coverage Sources Applied to Out-of-Pocket Threshold Payment from Payment from People with Medicare themselves People with Medicare themselves Another individual such as family member Another individual such as family member Medicares cost-sharing assistance Medicares cost-sharing assistance Qualified State Pharmacy Assistance Program Qualified State Pharmacy Assistance Program Out-of-Pocket Threshold

33. 10/28/05 33Medicare Prescription Drug Coverage Sources Not Applied to Out-of- Pocket Threshold Employer/retiree group health plans Employer/retiree group health plans TRICARE TRICARE Black Lung Black Lung VA VA Workers Compensation Workers Compensation Automobile/no-fault/liability insurance Automobile/no-fault/liability insurance Supplemental benefit portions of PDP or MA-PD Supplemental benefit portions of PDP or MA-PD Out-of-Pocket Threshold

34. 10/28/05 34Medicare Prescription Drug Coverage Sources Not Applied to Out-of- Pocket Threshold Most third party payment arrangements Most third party payment arrangements Drugs purchased outside the US Drugs purchased outside the US Over-the-counter drugs Over-the-counter drugs Drugs not on the Plans formulary Drugs not on the Plans formulary Drugs not covered by law Drugs not covered by law Out-of-Pocket Threshold

35. 10/28/05 35Medicare Prescription Drug Coverage How Out-of-Pocket Threshold Works Drug plans will calculate out-of-pocket threshold Drug plans will calculate out-of-pocket threshold Drug plan will ask person with Medicare what third party coverage he/she has Drug plan will ask person with Medicare what third party coverage he/she has Total out-of-pocket threshold for 2006 is $3,600 Total out-of-pocket threshold for 2006 is $3,600 Wrap-around drug coverage doesnt count but is beneficial Wrap-around drug coverage doesnt count but is beneficial Out-of-Pocket Threshold

36. 10/28/05 36Medicare Prescription Drug Coverage How Out-of-Pocket Threshold Works Example under standard benefit Example under standard benefit Met $250 deductible Met $250 deductible Gets a prescription for $100 Gets a prescription for $100 Drug plan pays $75 Drug plan pays $75 Person with Medicare pays $25 Person with Medicare pays $25 $250 deductible and $25 co-insurance are counted toward out-of-pocket threshold $250 deductible and $25 co-insurance are counted toward out-of-pocket threshold Out-of-Pocket Threshold

37. 10/28/05 37Medicare Prescription Drug Coverage Session Topics Overview Overview Eligibility and enrollment Eligibility and enrollment Extra help Extra help Out-of-pocket threshold Out-of-pocket threshold Medicare prescription drug coverage Medicare prescription drug coverage Medicare prescription drug plan finder web tool Medicare prescription drug plan finder web tool Partnering with CMS Partnering with CMS

38. 10/28/05 38Medicare Prescription Drug Coverage Available only by prescription Available only by prescription Prescription drugs, biologicals, insulin Prescription drugs, biologicals, insulin Medical supplies associated with injection of insulin Medical supplies associated with injection of insulin A PDP or MA-PD may not cover all drugs A PDP or MA-PD may not cover all drugs Brand name and generic drugs will be in each formulary Brand name and generic drugs will be in each formulary Covered Drugs

39. 10/28/05 39Medicare Prescription Drug Coverage Definition of Medicare Prescription Drug Definition of Medicare Prescription Drug Includes Drug dispensed by Rx Drug dispensed by Rx Insulin & associated supplies Insulin & associated supplies Compounded drugs Compounded drugs Parenteral nutrition Parenteral nutrition Vaccines (those not currently covered by Part B) Vaccines (those not currently covered by Part B) Does NOT Include Drugs covered under Medicare Parts A or B Drugs covered under Medicare Parts A or B Those excluded by statute, including benzodiazepines, barbiturates, and OTCs [1927(d)(2)] Those excluded by statute, including benzodiazepines, barbiturates, and OTCs [1927(d)(2)] Covered Drugs

40. 10/28/05 40Medicare Prescription Drug Coverage Excluded Drugs Drugs for Drugs for Anorexia, weight loss, or weight gain Anorexia, weight loss, or weight gain Fertility Fertility Cosmetic purposes or hair growth Cosmetic purposes or hair growth Symptomatic relief of cough and colds Symptomatic relief of cough and colds Prescription vitamins and mineral products Prescription vitamins and mineral products Except prenatal vitamins and fluoride preparations Except prenatal vitamins and fluoride preparations Non-prescription drugs Non-prescription drugs Barbiturates Barbiturates Benzodiazepines Benzodiazepines Covered Drugs

41. 10/28/05 41Medicare Prescription Drug Coverage Formulary Drug plans may have a formulary Drug plans may have a formulary CMS will ensure formularies do not discourage enrollment among certain groups of people CMS will ensure formularies do not discourage enrollment among certain groups of people Formulary review requirements are posted on the cms.hhs.gov/pdps website Formulary review requirements are posted on the cms.hhs.gov/pdps website CMS approved formularies in advance for plans to complete their bid CMS approved formularies in advance for plans to complete their bid Covered Drugs

42. 10/28/05 42Medicare Prescription Drug Coverage Pharmacy Access Standards Retail pharmacy TRICARE access standards Retail pharmacy TRICARE access standards Urban areas: network pharmacy within 2 miles of 90% of beneficiaries Urban areas: network pharmacy within 2 miles of 90% of beneficiaries Suburban areas: network pharmacy within 5 miles of 90% of beneficiaries Suburban areas: network pharmacy within 5 miles of 90% of beneficiaries Rural areas: network pharmacy within 15 miles of 70% of beneficiaries Rural areas: network pharmacy within 15 miles of 70% of beneficiaries Covered Drugs

43. 10/28/05 43Medicare Prescription Drug Coverage Count toward TRICARE standards: Count toward TRICARE standards: Community pharmacies Community pharmacies Indian Tribe/Tribal Organization/Urban Indian Organization (I/T/U) pharmacies Indian Tribe/Tribal Organization/Urban Indian Organization (I/T/U) pharmacies Federally Qualified Health Center pharmacies Federally Qualified Health Center pharmacies Rural Health Center Rural Health Center Community Pharmacy Access Standards Does not count Does not count Mail-service pharmacies Mail-service pharmacies Covered Drugs

44. 10/28/05 44Medicare Prescription Drug Coverage Session Topics Overview Overview Eligibility and enrollment Eligibility and enrollment Extra help Extra help Out-of-pocket threshold Out-of-pocket threshold Medicare prescription drug coverage Medicare prescription drug coverage Medicare prescription drug plan finder web tool Medicare prescription drug plan finder web tool Partnering with CMS Partnering with CMS

45. 10/28/05 45Medicare Prescription Drug Coverage Medicare Prescription Drug Plan Finder Web Tool Makes it easy to find & compare Medicare drug plans Makes it easy to find & compare Medicare drug plans www.medicare.gov www.medicare.gov www.medicare.gov To use, a person needs: To use, a person needs: Medicare card Medicare card List of prescription drugs List of prescription drugs Key factors to consider: Key factors to consider: Cost Cost Coverage Coverage Convenience Convenience

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57. 10/28/05 57Medicare Prescription Drug Coverage Session Topics Overview Overview Eligibility and enrollment Eligibility and enrollment Extra help Extra help Out-of-pocket threshold Out-of-pocket threshold Medicare prescription drug coverage Medicare prescription drug coverage Medicare prescription drug plan finder web tool Medicare prescription drug plan finder web tool Partnering with CMS Partnering with CMS

58. 10/28/05 58Medicare Prescription Drug Coverage Partnering with CMS Education is key Education is key We need your help to reach beneficiaries We need your help to reach beneficiaries CMS Partner Center http://www.cms.hhs.gov/partnerships/ CMS Partner Center http://www.cms.hhs.gov/partnerships/ Key messages Key messages Outreach toolkit Outreach toolkit Fact sheets and timelines Fact sheets and timelines Presentations, handouts, scripts, and more Presentations, handouts, scripts, and more SocialSecurity.gov for information about extra help SocialSecurity.gov for information about extra help Partnering with CMS

59. 10/28/05 59Medicare Prescription Drug Coverage CMS Marketing Guidance: Providers CAN… Provide names of plans with which they participate Provide names of plans with which they participate Provide objective information on specific plans Provide objective information on specific plans Distribute PDP marketing materials, including enrollment applications* Distribute PDP marketing materials, including enrollment applications* Distribute MA and/or MA-PD marketing materials, excluding enrollment applications Distribute MA and/or MA-PD marketing materials, excluding enrollment applications Provide information and assistance in applying for the low- income subsidy Provide information and assistance in applying for the low- income subsidy Refer patients to other sources of information Refer patients to other sources of information Print out and share information with patients from CMS web site Print out and share information with patients from CMS web site Use comparative marketing materials created by a non- benefit/service providing third- party Use comparative marketing materials created by a non- benefit/service providing third- party Partnering with CMS

60. 10/28/05 60Medicare Prescription Drug Coverage CMS Marketing Guidelines: Providers CANNOT… Direct, urge, or attempt to persuade any prospective enrollee or to insure with a particular company based on financial or any other interest of the provider (or subcontractor) Direct, urge, or attempt to persuade any prospective enrollee or to insure with a particular company based on financial or any other interest of the provider (or subcontractor) Collect enrollment applications Collect enrollment applications Offer inducements to persuade beneficiaries to enroll in a particular plan or organization Offer inducements to persuade beneficiaries to enroll in a particular plan or organization Health screen when distributing information to patients Health screen when distributing information to patients Offer anything of value to induce Plan enrollees to select them as a provider Offer anything of value to induce Plan enrollees to select them as a provider Expect compensation for enrollment of a beneficiary Expect compensation for enrollment of a beneficiary Expect compensation directly or indirectly from the Plan for beneficiary enrollment activities Expect compensation directly or indirectly from the Plan for beneficiary enrollment activities Partnering with CMS

61. 10/28/05 61Medicare Prescription Drug Coverage CMS Marketing Guidelines: Common Areas Common Areas: Hospital or nursing home cafeterias Hospital or nursing home cafeterias Community or recreational rooms Community or recreational rooms Conference rooms Conference rooms AWAY from the pharmacy counter, where patients wait for services or interact with pharmacy providers and obtain medications AWAY from the pharmacy counter, where patients wait for services or interact with pharmacy providers and obtain medications NOT Common Areas: Areas where patients primarily intend to receive health care services Areas where patients primarily intend to receive health care services Waiting rooms Waiting rooms Exam rooms Exam rooms Hospital patient rooms Hospital patient rooms Pharmacy counter areas where patients wait for services or interact with pharmacy providers and obtain medication Pharmacy counter areas where patients wait for services or interact with pharmacy providers and obtain medication Partnering with CMS

62. 10/28/05 62Medicare Prescription Drug Coverage For More Information Visit www.medicare.gov Visit www.medicare.gov Visit www.cms.hhs.gov Visit www.cms.hhs.gov Publications such as: Publications such as: Medicare & You 2006 handbook Medicare & You 2006 handbook Facts About Medicare Prescription Drug Plans Facts About Medicare Prescription Drug Plans 1-800-MEDICARE 1-800-MEDICARE

63. 10/28/05 63Medicare Prescription Drug Coverage Patrick Hamilton, Rural Health Coordinator: patrick.hamilton@cms.hhs.gov 215-861-4097