Choosing a Medicare Prescription Drug Plan
December 2, 2005
Session Objectives
Discuss… Auto-enrollment
Which plan are you enrolled in? What plans are available? How to change plans?
Comparing plans
Online Tools Scorecards
Joining/changing drug plans
Auto-Enrollment
Medicare will auto-enroll dual eligibles… Find out which plan
Auto-enrollment notice Visit medicare.gov Call 1-800-MEDICARE (1-800-633-4227) Visit your pharmacist
Do people who have been auto-enrolled need to do anything?
Auto-Enrollment
Medicare will auto-enroll dual eligibles… Available Plans 43 PDPs 6 with $0 Premium for LIS 37 with supplemental benefits (+out-ofpocket costs for premiums) 28 MA-PD Organizations (>1,000 plan variations) Change Plans Select your new plan
Comparing Plans
Things to Consider
Coverage Cost Convenience
Online Tools/ Scorecards
http://plancompare.gov Florida Medicaid/Gold Standard “Scorecards”
Joining or Changing Drug Plans
By paper application – through the plan On the plan’s website By phone Medicare website
PDP Choices
$0 Premium for LIS
Plan Name
AARP MedicareRx Plan AmeriHealth Advantage Rx Option 1
Organization Name
United Healthcare QCC/d/b/a AmeriHealth Advantage Rx
Humana PDL Standard S5884-069 Humana Inc Medicare Rx Rewards Unicare
PacifiCare Saver Plan
WellCare Signature
Pacificare Life and Health Insurance Company
Wellcare
The Medicare Modernization Act
Cost to Full Benefit Duals
Dual Eligible Benefits
Component Premium Deductible Copayment Initial coverage ends and “gap” or“doughnut hole” starts 2006 Low Income Benefit (Full Dual) Income < 100% FPL None None $1/generic $3/brand No gap in coverage $2/generic $5/brand No gap in coverage Income > 100% FPL None None
Coverage gap—when you have no coverage
Catastrophic coverage
No gap in coverage
After your total 2006 drug expenses (what you paid plus what Medicare paid) reach $5,100 in drug, your drugs are free for the rest of the year
No gap in coverage
After your total 2006 drug expenses (what you paid plus what Medicare paid) reach $5,100 in drug, your drugs are free for the rest of the year
Important Dates
October 2005
CMS releases:
November 30, 2005
Medicare & You 2006 Handbook Plan Information Auto-assignment information FL DCF sends MEDS-AD Waiver notices FL Medicaid sends Adverse Action notices to full duals
Silver Saver program stops new enrollment FL DCF sends program termination notices to MEDS-AD
December 1, 2005
November 1, 2005
December 8, 2005
FL Medicaid begins mailing “Scorecards” to full Duals and Silver Savers
MEDS-AD program terminates Silver Saver program terminates Dual Eligibles no longer have prescription coverage with Medicaid.
November 7, 2005
December 31, 2005
FL Medicaid sends Silver Savers program termination notices
November 15, 2005
Part D Open Enrollment period begins
January 1, 2006 PART D COVERAGE BEGINS
Resources (Web links)
CMS - State Resources CMS - Formulary Finder
http://www.cms.hhs.gov/medicarereform/states/stateresrcs.asp http://plancompare.medicare.gov/formularyfinder/selectstate.asp
CMS - Access-to-Benefits
SSA - Application Information FamiliesUSA - Cost Calculator FamiliesUSA - Regulations Analysis
http://www.accesstobenefits.org/
http://www.ssa.gov/organizations/medicareoutreach2/
http://www.familiesusa.org/issues/medicare/rx-drugs/medicare-calculator.html http://www.familiesusa.org/issues/medicare/MMA-Regulations-Analysis.html