Medicare Part D What You Need to Know for

Medicare Part D What You Need to Know for 2008 Partners in D University of California - San Francisco School of Pharmacy, Skaggs School of Pharmacy & Pharmaceutical Sciences, Asian Pacific Health Center Goals for Today  Describe the basic Medicare Prescription Drug Benefit under Medicare Part D  Remember important dates  Determine if you are eligible for extra help to pay for the costs of your drugs What Is Medicare?  Medicare is available to: – 65 and older – Permanently disabled  Medicare has 4 parts – A: Hospital coverage – B: Medical coverage (doctor visits) – C: Medicare Advantage Plans (A and B coverage and often D) – D: Prescription Drug Coverage What is Medicare Part C?  Medicare Advantage Plans or Medicare health plans  Plans that cover your hospital stay, doctor visits and your prescriptions all in one  These plans are private health insurance plans that partner with Medicare What is Medicare Part D?  New Prescription Drug Benefit from Medicare  Started January 1, 2006  Offers brand and generic drug coverage  Voluntary, you must choose to enroll Why is This Important to Me?  Each Drug plan covers different medicines  Part D does not cover everything  There are gaps in coverage  The plans change every year  You must look at your plan every year to decide if you are in the correct one What Do Medicare Prescription Drug Plans Cover?  Prescription drugs, some injectable medicines and insulin  Might not cover all drugs  Brand name and generic drugs must be covered What Drugs Are Not Covered* ?  Drugs for – Weight loss or weight gain – Cosmetic purposes or hair growth – Relief of cough and colds     Prescription vitamins and mineral products Over-the-Counter Medicines Barbiturates Benzodiazepines * These drugs might still be covered for Medi-Cal patients What will Medicare Part D Cost Me?  Most people will pay: – A monthly premium – A portion of their drug costs – A deductible • Not all plans have this  You will pay less if you have – Medi-Cal – A low-income subsidy (LICS) What are My Choices in California?  There are 56 Medicare Part D plans in California. – These can be added to original Medicare A and B  There are 24 Medicare Advantage Plans – Sometimes called Medicare Health Plans or Medicare Part C plans  These choices can be CONFUSING – We are here to help! How are the Part D Plans Different?  Each Medicare Part D plan and each Medicare Health Plan can have its own: – – – – – List of covered drugs Amount you pay for drugs Monthly premium Deductible Rules about what they pay for while in the coverage gap – Authorization process for restricted drugs Is There a Penalty if I do not Join Part D?  You only pay a penalty if you do not enroll when eligible  No penalty for those that qualify for the Low Income Subsidy or Medi-Cal patients  No penalty for those with coverage equivalent to Medicare through the following: • VA or TRICARE • Employer benefit or Union When Do I Enroll or Change Part D Plans?  Those just turning 65 can enroll:  Everyone can change annually: – Between November 15-December 31 – Coverage begins on January 1 of the next year  Those with the Low Income Subsidy and Medi-Cal and Medicare: – Can change monthly If I have Limited Income, What Help is Available to Me?  Extra help is available for those with limited income and resources  If you qualify, this help will decrease your drug costs, and your monthly and annual payments  Some people will automatically qualify  Others must apply through Social Security If You Meet Both the Income and Resource Requirements…  Do you get extra help paying for your prescription drugs?  If you do not get extra help… We can help you apply today What if I Have Medicare and Medi-Cal?  You will receive your medicine coverage from Medicare Part D  Your drug costs are less than those with only Medicare  Medi-Cal will continue to cover Medicare excluded drugs  You should present BOTH Medicare prescription and Medi-Cal cards to the pharmacy Plan Options for Those with Medicare and Medi-Cal:  You were likely assigned to a plan – You may be re-assigned if that plan changes at the end of the year  You may choose a different Part D plan every month – But, choose one of the 9 Part D plans that is approved for a dual eligible, • otherwise you might pay a monthly premium Confused? Partners in D are Here to Help One-on-One Counseling with Your Partner in D: What You Will Need 1. 2. 3. 4. 5. Your Medicare number (on your Medicare card) The date you first enrolled (on your card) Your zip code Your medication list  Write out the names or get a printout from your pharmacy The name and location of your pharmacy