Medicare Prescription Drug Finder Over the Counter by MikeJenny

VIEWS: 3 PAGES: 85

More Info
									  Medicare Prescription
       Drug Plans

What Do You Need To Know?
           Medicare Basics
• Part A
  – Hospital Insurance
• Part B
  – Medical Insurance (doctor visits)
• Part C
  – Medicare Advantage
• Part D
  – NEW Prescription Drug Benefit
  Eligibility and Enrollment
• Entitled to Part A and/or enrolled in
 Part B

• Must reside in the plan’s service area
• Program voluntary (for most)
• Must enroll with the drug plan
• Monthly fees apply (for most)
  Prescription Drug Benefit
• Available to everyone with Medicare
• Medicare contracts with private
  companies
• Benefits begin as early as January
  2006
• Financial aid is available through the
  Social Security Administration
   – Income and resource limits apply
   Example of Standard
Prescription Drug Coverage
• Estimated $32 monthly premium
• $250 deductible
• Co-insurance of 25% of drug costs
 from $250 to $2,250 (total drug
 spending)
   Example of Standard
Prescription Drug Coverage
• Coverage gap from $2,250 to $5,100
  – Beneficiary pays 100% of drug
    costs
• Catastrophic coverage after $5,100
 ($3,600 in out-of-pocket costs)
  – Beneficiary pays only 5% of drug
    costs
       Five Main Groups

• No Prescription Drug Coverage
  – Consider the current costs of your
    medications

  – Do you qualify for extra help?
       Five Main Groups
• Employer/union coverage (including
 VA, TRICARE, and FEHB)

  – Is your current coverage as good
    as the standard Medicare
    prescription coverage?

  – Contact your plan administrator
       Five Main Groups
• Medicare and Medicaid
  – Auto-enrolled unless plan chosen
    before January 1, 2006
  – Automatically qualify for the extra
    help
  – Do not need to complete the
    application for extra help
           Five Groups
• Medicare Advantage Plan or other
 Medicare Health Plan

  – Provide medical and drug
    coverage

  – Similar to HMO or PPO, required to
    use doctors in plan
           Five Groups
• Medigap Policy with Prescription
 Drug Coverage
  – In general, the Medicare
    prescription drug coverage will
    offer savings
  – If you join a Medicare drug plan,
    contact your Medigap insurer
           Need Help?
• Call 1-800-MEDICARE
      (1-800-633-4227)
• Visit www.medicare.gov
• For extra help:
 - Social Security Administration
 - 1-800-772-1213
 - www.socialsecurity.gov
 - 1-800-AGELINE (1-800-243-5463)
            Resources
• For enrollment:
   – 1-800-MEDICARE (1-800-633-4227)
   – www.medicare.gov
• For extra help:
   – Social Security Administration
   – 1-800-772-1213
   – www.socialsecurity.gov
• 1-800-AGELINE (1-800-243-5463)
           Resources

• Alabama Medicaid Agency
    www.medicaid.state.al.us
  This presentation made
possible by support from the
    American Pharmacy
     Cooperative, Inc.
Enrolling in Medicare Part D
   Initial Enrollment Period
• If you have Medicare and Medicaid,
 choose a drug plan before January 1,
 2006
• If you fall in one of the other four
 groups you have until May 15, 2006,
 to enroll
  Initial Enrollment Period
• Penalty of 1% per month added to
 monthly fee if
  – Enrollment is delayed and
  – Beneficiary is without “creditable
    coverage”
 You Have Responsibilities
• Decide if you should participate
• Apply for extra help with Social
  Security
• Choose a plan that best meets your
  needs
• Enroll in a Prescription Drug Plan
• Change plans, if necessary
• Pay your premiums, co-pays and
  deductibles
   Applying for Extra Help
• For those with limited income and
 resources
  – Contact Social Security at
   1-800-772-1213
    Applying for Medicare
      Savings Program
• For those with limited income
  – Contact Medicaid at
    1-800-362-1504
         What You Need
        To Do To Prepare
• You have time. Sign up ends May 15,
  2006. Choose wisely.
• Find out if you qualify for extra help
  from Social Security.
• Think of the three “C’s”
   – Cost
   – Coverage
   – Convenience
                Cost
• What do you currently pay for your
  medications?
  – True out-of-pocket costs
• How much do you want to pay?
  – Deductible?
  – Co-pay?
  – Premium?
  – Medication costs?
             Coverage
• Make a list of the drugs you currently
 take
  – Name of the medicine
  – Dosage
  – How often you take it
  – Cost (not just your co-pay)
          Convenience
• Write down the names of the
 pharmacies you use.

• Find out what plans they accept.
• Do you want to use a mail order
 pharmacy?

• How much do you travel?
    Protect Your Personal
         Information
• Don’t pay cash, write a check
• Only plans that are approved by
 Medicare can offer a Medicare
 prescription drug plan

• Social Security is making follow-up
 calls to people
    Protect Your Personal
         Information
• You do not HAVE to join or else lose
 benefits

• Cannot enroll over the phone, only
 promote the plan

• Keep your personal information safe!
    Protect Your Personal
         Information
• Don’t give your personal information
 out
 – Never give your bank account,
   credit card or social security
   number out over the phone
 – Never pay cash or send enrollment
   payments over the internet
 – Persons working with Medicare will
   never show up uninvited at your
   home
           Need Help?
• Call 1-800-MEDICARE
      (1-800-633-4227)
• Visit www.medicare.gov
• For extra help:
 - Social Security Administration
 - 1-800-772-1213
 - www.socialsecurity.gov
 - 1-800-AGELINE (1-800-243-5463)
            Resources
• For enrollment:
   – 1-800-MEDICARE (1-800-633-4227)
   – www.medicare.gov
• For extra help:
   – Social Security Administration
   – 1-800-772-1213
   – www.socialsecurity.gov
• 1-800-AGELINE (1-800-243-5463)
           Resources

• Alabama Medicaid Agency
    www.medicaid.state.al.us
  This presentation made
possible by support from the
    American Pharmacy
     Cooperative, Inc.
 Special Information
 For People Now On
Medicaid and Medicare
    What Will be Different
       Under Part D
• Full Dual Eligibles
  – Previously had drug coverage
    under Medicaid
  – Medicaid drug coverage ends
    12/31/05
  – Auto-assigned to a Part D plan
  – Can change plans monthly
  – Automatically qualify for extra help
What Drugs are not Covered
and How Medicaid Will Help
• Full Dual Eligibles
  – Will continue to receive coverage
    for certain excluded drugs by
    Medicaid
  – Still subject to Medicaid approval
    (PA) or other requirements
      Part D Excluded Drugs
       Covered by Medicaid
•   Over-the-counter drugs
•   Cough and Cold medicines
•   Most vitamin and mineral products
•   Drugs for weight gain or loss
•   Barbituates
•   Benzodiazpines
      The Auto-Assignment
            Process
•   How assignments made
•   Recent changes
•   Changing plans
•   What to do if you have other
    insurance for your medicine now
    Medicare Savings Program
•   QMB, SLMB, Q1 recipients
•   Can choose to participate
•   Participants must choose a plan
•   Auto-assigned to a Part D plan
•   Automatically qualify for extra help
           Need Help?
• Call 1-800-MEDICARE
      (1-800-633-4227)
• Visit www.medicare.gov
• For extra help:
 - Social Security Administration
 - 1-800-772-1213
 - www.socialsecurity.gov
 - 1-800-AGELINE (1-800-243-5463)
            Resources
• For enrollment:
   – 1-800-MEDICARE (1-800-633-4227)
   – www.medicare.gov
• For extra help:
   – Social Security Administration
   – 1-800-772-1213
   – www.socialsecurity.gov
• 1-800-AGELINE (1-800-243-5463)
           Resources

• Alabama Medicaid Agency
    www.medicaid.state.al.us
  This presentation made
possible by support from the
    American Pharmacy
     Cooperative, Inc.
 Special Information
          for
Health Care Providers
Identifying Recipients with a
         Part D Plan
• Yellow recipient letter
• Medicare Pharmacy Line
  – 1-866-835-7595
• E1 eligibility transaction to the
 TrOOP facilitator
          Dual Eligibles:
      If Not Auto Enrolled
• Point of Sale Facilitated Enrollment
• CMS Contractor (WellPointe)
• Pharmacist to bill special account
 that will engage in a series of steps
• CMS website has instructional video
 on this process
    Identifying PDPs for
   Nursing Home Patients
• Procedure for up to 100 recipients
• Procedure for over 100 recipients
• Questions about these procedures,
 contact:
    Michele Ramirez 215-861-4159
    Identifying PDPs for
   Nursing Home Patients
• Fax number:
    1-785-830-2593
• Mailing information:
    Medicare Nursing Home Requests
    3383 Greenway Drive
    Lawrence, KS 66046-5504
    785-838-2107 (delivery only)
     Options for Full Dual
          Eligibles
• One time fill
• Switch to a therapeutic equivalent
 drug
• Appeals process
• Change PDP
What Drugs are not Covered
and How Medicaid Will Help?
• Full Dual Eligibles
  – Will continue to receive coverage
    for certain excluded drugs by
    Medicaid
  – Still subject to Medicaid approval
    (PA) or other requirements
      Part D Excluded Drugs
       Covered by Medicaid
•   Over-the-counter drugs
•   Cough and Cold medicines
•   Most vitamin and mineral products
•   Drugs for weight gain or loss
•   Barbituates
•   Benzodiazpines
       Information on PDPs

•   CMS website: www.medicare.gov
•   Medicare 1-800-633-4227
•   Medicare and You 2006 Handbook
•   Alabama Medicaid website:
    www.medicaid.state.al.us
           Need Help?
• Call 1-800-MEDICARE
      (1-800-633-4227)
• Visit www.medicare.gov
• For extra help:
 - Social Security Administration
 - 1-800-772-1213
 - www.socialsecurity.gov
 - 1-800-AGELINE (1-800-243-5463)
            Resources
• For enrollment:
   – 1-800-MEDICARE (1-800-633-4227)
   – www.medicare.gov
• For extra help:
   – Social Security Administration
   – 1-800-772-1213
   – www.socialsecurity.gov
• 1-800-AGELINE (1-800-243-5463)
           Resources

• Alabama Medicaid Agency
    www.medicaid.state.al.us
  This presentation made
possible by support from the
    American Pharmacy
     Cooperative, Inc.
Using the Medicare Website
   to Find a Prescription
         Drug Plan
www.medicare.gov
           Need Help?
• Call 1-800-MEDICARE
      (1-800-633-4227)
• Visit www.medicare.gov
• For extra help:
 - Social Security Administration
 - 1-800-772-1213
 - www.socialsecurity.gov
 - 1-800-AGELINE (1-800-243-5463)
            Resources
• For enrollment:
   – 1-800-MEDICARE (1-800-633-4227)
   – www.medicare.gov
• For extra help:
   – Social Security Administration
   – 1-800-772-1213
   – www.socialsecurity.gov
• 1-800-AGELINE (1-800-243-5463)
           Resources

• Alabama Medicaid Agency
    www.medicaid.state.al.us
  This presentation made
possible by support from the
    American Pharmacy
     Cooperative, Inc.

								
To top