Medicare Part D Prescription Drug Benefit Introducing Blue MedicareRxSM

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Medicare Part D Prescription Drug Benefit Introducing Blue MedicareRxSM

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Anthem Insurance Companies, Inc (AICI), Blue Cross and Blue Shield of ... you qualify for extra help with your Medicare Prescription Drug Plan costs, your ... – PowerPoint PPT presentation

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Title: Medicare Part D Prescription Drug Benefit Introducing Blue MedicareRxSM

1
Medicare Part DPrescription Drug
BenefitIntroducing Blue MedicareRxSM!
Connecticut
In Connecticut, Anthem Blue Cross and Blue Shield
is the trade name of Anthem Health Plans, Inc. In
New Hampshire, Anthem Blue Cross and Blue Shield
is the trade name of Anthem Health Plans of New
Hampshire, Inc. In Maine, Anthem Blue Cross and
Blue Shield is the trade name of Anthem Health
Plans of Maine, Inc. Independent licensees of the
Blue Cross and Blue Shield Association.
Registered marks of the Blue Cross and Blue
Shield Association.
S2893_042_CT 11/2005
2
Agenda

Overview
Eligibility
Plan Options
Enrollment
Questions

2
3
What Is Medicare Part D?

Drug coverage that helps you pay for the
prescriptions you need
Starts January 1, 2006
Available to all people with Medicare Part A
and/or enrolled in Part B
Enrollees must reside in the service area
Connecticut

3
4
Eligibility

You must continue to pay your Medicare Part B
premium if not otherwise paid for under Medicaid
or by another third-party.
Can be enrolled in only one Prescription Drug
Plan at a time
Cannot have drug coverage under both a Medicare
Supplemental plan and Prescription Drug Plan
Cannot be enrolled in a Medicare Advantage Plan,
unless a member of a Private Fee For Service or
Medicare Savings Account Plan
Cannot be enrolled in a Medicare Advantage
Prescription Drug Plan
Cannot enroll in this plan if your current or
former employer helps pay for your drugs.

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5
Why Join a Part D Plan?

Medical practice relies on new drug therapies to
treat chronic conditions
Out-of-pocket spending on drugs has increased
Most people need or will need prescription drugs
to stay healthy
Medicare insurance coverage for prescription
drugs will protect from high out-of-pocket costs
For most people, joining when first eligible
means paying the lowest monthly premiums

5
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3 Ways To Get Part D Coverage

1.Prescription drug plans (PDPs)
Blue MedicareRxSM
2. Medicare Advantage Plans (MA-PDs )
3. Retiree plans -
Employers, Unions, Veterans Administration
Anthem Insurance Companies, Inc (AICI), Blue
Cross and Blue Shield of Massachusetts, Blue
Cross and Blue Shield of Vermont, and Blue Cross
and Blue Shield of Rhode Island are the legal
entities who have contracted with the Centers for
Medicare and Medicaid Services (CMS) to offer the
Part D plan (s) noted and are the risk-bearing
entities for the Blue Medicare Rx plans.

6
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Initial Enrollment Period

November 15, 2005 May 15, 2006
Enroll between November 15, 2005, and December
31, 2005
Coverage will begin on January 1, 2006
Enroll between January 1, 2006, and May 15, 2006
Coverage will begin the first day of the month
after the month joined

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Ongoing Enrollment

Annual Election Period
November 15 to December 31 of each year
Special Election Periods
Permanent move out of the plan service area
Individual entering, residing in, or leaving a
long-term care facility
Involuntary loss, reduction, or non-notification
of creditable coverage
Other exceptional circumstances

8
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Enrollment Process

After Initial Enrollment Period, enrollment
occurs only at certain times of the year
with coverage effective the 1st of the month
following enrollment
You will receive
Confirmation letter
Member materials
ID Card

9
10
Cost of Postponing Enrollment

Higher premiums for people who wait to enroll
Assessed 1 of base premium for every month
Applies to those eligible to enroll in a Medicare
prescription drug plan but not enrolled
Applies to those whose drug coverage is not as
good as a Medicare prescription drug coverage
for 63 consecutive days or longer
Exception for those with coverage at least as
good as a Medicare prescription drug plan

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Extra Help for Those Who Need it Most

Beneficiaries with low incomes may qualify for a
waiver or reduction of premiums, deductibles or
copayments
To qualify
Annual income less than 14,355 (single)
Annual income less than 19,245 (married)
AND
Limited assets
Some people will automatically qualify
Others will get an application from Social
Security
Certification required annually

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Limited Income Subsidy Premium

If you qualify for extra help with your Medicare
Prescription Drug Plan costs, your premium and
drug costs will be lower. When you join Blue
MedicareRx, Medicare will tell us how much extra
help you are getting. Then, we will let you know
the amount you will pay. If you arent getting
any extra help, you can see if you qualify by
calling
1-800-MEDICARE (1-800-633-4227). TTY/TDD users
should call 1-877-486-2048, or
your State Medicaid Office, or
the Social Security Administration at
1-800-772-1213 between 7 a.m. and 7 p.m, Monday
through Friday. TTY/TDD users should call
1-800-325-0778.

12
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For Information on Assistance

Beneficiaries interested in qualifying for extra
help with Medicare Prescription Drug Plan costs
should call
1-800-MEDICARE (1-800-633-4227). TTY/TDD users
should call 1-877-486-2048, 24 hours a day/7days
a week), or
Your State Medicaid Office, or
the Social Security Administration at
1-800-772-1213 between 7 a.m. and 7 p.m., Monday
through Friday. TTY/TDD users should call,
1-800-325-0778.

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Standard Medicare Part D Benefit

Standard Drug Benefit Highlights
250 deductible(Does not include medical)
Medicare will pay 75 of drug costs up to 2,250
Enrollee pays 100 of drug costs between 2,250
and 5,100 (Called a Coverage Gap)
After 3,600 in TrueOut-Of-Pocket (TrOOP)
spending, Medicare will pay approximately 95

5 Co-ins(min. 2/5)
Medicare Benefit(95)
5,100
Coverage Gap
3,600 out-of-pocket reached
2,250
Medicare Benefit(75 of 2,000)
25 Co-ins(500)
250
250 Deductible
14
15
Blue MedicareRxSM

Choice, Strength, Service, Value
Range of options prices
Wide choice of covered prescription drugs on
formulary
Brand/generic drug coverage available
No deductibles -1st dollar coverage
National pharmacy network
Dedicated service team

15
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Blue MedicareRXSM Plan Options
30 day supply/prescription
16
17
Blue Medicare RxSM Plan Copays
30-day supply from retail pharmacy
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Formulary

All covered drugs are on our formulary, or drug
list, unless otherwise noted.
You have the right to request an exception,
called an appeal.

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Pharmacy Network

A broad retail pharmacy network
Major store chains and local independents
90-day supply available at certain retail
pharmacies for 3x copays
Mail-order available
90 day supply for 21/2 copays
Must use network pharmacies, except in emergency
situations or when access to a network pharmacy
is unavailable
For more information on obtaining mail order
drugs, or for names and addresses of a Plans
network pharmacies, contact Customer Service
toll-free at (866) 755- 2776, M-F 8 AM-6 PM
(TTY/TDD (866) 798-7026)