MEDICARE PART D

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MEDICARE PART D

• Are We Ready?

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Medicare Part D Overview

• Medicare Part A and B covers individuals
• Age 65 and older
• Those with a disability who have collected
  Social Security for a minimum of 2 years
• Those with kidney failure or who need a kidney
  transplant
•  
• 42 Million Medicare beneficiaries growing

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Medicare Part D Overview

• On 1/1/06, Medicare Part D the largest
  Medicare reform in 40 years began
• Medicare Part D is a voluntary Insurance
  program for prescription drugs through Medicare
  prescription drug plans and other health plan
  options.
• Insurance companies and other private companies
  will work with Medicare to provide a choice of
  plans that cover both brand name and generic
  drugs. 

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Medicare Part D Overview

•   Part D Drug Coverage
• Includes prescription drugs, biological
  products, certain vaccines, insulin, and diabetic
  medical supplies  
• Excludes, among other categories, OTC drugs,
  barbiturates, benzodiazepines, weight loss or
  weight gain meds, meds for relief of cough, and
  any drug covered by Medicare Part A or B

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Medicare Part D Overview

• Part d is a voluntary program except for low
  income dual-eligible formerly on Medicaid
• Medicare eligible persons may remain on their
  current
• employer sponsored retiree Rx plans,
  participate in a
• MA-PD plan or PDP plan, be auto-enrolled
  in a dual-
• eligible plan, or not participate in any
  plan.
• Beginning 1/1/06, the current Medicaid Rx
  coverage for dual-eligible will change to
  federally managed Medicare Part D Rx

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Medicare Part D Overview

• Dual-Eligibles  (Medicare and Medicaid)
• Dual-eligibles (eligible for Medicare and
  Medicaid) are covered. An estimated 60 of
  Medicaid prescriptions come from persons that are
  also eligible for Medicare
• - At or below 135 of poverty level 
• Will be randomly auto-enrolled into one of the
  national plans that meets the benchmark pricing
  within a given area
• - Plan may not meet their particular medication
  needs
• - Over 6 million dual eligibles have already been
  randomly auto-enrolled into a Part D plan
• Medicaid prescription coverage will end
  beginning January 1, 2006 unless the drug is in a
  non-covered drug category

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Medicare Part D Overview

• Dual-Eligible (Medicare and Medicaid)
• No monthly premiums
• No deductible
• Low or no co-payments (may be higher than current
  Medicaid program)
• Possible differences in drug coverage and
  co-payments than current Medicaid plan
• Wrap around state public assistance programs
  (SPAPs) benefits or state Medicaid may apply to
  non-covered categories
• Can switch plans monthly into another available
  Part D plan - during the first year

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Medicare Part D Overview

•   Non-Dual eligible (Medicare Only)
• Voluntary enrollment Nov 15, 2005 thru May 15,
  2006 (1 per month premium penalty for
  enrollment after 5/15/06)
• Non-dual eligible must take action to enroll
  many choices between available Part D plans and
  plan designs
• Some low income will qualify for extra
  assistance
•  

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Medicare Part D Overview

•   Non-Dual eligible (Medicare Only)
• Monthly premiums
• Deductible
• Co-payments
• Can only switch plans once a year into another
  available Part D plan
•  

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Medicare Part D Overview

• Ability to Change Plans  
• Non-dual-eligibles will have the opportunity to
  change between plans only once a year.
• Dual-eligibles will have the opportunity to
  change between plans once a month, starting in
  November 2005.  

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Medicare Part D Overview

•  Standard Benefit
• Monthly premiums from participants will be paid
  for most plans
• - (Average premium is around 32.30 per month)
• 250 beneficiary deductible
• For non-dual eligibles, Medicare will pay 75
  of
• drug costs up to 2,250. The beneficiary will
  pay
• 25 of these costs
• Beneficiary will pay 100 of drug costs between
• 2,250 and 5,100
• After 3,600 in out-of-pocket spending,
  Medicare
• will pay approximately 95

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Medicare Part D Overview
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Medicare Part D Overview
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Medicare Part D Overview Standard Benefit (dual
eligibles non-dual eligibles co-payments)
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Medicare Part D

•  
• Beneficiary Enrollment

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Medicare Part DGeneral Enrollment

• Medicare Part D is an insurance product
• Pharmacists and pharmacy staff members may not
  enroll
• participants in any plan but may offer
  information and advice to
• participants
• In pharmacies choosing to endorse a particular
  plan, there might
• be opportunities for insurance brokers to
  enroll participants within
• their pharmacies or clinics.
• Endorsement also requires agreement to promote
  the plan,
• provide enrollment information, explain the
  benefits of enrollment,
• describe the rules that apply to enrollees,
  explain how services
• are covered, communicate with individuals on
  operational policies,
• rules and procedures, provide marketing and
  informational
• materials to participants

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Medicare Part DGeneral Enrollment

• Voluntary enrollment
• Non-dual eligibles will have an opportunity to
  enroll in one of a number of PDP or MA-PD
  Medicare Part D plans in their area beginning
  November 15, 2006  
• Non-dual eligibles have financial penalties (1
  per month after May 15, 2005) for late enrollment
  
• Non-dual eligible participants are only able to
  change from the plan in which they participate,
  once a year
• Must consider the plans formulary coverage of
  the medications they are taking, the deductible,
  the co-payment structure, and the monthly premium
  before selecting a plan in their area.

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Medicare Part DAuto-Enrollment

• Limited to only the dual-eligibles  
• Randomly assigned to selected prescription plans
  within their local areas
• Plans selected to participate in auto-enrollment
  process were at or less than benchmark in the
  Medicare Part D bid process
• May change plans monthly http//www.medicare.gov
  or http//www.id-health.com
• Plan coverage begins January 1, 2006

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Medicare Part DPrescription Drug Plans (PDP)

• There are 10 approved nationwide PDPs
• Aetna Life Insurance Company
• Connecticut General Life Insurance Company
• Coventry Health Life Insurance/First Health
  Life Health Insurance/ Cambridge Life Insurance
  
• Medco Containment Life Insurance Company
• MemberHealth, Inc
• Pacificare Life and Health Insurance Company
• Silverscript Insurance Company
• Wellpoint
• United Health Care Insurance Company
• Wellcare Health Plans

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Medicare Part D

• There are hundreds of regional, state, and county
  PDP and MA-PD plans in addition to thousands of
  employer sponsored equivalent plans
• - A list of the regional PDP and
  MA-PD plans designated to
• receive auto-enrollees within
  each state is available on the
• on the http//www.tachc.org web
  site.

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Medicare Part D

• So some of the questions are
• What if I dont take any prescription drugs?
• How do I chose a Medicare Part D plan that meets
  my
• needs?
• How do I enroll?
• What happens to my Medicare-approved drug
  discount
• card when I enroll and can I still use any
  credits left on the
• card?

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Medicare Part D

• What if I dont take any prescription drugs?
• Even if you dont use any or a lot of
  prescription drugs
• now, you should still consider joining a
  Medicare
• prescription drug plan. As we age, most people
  need
• prescription drugs to stay healthy. For most
  people,
• joining as soon as possible means you will pay
  the lowest
• monthly premium.

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Medicare Part D

• How do I chose a Medicare Part D plan that meets
  my needs?
• This is not an easy question to answer, because
  it involves
• determining the plans available, what medications
  their
• plans have on the formulary, costs, what pharmacy
• contracts with them, etc.
• Later we will look at a website
  http//www.MyMedicareMatters and
• show you how to select a plan.

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Medicare Part D

• How do I enroll?
• Paper applications through the drug plan
• On the Plans web site
• http//www.medicare.gov
• 1-800-MEDICARE (1-800-633-4227) TTY
  1-800-486-2048

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Medicare Part D

• What happens to my Medicare-approved drug
• discount card when I enroll and can I still use
• any credits left on the card?
• You can use your Medicare-approved drug discount
  card
• until May 15, 2006 or until you join a Medicare
  Prescription
• Drug Plan, whichever is first.

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Medicare Part D

• For Additional Details and Information on
  Medicare, please refer to the following web
  sites
• Centers for Medicare and Medicaid (CMS) website
  http//www.cms.hhs.gov OR http//www.cms.gov
• Official US Government Medicare website
  http//www.medicare.gov
• NACDS website http//www.nacds.org/wmspage.cfm?pa
  rm13899
• Kaiser foundation website on Medicare
  http//www.kff.org/medicare/index.cfm
• US Department of Health and Human Services
  website http//www.dhhs.gov/
• Office of Pharmacy Affairs http//www.hrta.gov.op
  a/

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Medicare Part D

• Most helpful web site
• MyMedicareMatters
• http//mymedicarematters.org/
• http//mymedicarematters.org/ZipFinder/

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Medicare Part D

• Remember
• Medicare Part D
• Pharmacy benefit coverage
• begins in all states on
• January 1, 2006

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Medicare Part D

• Questions?