IMPORTANT INFORMATION FOR SENIOR CITIZENS Maranatha Community Development Corporation

Module 1: Overview

Module 1: Overview

Medicare Prescription Drug Coverage Begins January 1, 2006 Available for all people with Medicare Part A, Part B, or both For minimum standard coverage in 2006, enrollees would pay Monthly premium of about $32 First $250 per year for prescriptions (“deductible”) Part of the cost of prescriptions after $250 5% of the drug costs (or small copayment) after paying $3,600 out-of-pocket

Begins January 1, 2006

Available for all people with Medicare

Part A, Part B, or both

For minimum standard coverage in 2006,

enrollees would pay

Monthly premium of about $32

First $250 per year for prescriptions

(“deductible”)

Part of the cost of prescriptions after $250

5% of the drug costs (or small copayment)

after paying $3,600 out-of-pocket

Savings in 2006 On average , for a person with Medicare and no drug coverage now Total drug spending will go down by about 50% Over $1,100 per year saved People with other drug coverage that, on average, is at least as good as the minimum standard Medicare prescription drug coverage also may save money These estimates do not include the extra help for people with limited incomes and resources

On average , for a person with Medicare and no drug coverage now

Total drug spending will go down by about 50%

Over $1,100 per year saved

People with other drug coverage that, on average, is at least as good as the minimum standard Medicare prescription drug coverage also may save money

These estimates do not include the extra help for people with limited incomes and resources

Protections for People with Medicare Customer service Pharmacy access Medication therapy management Generic drug information Privacy Uniform benefits and premiums Formulary Protections

Customer service

Pharmacy access

Medication therapy management

Generic drug information

Privacy

Uniform benefits and premiums

Formulary Protections

Module 2: Extra Help for People with Limited Incomes and Resources

Module 2:

Extra Help for People

with Limited Incomes

and Resources

Extra Help With Drug Costs Available for many people with limited income and resources Those below Federal poverty level save over 95% on average People with lowest income and resources Pay no premiums or deductibles Have small or no copayments Those with slightly higher income and resources Have a reduced deductible Pay a little more out-of-pocket

Available for many people with limited income and resources

Those below Federal poverty level save over 95% on average

People with lowest income and resources

Pay no premiums or deductibles

Have small or no copayments

Those with slightly higher income and resources

Have a reduced deductible

Pay a little more out-of-pocket

Eligibility for Extra Help Income Below 150% Federal poverty level $1,197 per month for an individual* or $1,604 per month for a married couple* Based on family size Resources Up to $11,500 (individual) Up to $23,000 (married couple living together) Includes $1,500/person funeral or burial expenses Counts savings and stocks Does not count home the person lives in 2005 amounts

Income

Below 150% Federal poverty level

$1,197 per month for an individual* or

$1,604 per month for a married couple*

Based on family size

Resources

Up to $11,500 (individual)

Up to $23,000 (married couple living together)

Includes $1,500/person funeral or burial expenses

Counts savings and stocks

Does not count home the person lives in

Automatic Eligibility for Extra Help Some people may automatically qualify People with Medicare who Get full Medicaid benefits Get Supplemental Security Income (SSI) Get help from Medicaid paying their Medicare premiums All others must apply

Some people may automatically qualify

People with Medicare who

Get full Medicaid benefits

Get Supplemental Security Income (SSI)

Get help from Medicaid paying their Medicare premiums

All others must apply

How to Apply For Extra Help Social Security Administration (SSA) is mailing applications to those who may be eligible Throughout the summer of 2005 Those who think they may qualify should Complete this application Mail it to the address on the back of the application Use the enclosed postage-paid envelope Use original forms only (do not photocopy) People who are not sure should still apply www.socialsecurity.gov can help people decide

Social Security Administration (SSA) is mailing applications to those who may be eligible

Throughout the summer of 2005

Those who think they may qualify should

Complete this application

Mail it to the address on the back of the application

Use the enclosed postage-paid envelope

Use original forms only (do not photocopy)

People who are not sure should still apply

www.socialsecurity.gov can help people decide

Module 3: Types of Plans/Coverage

Module 3:

Types of Plans/Coverage

Ways to Get Coverage Medicare prescription drug coverage is provided through Medicare Prescription Drug Plans Medicare Advantage and other Medicare Health Plans Coverage is NOT automatic People need to understand their options

Medicare prescription drug coverage is provided through

Medicare Prescription Drug Plans

Medicare Advantage and other Medicare Health Plans

Coverage is NOT automatic

People need to understand their options

Joining a Plan Join directly with the plan sponsor Can get help joining Legal representative Spouse, other relative, friend, or advocate Initial Enrollment Period 7-month period For people entitled to Medicare on February 1, 2006, or later November 15, 2005 through May 15, 2006 For people entitled to Medicare before February 2006

Join directly with the plan sponsor

Can get help joining

Legal representative

Spouse, other relative, friend, or advocate

Initial Enrollment Period

Late Enrollment Most people will have to pay a penalty if they wait to join Premium will go up 1% per month for every month the person was eligible but did not join The person will have to pay this penalty as long as they have a Medicare Prescription Drug Plan Unless they have other prescription drug coverage that is, on average, at least as good as the minimum standard Medicare prescription drug coverage

Most people will have to pay a penalty if they wait to join

Premium will go up 1% per month for every month the person was eligible but did not join

The person will have to pay this penalty as long as they have a Medicare Prescription Drug Plan

Unless they have other prescription drug coverage that is, on average, at least as good as the minimum standard Medicare prescription drug coverage

Coverage on Average at Least as Good as the Minimum Standard Medicare Drug Coverage People with other coverage Will receive information from the other plan Will not pay a penalty if they wait to join If coverage is, on average, at least as good as Medicare prescription drug coverage Possible examples Some Employer Group Health Plans (EGHP) State Pharmacy Assistance Program (SPAP) Veteran Affairs (VA) coverage Military retiree coverage including TRICARE

People with other coverage

Will receive information from the other plan

Will not pay a penalty if they wait to join

If coverage is, on average, at least as good as Medicare prescription drug coverage

Possible examples

Some Employer Group Health Plans (EGHP)

State Pharmacy Assistance Program (SPAP)

Veteran Affairs (VA) coverage

Military retiree coverage including TRICARE

What if a patient has prescription drug coverage from… A Medigap (Medicare Supplement Insurance) policy? An employer or union?

A Medigap (Medicare Supplement Insurance) policy?

An employer or union?

Original Medicare And Medigap With Drug Coverage People who have a Medigap prescription drug policy will receive important information in the mail this fall from their Medigap insurance company on how the new Medicare prescription drug coverage will affect their Medigap prescription drug coverage Choices to make Keep prescription coverage through the Medigap policy Join a Medicare Prescription Drug Plan after they Modify the Medigap policy to remove drug coverage, or Change to a Medigap policy with no drug coverage Drop Medigap policy and join a Medicare Advantage Plan or other Medicare Health Plan with prescription drug coverage

People who have a Medigap prescription drug policy will receive important information in the mail this fall from their Medigap insurance company on how the new Medicare prescription drug coverage will affect their Medigap prescription drug coverage

Choices to make

Keep prescription coverage through the Medigap policy

Join a Medicare Prescription Drug Plan after they

Modify the Medigap policy to remove drug coverage, or

Change to a Medigap policy with no drug coverage

Drop Medigap policy and join a Medicare Advantage Plan or other Medicare Health Plan with prescription drug coverage

Employer/Union Coverage Medicare is working with employers to help people with Medicare keep their current prescription coverage Employer/Union options Offer coverage in place of Medicare prescription drug coverage and get a tax-free subsidy Offer or contract with a Medicare drug plan to provide prescription drug coverage Provide coverage that supplements the Medicare prescription drug coverage Pay all or part of Medicare drug plan premiums

Medicare is working with employers to help people with Medicare keep their current prescription coverage

Employer/Union options

Offer coverage in place of Medicare prescription drug coverage and get a tax-free subsidy

Offer or contract with a Medicare drug plan to provide prescription drug coverage

Provide coverage that supplements the Medicare prescription drug coverage

Pay all or part of Medicare drug plan premiums

Employer/Union Coverage People with Medicare and employer/union coverage will get important information in the mail this fall from their plan sponsor They should contact their benefits administrator before making any changes Choices to make Keep coverage offered by employer/union Join a Medicare Prescription Drug Plan Join a Medicare Advantage Plan or other Medicare Health Plan with prescription drug coverage NOTE: If a Medicare beneficiary drops or loses their employer/union coverage, they may not be able to get it back

People with Medicare and employer/union coverage will get important information in the mail this fall from their plan sponsor

They should contact their benefits administrator before making any changes

Choices to make

Keep coverage offered by employer/union

Join a Medicare Prescription Drug Plan

Join a Medicare Advantage Plan or other Medicare Health Plan with prescription drug coverage

NOTE: If a Medicare beneficiary drops or loses their employer/union

coverage, they may not be able to get it back

Medicare and Medicaid These people automatically qualify for the extra help They should watch the mail this fall Letter about choosing a Medicare Prescription Drug Plan “ Medicare & You 2006” handbook Choices to make Compare prescription drug plan options and join in a plan If not, Medicare will enroll them in one by December 31, 2005 Starting January 1, 2006, Medicare will pay for their prescription drugs Can switch to another plan at any time

These people automatically qualify for the extra help

They should watch the mail this fall

Letter about choosing a Medicare Prescription Drug Plan

“ Medicare & You 2006” handbook

Choices to make

Compare prescription drug plan options and join in a plan

If not, Medicare will enroll them in one by December 31, 2005

Starting January 1, 2006, Medicare will pay for their prescription drugs

Can switch to another plan at any time

Other State/Federal Assistance Programs These people automatically qualify for the extra help if they Get help from Medicaid paying their Medicare premiums Get Medicare and Supplemental Security Income (SSI) benefits They should watch the mail for “Medicare & You 2006” handbook Choices to make Compare prescription drug plan options Find a plan that meets their needs If no choice made by May 15, 2006, will be enrolled on June 1, 2006 Also applies to people who applied and qualify for extra help

These people automatically qualify for the extra help if they

Get help from Medicaid paying their Medicare premiums

Get Medicare and Supplemental Security Income (SSI) benefits

They should watch the mail for “Medicare & You 2006” handbook

Choices to make

Compare prescription drug plan options

Find a plan that meets their needs

If no choice made by May 15, 2006, will be enrolled on June 1, 2006

Also applies to people who applied and qualify for extra help

Module 4: Specific Drug Coverage

Module 4:

Specific Drug Coverage

Medicare Prescription Drug Coverage Covers drugs available only by prescription Prescription drugs, biologicals, insulin Medical supplies associated with injection of insulin A prescription drug plan (PDP) or Medicare Advantage prescription drug (MA-PD) plan may not cover all drugs Brand name and generic drugs will be in each formulary

Covers drugs available only by prescription

Prescription drugs, biologicals, insulin

Medical supplies associated with injection

of insulin

A prescription drug plan (PDP) or Medicare

Advantage prescription drug (MA-PD) plan

may not cover all drugs

Brand name and generic drugs will be in

each formulary

Medicare Prescription Drug Coverage Plans Must Cover Cancer medications HIV/AIDS treatments Antidepressants Antipsychotic medications Anticonvulsive treatments for epilepsy and other conditions Immunosuppressants

Cancer medications

HIV/AIDS treatments

Antidepressants

Antipsychotic medications

Anticonvulsive treatments for epilepsy and other conditions

Immunosuppressants

Excluded Drugs Drugs for Anorexia, weight loss, or weight gain Fertility Cosmetic purposes or hair growth Symptomatic relief of cough and colds Prescription vitamins and mineral products Except prenatal vitamins and fluoride preparations Non-prescription drugs Barbiturates Benzodiazepines

Drugs for

Anorexia, weight loss, or weight gain

Fertility

Cosmetic purposes or hair growth

Symptomatic relief of cough and colds

Prescription vitamins and mineral products

Except prenatal vitamins and fluoride preparations

Non-prescription drugs

Barbiturates

Benzodiazepines

Prescription drug plans (PDP) and Medicare Advantage prescription drug (MA-PD) plans may have a formulary CMS will ensure formularies do not discourage enrollment among certain groups of people Formulary review requirements are posted at www.cms.hhs.gov/pdps on the web CMS will approve formularies in advance for plans to complete their bid Formulary

Prescription drug plans (PDP) and Medicare Advantage prescription drug (MA-PD) plans may have a formulary

CMS will ensure formularies do not

discourage enrollment among certain groups of people

Formulary review requirements are posted at www.cms.hhs.gov/pdps on the web

CMS will approve formularies in advance for plans to complete their bid

Tier 1 is lowest cost sharing Subsequent tiers have higher cost sharing in ascending order CMS will review to identify drug categories that may discourage enrollment of certain people with Medicare by placing drugs in non-preferred tiers Plan must have exceptions procedures for tiered formularies Tiered F ormularies – Preferred Drug Levels

Tier 1 is lowest cost sharing

Subsequent tiers have higher cost sharing in ascending order

CMS will review to identify drug categories that may discourage enrollment of certain people with Medicare by placing drugs in non-preferred tiers

Plan must have exceptions procedures for tiered formularies

How Drug Plans Vary What prescription drugs are covered How much the individual needs to pay Which pharmacies are used Whether they offer more than the standard level of coverage For a higher monthly premium

What prescription drugs are covered

How much the individual needs

to pay

Which pharmacies are used

Whether they offer more than the standard level of coverage

For a higher monthly premium

Module 5: Individual Choice of a Prescription Drug Plan (PDP)

Module 5:

Individual Choice of a Prescription Drug Plan (PDP)

Annual Coordinated Election Period November 15 – December 31 every year Person who does not have a Medicare drug plan can join Person who currently has a Medicare drug plan can switch Change effective January 1

November 15 – December 31 every year

Person who does not have a Medicare drug plan can join

Person who currently has a Medicare drug plan can switch

Change effective January 1

Things to Consider What is current health insurance coverage? Medicare and employer/union, including military retiree coverage (like TRICARE) Original Medicare Plan Medicare Advantage and other Medicare Health Plans Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Special Needs, Private Fee-For-Service Plan (PFFS) Medicare Cost Plans Medicare and Medicaid Is there currently prescription drug coverage? Even those with current prescription drug coverage should ask “ Is Medicare prescription drug coverage right for me?”

What is current health insurance coverage?

Medicare and employer/union, including military retiree coverage (like TRICARE)

Original Medicare Plan

Medicare Advantage and other Medicare Health Plans

Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Special Needs, Private Fee-For-Service Plan (PFFS)

Medicare Cost Plans

Medicare and Medicaid

Is there currently prescription drug coverage?

Even those with current prescription drug coverage should ask

“ Is Medicare prescription drug coverage right for me?”

Medicaid prescription drug coverage for people with Medicare and Medicaid ends December 31, 2005 People with Medicare and Medicaid who do not join a plan by December 31, 2005 CMS will enroll them in a prescription drug plan with a premium covered by the extra help Their Medicare prescription drug coverage will begin January 1, 2006 People with Medicare and Medicaid have a Special Enrollment Period (SEP) Can change plans any time Auto-Enrollment ( can change plans any time )

Medicaid prescription drug coverage for people with Medicare and Medicaid ends December 31, 2005

People with Medicare and Medicaid who do not join a plan by December 31, 2005

CMS will enroll them in a prescription drug plan with a premium covered by the extra help

Their Medicare prescription drug coverage will begin January 1, 2006

People with Medicare and Medicaid have a Special Enrollment Period (SEP)

Can change plans any time

Special Populations State Pharmacy Assistance Program participants People in long-term care facilities Residents of the U.S. territories

State Pharmacy Assistance Program participants

People in long-term care facilities

Residents of the U.S. territories

State Pharmacy Assistance Programs (SPAP) Provide wraparound coverage Provide same or better coverage and save money Reduce state costs or expand population served Costs incurred by SPAP may or may not be counted toward out-of-pocket limit

Provide wraparound coverage

Provide same or better coverage and save money

Reduce state costs or expand population served

Costs incurred by SPAP may or may not be counted toward out-of-pocket limit

Long-Term Care Facilities Residents Obtain drug benefits from pharmacy chosen by the facility Can change plans at any time if they have both Medicare and full Medicaid benefits Will have convenient access Those persons who are dually eligible for Medicare and Medicaid have no deductibles and no copayments.

Residents

Obtain drug benefits from pharmacy chosen by the facility

Can change plans at any time if they have both Medicare and full Medicaid benefits

Will have convenient access

Those persons who are dually eligible for Medicare and Medicaid have no deductibles and no copayments.

U.S. Territories Each territory has its own prescription drug plan region Each territory can develop its own extra help Help with premiums, coinsurance, copayments, deductibles or Provide supplemental coverage

Each territory has its own prescription drug plan region

Each territory can develop its own extra help

Help with premiums, coinsurance, copayments, deductibles or

Provide supplemental coverage

For More Information See “Medicare & You 2006” handbook To be mailed October 2005 Read about prescription drug plans in the area For help in choosing a plan Visit www.medicare.gov on the web To get personalized information Visit www.shiptalk.org or call the local State Health Insurance Assistance Program (SHIP) For assistance with enrollment Call 1-800-MEDICARE (1-800-633-4227) TTY users call 1-877-486-2048 Attend local community events

See “Medicare & You 2006” handbook

To be mailed October 2005

Read about prescription drug plans in the area

For help in choosing a plan

Visit www.medicare.gov on the web

To get personalized information

Visit www.shiptalk.org or call the local State Health Insurance Assistance Program (SHIP)

For assistance with enrollment

Call 1-800-MEDICARE (1-800-633-4227)

TTY users call 1-877-486-2048

Attend local community events

Important Dates January 1, 2006 Medicare Prescription Drug Plan coverage begins for those enrolled May 15, 2006 Last day of Initial Enrollment Period June 1, 2006 Facilitated enrollment of people entitled to extra help who did not enroll by May 15, 2006

January 1, 2006

Medicare Prescription Drug Plan coverage begins for those enrolled

May 15, 2006

Last day of Initial Enrollment Period

June 1, 2006

Facilitated enrollment of people entitled to extra help who did not enroll by May 15, 2006

More Information for People with Medicare Websites www.medicare.gov www.cms.hhs.gov www.socialsecurity.gov Publications “ Medicare & You 2006” handbook “ Facts About Medicare Prescription Drug Plans” 1-800-MEDICARE (1-800-633-4227) TTY users should call 1-877-486-2048 Social Security Administration 1-800-772-1213 TTY users should call 1-800-325-0778

Websites

www.medicare.gov

www.cms.hhs.gov

www.socialsecurity.gov

Publications

“ Medicare & You 2006” handbook

“ Facts About Medicare Prescription Drug Plans”

1-800-MEDICARE (1-800-633-4227)

TTY users should call 1-877-486-2048

Social Security Administration

1-800-772-1213

TTY users should call 1-800-325-0778

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