Your SlideShare is downloading. ×
0
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Mcdc Medicare Workshop 2006
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Mcdc Medicare Workshop 2006

858

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
858
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
16
Comments
0
Likes
1
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide
  • This training module was developed and approved by the Centers for Medicare & Medicaid Services (CMS), the Federal agency that administers Medicare and Medicaid. This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose obligations. Although every reasonable effort has been made to assure the accuracy of the information within these pages, the ultimate responsibility for the correct submission of claims and response to any remittance advice lies with the provider of services. The Centers for Medicare & Medicaid Services (CMS) employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this guide. This publication is a general summary that explains certain aspects of the Medicare Program, but is not a legal document. The official Medicare Program provisions are contained in the relevant laws, regulations, and rulings. The information in this module was correct at the time it was posted (August 2005). This material is not a legal document. The official Medicare program provisions are contained in the relevant laws, regulations, and rulings.
  • Transcript

    • 1. IMPORTANT INFORMATION FOR SENIOR CITIZENS Maranatha Community Development Corporation
    • 2. <ul><li>Module 1: Overview </li></ul>
    • 3. Medicare Prescription Drug Coverage <ul><li>Begins January 1, 2006 </li></ul><ul><li>Available for all people with Medicare </li></ul><ul><ul><li>Part A, Part B, or both </li></ul></ul><ul><li>For minimum standard coverage in 2006, </li></ul><ul><li>enrollees would pay </li></ul><ul><ul><li>Monthly premium of about $32 </li></ul></ul><ul><ul><li>First $250 per year for prescriptions </li></ul></ul><ul><ul><li>(“deductible”) </li></ul></ul><ul><ul><li>Part of the cost of prescriptions after $250 </li></ul></ul><ul><ul><li>5% of the drug costs (or small copayment) </li></ul></ul><ul><ul><li>after paying $3,600 out-of-pocket </li></ul></ul>
    • 4. Savings in 2006 <ul><li>On average , for a person with Medicare and no drug coverage now </li></ul><ul><ul><li>Total drug spending will go down by about 50% </li></ul></ul><ul><ul><li>Over $1,100 per year saved </li></ul></ul><ul><li>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 </li></ul><ul><li>These estimates do not include the extra help for people with limited incomes and resources </li></ul>
    • 5. Protections for People with Medicare <ul><li>Customer service </li></ul><ul><li>Pharmacy access </li></ul><ul><li>Medication therapy management </li></ul><ul><li>Generic drug information </li></ul><ul><li>Privacy </li></ul><ul><li>Uniform benefits and premiums </li></ul><ul><li>Formulary Protections </li></ul>
    • 6. <ul><li>Module 2: </li></ul><ul><li>Extra Help for People </li></ul><ul><li>with Limited Incomes </li></ul><ul><li>and Resources </li></ul>
    • 7. Extra Help With Drug Costs <ul><li>Available for many people with limited income and resources </li></ul><ul><li>Those below Federal poverty level save over 95% on average </li></ul><ul><li>People with lowest income and resources </li></ul><ul><ul><li>Pay no premiums or deductibles </li></ul></ul><ul><ul><li>Have small or no copayments </li></ul></ul><ul><li>Those with slightly higher income and resources </li></ul><ul><ul><li>Have a reduced deductible </li></ul></ul><ul><ul><li>Pay a little more out-of-pocket </li></ul></ul>
    • 8. Eligibility for Extra Help <ul><li>Income </li></ul><ul><ul><li>Below 150% Federal poverty level </li></ul></ul><ul><ul><ul><li>$1,197 per month for an individual* or </li></ul></ul></ul><ul><ul><ul><li>$1,604 per month for a married couple* </li></ul></ul></ul><ul><ul><ul><li>Based on family size </li></ul></ul></ul><ul><li>Resources </li></ul><ul><ul><li>Up to $11,500 (individual) </li></ul></ul><ul><ul><li>Up to $23,000 (married couple living together) </li></ul></ul><ul><ul><ul><li>Includes $1,500/person funeral or burial expenses </li></ul></ul></ul><ul><ul><ul><li>Counts savings and stocks </li></ul></ul></ul><ul><ul><ul><li>Does not count home the person lives in </li></ul></ul></ul>2005 amounts
    • 9. Automatic Eligibility for Extra Help <ul><li>Some people may automatically qualify </li></ul><ul><li>People with Medicare who </li></ul><ul><ul><li>Get full Medicaid benefits </li></ul></ul><ul><ul><li>Get Supplemental Security Income (SSI) </li></ul></ul><ul><ul><li>Get help from Medicaid paying their Medicare premiums </li></ul></ul><ul><li>All others must apply </li></ul>
    • 10. How to Apply For Extra Help <ul><li>Social Security Administration (SSA) is mailing applications to those who may be eligible </li></ul><ul><ul><li>Throughout the summer of 2005 </li></ul></ul><ul><li>Those who think they may qualify should </li></ul><ul><ul><li>Complete this application </li></ul></ul><ul><ul><ul><li>Mail it to the address on the back of the application </li></ul></ul></ul><ul><ul><ul><li>Use the enclosed postage-paid envelope </li></ul></ul></ul><ul><ul><ul><li>Use original forms only (do not photocopy) </li></ul></ul></ul><ul><li>People who are not sure should still apply </li></ul><ul><ul><li>www.socialsecurity.gov can help people decide </li></ul></ul>
    • 11. <ul><li>Module 3: </li></ul><ul><li>Types of Plans/Coverage </li></ul>
    • 12. Ways to Get Coverage <ul><li>Medicare prescription drug coverage is provided through </li></ul><ul><ul><li>Medicare Prescription Drug Plans </li></ul></ul><ul><ul><li>Medicare Advantage and other Medicare Health Plans </li></ul></ul><ul><li>Coverage is NOT automatic </li></ul><ul><li>People need to understand their options </li></ul>
    • 13. Joining a Plan <ul><li>Join directly with the plan sponsor </li></ul><ul><li>Can get help joining </li></ul><ul><ul><li>Legal representative </li></ul></ul><ul><ul><li>Spouse, other relative, friend, or advocate </li></ul></ul><ul><li>Initial Enrollment Period </li></ul>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
    • 14. Late Enrollment <ul><li>Most people will have to pay a penalty if they wait to join </li></ul><ul><ul><li>Premium will go up 1% per month for every month the person was eligible but did not join </li></ul></ul><ul><ul><li>The person will have to pay this penalty as long as they have a Medicare Prescription Drug Plan </li></ul></ul><ul><li>Unless they have other prescription drug coverage that is, on average, at least as good as the minimum standard Medicare prescription drug coverage </li></ul>
    • 15. Coverage on Average at Least as Good as the Minimum Standard Medicare Drug Coverage <ul><li>People with other coverage </li></ul><ul><ul><li>Will receive information from the other plan </li></ul></ul><ul><ul><li>Will not pay a penalty if they wait to join </li></ul></ul><ul><ul><ul><li>If coverage is, on average, at least as good as Medicare prescription drug coverage </li></ul></ul></ul><ul><li>Possible examples </li></ul><ul><ul><li>Some Employer Group Health Plans (EGHP) </li></ul></ul><ul><ul><li>State Pharmacy Assistance Program (SPAP) </li></ul></ul><ul><ul><li>Veteran Affairs (VA) coverage </li></ul></ul><ul><ul><li>Military retiree coverage including TRICARE </li></ul></ul>
    • 16. What if a patient has prescription drug coverage from… <ul><li>A Medigap (Medicare Supplement Insurance) policy? </li></ul><ul><li>An employer or union? </li></ul>
    • 17. Original Medicare And Medigap With Drug Coverage <ul><li>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 </li></ul><ul><li>Choices to make </li></ul><ul><ul><li>Keep prescription coverage through the Medigap policy </li></ul></ul><ul><ul><li>Join a Medicare Prescription Drug Plan after they </li></ul></ul><ul><ul><ul><li>Modify the Medigap policy to remove drug coverage, or </li></ul></ul></ul><ul><ul><ul><li>Change to a Medigap policy with no drug coverage </li></ul></ul></ul><ul><ul><li>Drop Medigap policy and join a Medicare Advantage Plan or other Medicare Health Plan with prescription drug coverage </li></ul></ul>
    • 18. Employer/Union Coverage <ul><li>Medicare is working with employers to help people with Medicare keep their current prescription coverage </li></ul><ul><li>Employer/Union options </li></ul><ul><ul><li>Offer coverage in place of Medicare prescription drug coverage and get a tax-free subsidy </li></ul></ul><ul><ul><li>Offer or contract with a Medicare drug plan to provide prescription drug coverage </li></ul></ul><ul><ul><li>Provide coverage that supplements the Medicare prescription drug coverage </li></ul></ul><ul><ul><li>Pay all or part of Medicare drug plan premiums </li></ul></ul>
    • 19. Employer/Union Coverage <ul><li>People with Medicare and employer/union coverage will get important information in the mail this fall from their plan sponsor </li></ul><ul><li>They should contact their benefits administrator before making any changes </li></ul><ul><li>Choices to make </li></ul><ul><ul><li>Keep coverage offered by employer/union </li></ul></ul><ul><ul><li>Join a Medicare Prescription Drug Plan </li></ul></ul><ul><ul><li>Join a Medicare Advantage Plan or other Medicare Health Plan with prescription drug coverage </li></ul></ul><ul><li>NOTE: If a Medicare beneficiary drops or loses their employer/union </li></ul><ul><li>coverage, they may not be able to get it back </li></ul>
    • 20. Medicare and Medicaid <ul><li>These people automatically qualify for the extra help </li></ul><ul><li>They should watch the mail this fall </li></ul><ul><ul><li>Letter about choosing a Medicare Prescription Drug Plan </li></ul></ul><ul><ul><li>“ Medicare &amp; You 2006” handbook </li></ul></ul><ul><li>Choices to make </li></ul><ul><ul><li>Compare prescription drug plan options and join in a plan </li></ul></ul><ul><ul><li>If not, Medicare will enroll them in one by December 31, 2005 </li></ul></ul><ul><ul><li>Starting January 1, 2006, Medicare will pay for their prescription drugs </li></ul></ul><ul><ul><li>Can switch to another plan at any time </li></ul></ul>
    • 21. Other State/Federal Assistance Programs <ul><li>These people automatically qualify for the extra help if they </li></ul><ul><ul><li>Get help from Medicaid paying their Medicare premiums </li></ul></ul><ul><ul><li>Get Medicare and Supplemental Security Income (SSI) benefits </li></ul></ul><ul><li>They should watch the mail for “Medicare &amp; You 2006” handbook </li></ul><ul><li>Choices to make </li></ul><ul><ul><li>Compare prescription drug plan options </li></ul></ul><ul><ul><li>Find a plan that meets their needs </li></ul></ul><ul><ul><li>If no choice made by May 15, 2006, will be enrolled on June 1, 2006 </li></ul></ul><ul><ul><ul><li>Also applies to people who applied and qualify for extra help </li></ul></ul></ul>
    • 22. <ul><li>Module 4: </li></ul><ul><li>Specific Drug Coverage </li></ul>
    • 23. Medicare Prescription Drug Coverage <ul><li>Covers drugs available only by prescription </li></ul><ul><li>Prescription drugs, biologicals, insulin </li></ul><ul><li>Medical supplies associated with injection </li></ul><ul><li>of insulin </li></ul><ul><li>A prescription drug plan (PDP) or Medicare </li></ul><ul><li>Advantage prescription drug (MA-PD) plan </li></ul><ul><li>may not cover all drugs </li></ul><ul><li>Brand name and generic drugs will be in </li></ul><ul><li>each formulary </li></ul>
    • 24. Medicare Prescription Drug Coverage Plans Must Cover <ul><li>Cancer medications </li></ul><ul><li>HIV/AIDS treatments </li></ul><ul><li>Antidepressants </li></ul><ul><li>Antipsychotic medications </li></ul><ul><li>Anticonvulsive treatments for epilepsy and other conditions </li></ul><ul><li>Immunosuppressants </li></ul>
    • 25. Excluded Drugs <ul><li>Drugs for </li></ul><ul><ul><li>Anorexia, weight loss, or weight gain </li></ul></ul><ul><ul><li>Fertility </li></ul></ul><ul><ul><li>Cosmetic purposes or hair growth </li></ul></ul><ul><ul><li>Symptomatic relief of cough and colds </li></ul></ul><ul><li>Prescription vitamins and mineral products </li></ul><ul><ul><li>Except prenatal vitamins and fluoride preparations </li></ul></ul><ul><li>Non-prescription drugs </li></ul><ul><li>Barbiturates </li></ul><ul><li>Benzodiazepines </li></ul>
    • 26. <ul><li>Prescription drug plans (PDP) and Medicare Advantage prescription drug (MA-PD) plans may have a formulary </li></ul><ul><li>CMS will ensure formularies do not </li></ul><ul><li>discourage enrollment among certain groups of people </li></ul><ul><li>Formulary review requirements are posted at www.cms.hhs.gov/pdps on the web </li></ul><ul><li>CMS will approve formularies in advance for plans to complete their bid </li></ul>Formulary
    • 27. <ul><li>Tier 1 is lowest cost sharing </li></ul><ul><li>Subsequent tiers have higher cost sharing in ascending order </li></ul><ul><li>CMS will review to identify drug categories that may discourage enrollment of certain people with Medicare by placing drugs in non-preferred tiers </li></ul><ul><li>Plan must have exceptions procedures for tiered formularies </li></ul>Tiered F ormularies – Preferred Drug Levels
    • 28. How Drug Plans Vary <ul><li>What prescription drugs are covered </li></ul><ul><li>How much the individual needs </li></ul><ul><li>to pay </li></ul><ul><li>Which pharmacies are used </li></ul><ul><li>Whether they offer more than the standard level of coverage </li></ul><ul><ul><li>For a higher monthly premium </li></ul></ul>
    • 29. <ul><li>Module 5: </li></ul><ul><li>Individual Choice of a Prescription Drug Plan (PDP) </li></ul>
    • 30. Annual Coordinated Election Period <ul><li>November 15 – December 31 every year </li></ul><ul><li>Person who does not have a Medicare drug plan can join </li></ul><ul><li>Person who currently has a Medicare drug plan can switch </li></ul><ul><li>Change effective January 1 </li></ul>
    • 31. Things to Consider <ul><li>What is current health insurance coverage? </li></ul><ul><ul><li>Medicare and employer/union, including military retiree coverage (like TRICARE) </li></ul></ul><ul><ul><li>Original Medicare Plan </li></ul></ul><ul><ul><li>Medicare Advantage and other Medicare Health Plans </li></ul></ul><ul><ul><ul><li>Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Special Needs, Private Fee-For-Service Plan (PFFS) </li></ul></ul></ul><ul><ul><ul><li>Medicare Cost Plans </li></ul></ul></ul><ul><ul><li>Medicare and Medicaid </li></ul></ul><ul><li>Is there currently prescription drug coverage? </li></ul><ul><li>Even those with current prescription drug coverage should ask </li></ul><ul><ul><li>“ Is Medicare prescription drug coverage right for me?” </li></ul></ul>
    • 32. <ul><li>Medicaid prescription drug coverage for people with Medicare and Medicaid ends December 31, 2005 </li></ul><ul><li>People with Medicare and Medicaid who do not join a plan by December 31, 2005 </li></ul><ul><ul><li>CMS will enroll them in a prescription drug plan with a premium covered by the extra help </li></ul></ul><ul><ul><li>Their Medicare prescription drug coverage will begin January 1, 2006 </li></ul></ul><ul><li>People with Medicare and Medicaid have a Special Enrollment Period (SEP) </li></ul><ul><ul><li>Can change plans any time </li></ul></ul>Auto-Enrollment ( can change plans any time )
    • 33. Special Populations <ul><li>State Pharmacy Assistance Program participants </li></ul><ul><li>People in long-term care facilities </li></ul><ul><li>Residents of the U.S. territories </li></ul>
    • 34. State Pharmacy Assistance Programs (SPAP) <ul><li>Provide wraparound coverage </li></ul><ul><li>Provide same or better coverage and save money </li></ul><ul><li>Reduce state costs or expand population served </li></ul><ul><li>Costs incurred by SPAP may or may not be counted toward out-of-pocket limit </li></ul>
    • 35. Long-Term Care Facilities <ul><li>Residents </li></ul><ul><ul><li>Obtain drug benefits from pharmacy chosen by the facility </li></ul></ul><ul><ul><li>Can change plans at any time if they have both Medicare and full Medicaid benefits </li></ul></ul><ul><ul><li>Will have convenient access </li></ul></ul><ul><li>Those persons who are dually eligible for Medicare and Medicaid have no deductibles and no copayments. </li></ul>
    • 36. U.S. Territories <ul><li>Each territory has its own prescription drug plan region </li></ul><ul><li>Each territory can develop its own extra help </li></ul><ul><ul><li>Help with premiums, coinsurance, copayments, deductibles or </li></ul></ul><ul><ul><li>Provide supplemental coverage </li></ul></ul>
    • 37. For More Information <ul><li>See “Medicare &amp; You 2006” handbook </li></ul><ul><ul><li>To be mailed October 2005 </li></ul></ul><ul><ul><li>Read about prescription drug plans in the area </li></ul></ul><ul><li>For help in choosing a plan </li></ul><ul><ul><li>Visit www.medicare.gov on the web </li></ul></ul><ul><ul><ul><li>To get personalized information </li></ul></ul></ul><ul><ul><li>Visit www.shiptalk.org or call the local State Health Insurance Assistance Program (SHIP) </li></ul></ul><ul><ul><ul><li>For assistance with enrollment </li></ul></ul></ul><ul><ul><li>Call 1-800-MEDICARE (1-800-633-4227) </li></ul></ul><ul><ul><ul><li>TTY users call 1-877-486-2048 </li></ul></ul></ul><ul><ul><li>Attend local community events </li></ul></ul>
    • 38. Important Dates <ul><li>January 1, 2006 </li></ul><ul><ul><li>Medicare Prescription Drug Plan coverage begins for those enrolled </li></ul></ul><ul><li>May 15, 2006 </li></ul><ul><ul><li>Last day of Initial Enrollment Period </li></ul></ul><ul><li>June 1, 2006 </li></ul><ul><ul><li>Facilitated enrollment of people entitled to extra help who did not enroll by May 15, 2006 </li></ul></ul>
    • 39. More Information for People with Medicare <ul><li>Websites </li></ul><ul><ul><li>www.medicare.gov </li></ul></ul><ul><ul><li>www.cms.hhs.gov </li></ul></ul><ul><ul><li>www.socialsecurity.gov </li></ul></ul><ul><li>Publications </li></ul><ul><ul><li>“ Medicare &amp; You 2006” handbook </li></ul></ul><ul><ul><li>“ Facts About Medicare Prescription Drug Plans” </li></ul></ul><ul><li>1-800-MEDICARE (1-800-633-4227) </li></ul><ul><li>TTY users should call 1-877-486-2048 </li></ul><ul><li>Social Security Administration </li></ul><ul><ul><li>1-800-772-1213 </li></ul></ul><ul><ul><li>TTY users should call 1-800-325-0778 </li></ul></ul>
    • 40. <ul><li>Show Video </li></ul>Questions And Answers
    • 41. Post Assessment Click here to take the Post Assessment.

    ×