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PDP011 _Part D Central Content PARTIAL_012406

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PDP011 _Part D Central Content PARTIAL_012406

  1. 1. Page title Page # ALL PAGES ALL [MAIN NAVIGATION] About Part D | About Our Plan | Taking action [SECONDARY NAVIGATION] FAQs | Resources | Contact Us | About Us | Privacy | Appendix |Site Map Footer <date and time stamp> [LEFT COLUMN] [Show Them Guide cover] Show them how! Our free Show-Them Guide helps you explain Part D to your parent or loved one -- so they can make a decision with confidence. Download it now! [2.5] Helpful information > Tips for talking with your parents [3.2] > Information checklists [3.1.1] > Key Dates [3.1] > How does the plan help people with limited incomes or resources? Find out now [3.3] >[Medicare Advantage plans Plans for people with complex health needs. >>Learn more [2.6] >Medicare Supplement plans Get help with the expenses that Medicare doesn't cover. >>Learn more [2.7] [RIGHT COLUMN] AARP logo AARP endorsed Our new Medicare Prescription Drug Plan (Medicare Part D) is the only one endorsed by AARP. [COUNTDOWN CLOCK - UNTIL NOV. 15] Part D enrollment begins in <X> days. Is your parent ready to enroll? Learn more [3.1] [COUNTDOWN CLOCK - NOV 15 - JAN 1.] Part D benefits begin in <X> days. Has your parent enrolled yet?
  2. 2. Learn more [3.1] [COUNTDOWN CLOCK - JAN. 1 - MAY 15.] Part D enrollment closes in <X> days. Be sure to enroll before the deadline to avoid late fees! Learn more [3.1] Certain exceptions apply. Short on time? Subscribe now [4.0] and we'll alert you to important Part D deadlines > Are your parent's drugs covered by the AARP MedicareRx Plan? Search the formulary [2.2] > Is your parent's pharmacy included in the AARP MedicareRx Plan? Find your pharmacy [2.2] S5820S5805 - PDP011 © 2006 United HealthCare Services, Inc.
  3. 3. Page title Page # Medicare Advantage plans 2.6 Medicare Advantage plans In select markets, we offer plans for people with Medicare who are looking for more than standard, traditional Medicare coverage. Look below to see what plans might be helpful to you. Medicare Complete [www.medicarecomplete.com] Medicare Complete Rx combines a Medicare Advantage plan with the new MedicareRx prescription drug coverage (also known as Part D). With Medicare Complete Rx, you continue to receive the benefits of Medicare Part A and B, plus the additional benefits of Medicare prescription drug coverage. >>Learn more [www.medicarecomplete.com] <move Evercare and Evercare Connections to section 3.2 “Talking to your parents”> Page title Page # Medicare Supplement plans 2.7 Medicare Supplement plans Medicare, on average, covers just 56 percent* of your health care expenses. You're responsible for the rest, including deductibles, coinsurance, prescription drugs and other expenses. AARP Medicare Supplement Plans help cover some of the expenses that Medicare doesn't. With an AARP Medicare Supplement Plan, you get: The freedom to choose your own doctors No claim forms to file Rates that do not increase based solely on age. You can't be singled out for a rate increase. Any rate change will apply to all members of the same class insured under your plan who reside in your state Coverage wherever you travel in the U.S. Great customer care -- 98% of issues are resolved on the first call Plan availability in all 50 states, plus D.C., Puerto Rico and U.S. Virgin Islands >>Learn more about AARP Medicare Supplement Plans available in your state. [http://www.aarphealthcare.com/prodsvcs/medsup/plan_details.aspx] Insured by United HealthCare Insurance Company and United HealthCare Insurance Company of New York, for New York residents. All of the plans may not be available in all states/areas. *2001 Medicare Chart Book, The Henry J. Kaiser Family Foundation, Menlo Park, CA, Fall 2001, pg. 45.
  4. 4. Page title Page # Talking with your parents 3.2 Talking with Your Parents About the New Medicare Prescription Drug Coverage It's an important discussion that's worth having. Just as you’re helping to support your parent’s decisions about the New Medicare Prescription Drug coverage, we’re here to support you. Talking with our parents about health care and finances can sometimes bring in new dynamics that aren’t part of everyday conversations. It’s probably easier to talk with your parents about kids, work, the weather or family memories, but talking with your parents about prescription drug coverage, and their health and financial situation, can be difficult and touchy subjects to discuss. It’s useful to remember that as an adult child, you are not a parent to your parents. Older people are capable of making their own decisions and want to remain independent for as long as they are able. Adult children and friends can serve an important role in providing support and encouragement to older persons in making decisions. As you know, adult children can be immensely helpful to their parents in making health care and financial decisions, from researching the possibilities to helping fill out the paperwork. To help make this process run smoothly -- and make it more enjoyable -- we’ve put together some tips to help you learn about your parent’s perspectives and experiences. After all, the more you know about your parent’s medical and financial situation, the better prepared both of you will be to take the next step in this decision process. Things to keep in mind Consider yourself to be part of your parent’s health care team. Depending on your relationship with your parent, your role may be that of a coach, key player, or enthusiastic fan. In any case, you can expect that other members of your parent’s health care team include your parent’s physicians, pharmacists, friends, community groups and financial advisors. Each of these roles is important, since they will help guide your parent in making well-informed decisions. Listen to your parent’s opinions and ideas. Ask your parent how you can be of the most help to them. This might include simple actions such as making phone calls, or more involved activities, such as accompanying your parent to doctor visits and asking the doctor about your parent’s medical conditions and prescription drug needs.
  5. 5. Senior Perspectives and Communications Know when to tell, and when to ask. It can be easy to speak authoritatively to a parent about their health care options, yet sometimes a more consultative approach helps your parent feel more confident and in control. Tell your parent that you care about them, and want them to be as healthy and well cared for as possible. You’re taking an active role in their prescription coverage, in their health and well-being in their best interest.. Tell your parent there are options open to them, and you’ll help them to determine what would be a good option for them. Although the decision to enroll doesn’t need to be rushed, your parent will need to make a decision in a timely manner to avoid any late enrollment fees. Tell your parent there are key dates [3.1] in the prescription drug coverage that they need to meet. Ask your parent and determine what type of coverage they currently have. (For help determining coverage see the Information Checklist.) Ask your parent what physicians they see regularly, and ask them to help list their medical conditions. Ask your parent what prescriptions they currently take (make a complete list of the drug name - brand-name and chemical/generic name, dosage and frequency) and what pharmacists your parent prefers using (local or mail order). Ask about your parent’s financial situation so that you can assess whether your parent’s situation qualifies for assistance.[3.3] If your parent chooses to keep their financial information private, you can provide contact information for the Social Security Administration [6.0] so that they may make the call themselves. Many older people are on fixed incomes and very tight budgets, but choose not to discuss these situations with their children. Use a normal conversational tone. Although older Americans do tend to process verbal information differently, avoid using “elderspeak” which is often spoken to older persons and is characterized by sing-song verbal patterns, unnecessarily loud volumes, and overly shortened words. Older persons tend to feel that this is condescending. Instead, speak in a normal tone, and “chunk” ideas into separate sentences. Instead of saying, “There’s a new prescription drug plan, we need to get your prescription information collected, and apply soon,” use separate sentences, such as, “There’s a new prescription drug plan available nationwide. Let’s write down what prescriptions you take. We can apply soon.” Speak with clear verbal communication that is easy for your parent to understand. Organize your information, deciding on the three to five most important points. Give your parent an overview of what you’ll be talking about, and then give the details. Use common words, not jargon. For example, instead
  6. 6. of saying “Medicare uses a prescription formulary” you could say “there is a list of prescription drugs that are covered by a Medicare prescription drug plan.” Apply active listening and rephrasing. Ask your parent to put things into their own words, so you can be sure they have understood what you said. You might say something like, “I want to be sure we’ve talked about the important points. Would you repeat what I just told you? I want to be sure I have explained everything.” Be sensitive to your parent’s unique views. Your parent may want to be independent, maintain their pride or privacy, or may need to share their feelings of confusion. People at all ages have concerns about what others will think about their actions. In any case, think of ways you can be sensitive to your parent’s perspective. In the spirit of sensitivity… • Walk in your parent’s shoes. • Carry on an open-minded discussion. • Be sincere in your interactions. • Be considerate and non-judgmental. • Pay attention, listen to and acknowledge what is said. • Maintain open body language. Make a Plan Set up a time to talk so that both you and your parent can focus without interruptions. Keep this appointment just like any other important meeting. Since you’ll need to collect information about your parent, you’ll want to talk at home or over the phone instead of meeting at a restaurant where information is not readily available. Set up a “project plan” for this process. Schedule enough time with your parent to talk, and expect questions. Research your parent’s Part D plan options, plan the information you need your parent to collect and explore their best options before you talk to them. Take action in any case, whether that is to sign up for prescription drug coverage, or for your parent to keep their current coverage. Keep all Part D deadlines in mind, and let us know how we can help. Remember why this is important. We feel confident that you’ll see the benefits of our prescription drug plan, and want to help enroll your parent right away. The new AARP MedicareRx Plan is designed to make affordable, comprehensive prescription drug coverage available to Medicare beneficiaries, like your parents. The plan features include: No annual deductible.
  7. 7. Simple and predictable copays on prescriptions. Access to thousands of prescription drugs. Over 50,000 network pharmacies nationwide. Help for those with limited incomes. If you have questions or need more information, just call us at <1-800-583-4409> (TTY: <1-877-730-4192>, <Mon. - Fri., 8 a.m. - 11 p.m. ET, Sat. and Sun., 8 a.m. - 8 p.m. ET>) and a customer service representative will be happy to help you. We applaud your involvement in your parent’s prescription drug coverage and health care! <Separate Page & please include the logos for each product as well> Help for Medicare Enrollees who are Elderly, Disabled, Frail or Have Special Needs Evercare [www.evercareonline.com] Serving the needs of frail, disabled, elderly and chronically ill populations in both nursing homes and community settings, Evercare combines a Medicare Advantage plan with Medicare prescription drug coverage. With Evercare you continue to receive the benefits of Medicare Part A and B, plus the additional benefits of Medicare prescription drug coverage. >>Learn more [www.evercareonline.com] Evercare Connections® [www.evercareconnections.com] Evercare Connections is a care advocacy program designed to help people who are faced with the challenges and difficult decisions of caring for an aging parent, relative or friend. Our registered nurse Care Advocates provide services from initial needs assessment to planning to resource recommendation and access to ongoing monitoring for families nationwide. >>Learn more [www.evercareconnections.com] © 2006 United HealthCare Services, Inc.
  8. 8. Page title Page # Getting extra help 3.3 Getting extra help If your parent has difficulty paying for their prescriptions, they are not alone. Many older Americans find it hard to pay for their prescription drugs and sometimes cut their doses, skip taking doses or forego their treatment all together. Beginning Jan. 1, 2006, Medicare will give people with low incomes extra help with paying for their prescription drugs. How do you start? The first question to ask is: Does your parent qualify for extra help? [3.3.1] If you think your parent may qualify for extra help, then the next question to answer is: Does your parent need to apply for extra help? [3.3.2] Some people will receive extra help automatically, while others must apply. If you think your parent needs to apply, do this right away. Find out how to apply for extra help. [3.3.3] Applying for help To apply, fill out Social Security Administration form SSA-1020, Application for Help with Medicare Prescription Drug Plan Costs. Your parent may have already received a copy in the mail, or you can get a copy by calling 1-800-772-1213 (TTY:1-877-325- 0778) between 7 a.m. and 7 p.m., Monday through Friday. When they have finished the application form, mail it in. They can also apply online on the Web at www.socialsecurity.gov. After your parent applies, they will hear later whether they’ve qualified for extra help. Mail the form to: Social Security Administration Wilkes-Barre Data Operations Center P.O. Box 1020 Wilkes-Barre, PA 18767-9910 Click here for additional information on applying for extra help. [3.3.3] Joining a plan To receive Medicare prescription drug coverage, most Medicare beneficiaries must choose a plan and join. If your parent qualifies for extra help, things may be a little different. Some people who are eligible for extra help will be automatically assigned to a plan by Medicare and won’t need to choose a Part D plan. These individuals will have the option to change their Part D plans at any time. If your parent qualified for extra help and wants to change plans, they can choose another plan, contact the new plan insurer and switch their plans. © 2006 United HealthCare Services, Inc.
  9. 9. Page title Page # Does your parent qualify for extra help? 3.3.1 Does your parent qualify for extra help? What if your parent qualifies for extra help? If you qualify for extra help with your Medicare Prescription Drug Plan costs, your premium and drug costs will be lower. When you join the AARP MedicareRx Plan, Medicare will tell us how much extra help you are getting. Then, we will let you know the amount you will pay. If you aren’t 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. How can you find out if your parent qualifies for help? If they have both Medicare and Medicaid, they already qualify for low-income assistance. If they don't qualify for Medicaid, they may still qualify for some assistance if their income is below $14,355* for an individual, or $19,245* for a couple. In some cases, the government will also review how many assets your parent owns. If you think your parent might qualify, contact the local Social Security Administration office. Your parent has nothing to lose by applying. What assets will be counted to determine if your parent is eligible for help? The assets that will be counted include cash or property that can be converted to cash within 20 days. This includes checking accounts, savings accounts, certificates of deposit, retirement accounts (like IRAs or 401(k)s), stocks, bonds, mutual fund shares, promissory notes, mortgages and life insurance policies. Property that is not counted includes your parent’s primary home, burial plots, or burial agreements. Certain funds set aside for burial expenses (up to $1,500) will also not be counted. If your parent has limited income or resources They may get help paying the costs for their prescription drug plan if they are: • Single and have income and resources of less than $14,355* and don't have prescription drug benefits through Medicaid, OR • Married and have income and resources of less than $19,245* and don't have prescription drug benefits through Medicaid. * The above applies if they live in the continental United States. Your parent may qualify for extra help if they live in Alaska, have income and resources of less than $17,925, or if they are married and have income and resources of less than $24,045. If they live in Hawaii, have income and resources of less than $16,515, or if they are married and have income and resources of less than $22,140.
  10. 10. Programs may vary if they live in the U.S. territories (Puerto Rico, U. S. Virgin Islands, Guam and American Samoa and Northern Mariana Islands). If your parent qualifies, they will get help paying for their monthly premiums, as well as some or all of the cost they would normally have to pay for their prescriptions. The amount of extra help will be based on their income and resources. The charts below will help you see if your parent qualifies for extra help. 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.
  11. 11. Medicare Prescription Drug Plan Costs in 2006 for People Who Automatically Qualify For Extra Help They have They have They have They pay They pay Annual income is up to $9,570 if single or $12,830 if married. Was enrolled in Medicaid with prescription drug benefits in 2005. No Premium No Deductible No Coverage Gap $1 copay for generic drugs and preferred multiple source drugs on drug formulary $3 copay for other brand-name drugs on drug formulary No copay after $3,600 out-of- pocket for drugs on drug formulary Annual income is above $9,570 and below $12,920 if single or above $12,830 and below $17,321 if married. Were enrolled in Medicaid with prescription drug benefits in 2005. No Premium No Deductible No Coverage Gap $2 copay for generic drugs and preferred multiple source drugs on drug formulary $5 copay for other brand-name drugs on drug formulary No copay after $3,600 out-of- pocket for drugs on drug formulary Are in a medical institution or nursing facility and were enrolled in Medicaid with No Premium No Deductible No Coverage Gap No copay for drugs on drug formulary No copay for drugs on drug formulary
  12. 12. prescription drug benefits in 2005. In Alaska, income up to $11,950 if single or $16,030 if married; in Hawaii, income up to $11,010 if single or $14,760 if married. In Alaska, income above $11,950 and below $16,133 if single or above $16,030 and below $21,641 if married; in Hawaii, income above $11,010 and below $14,864 if single or above $14,760 and below $19,926 if married. Medicare Prescription Drug Plan Costs in 2006 for People Who Apply and Qualify For Extra Help They have They have They have They pay They pay Annual income is below $12,920 if single or $17,321 if married. Assets* below $6,000 if single or $9,000 if married. No Premium No Deductible No Coverage Gap $2 copay for generic drugs and preferred multiple source drugs on drug formulary $5 copay for other brand-name drugs on drug formulary No copay after $3,600 out-of- pocket for drugs on drug formulary Annual income is below $12,920 if single or $17,321 if married. Assets* below $10,000 if single or $20,000 if married. No Premium No Deductible No Coverage Gap Assigned copay or 15% coinsurance for both generic and brand- name drugs on drug formulary, whichever is lower After $3,600 out- of-pocket: $2 copay for generic or preferred multiple source drugs on drug formulary $5 copay for other brand- name drugs on drug formulary Annual income is below $14,355 if single or $19,245 if Discounted Premium No Deductible No Coverage Gap Assigned copay or 15% coinsurance for both generic and brand- name drugs on drug formulary, whichever is lower After $3,600 out- of-pocket: $2 copay for generic drugs and preferred multiple source
  13. 13. married. Assets* below $10,000 if single or $20,000 if married. drugs on drug formulary $5 copay for other brand- name drugs on drug formulary In Alaska, income below $16,133 if single or $21,641 if married; in Hawaii, income below $14,864 if single or $19,926 if married. In Alaska, income below $16,133 if single or $21,641 if married; in Hawaii, income below $14,864 if single or $19,926 if married. In Alaska, income below $17,925 if single or $24,045 if married; in Hawaii, income below $16,515 if single or $22,140 if married. *For example, assets do not include your parent’s home, car, a burial plot, burial funds up to $1,500, or life insurance policies up to $1,500 each. Assets do, for example, include savings and investments. For a comprehensive list of eligibility requirements, contact your local Social Security Administration office. NOTE: These amounts are for 2006 and are subject to change each year. United States territories (Puerto Rico, U.S. Virgin Islands, Guam, American Samoa and Northern Mariana Islands) that have low income assistance available may be different than those stated in the chart above. If your parent qualifies for the low income subsidy, Medicare will only cover the standard premium level. If they join a plan that has a premium higher than a standard plan, they will have to pay the difference (for example, if a standard plan costs $37 per month, and they join a plan that costs $40 per month, they will have to pay the $3 difference each month). © 2006 United HealthCare Services, Inc.
  14. 14. Page title Page # Does your parent need to apply for extra help? 3.3.2 Does your parent need to apply for extra help? Some people will be automatically eligible for help with the cost of Medicare Part D plans and will not need to apply. People who are automatically eligible include: • People who are currently receiving both Medicare and Medicaid benefits, with prescription drug coverage. • People who receive both Medicare and Supplemental Social Security (SSI) benefits. • People whose Medicare premiums are paid by a state Medicaid program. Other people who don’t fall in these groups, but who also have limited resources and income, must apply for help. 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. © 2006 United HealthCare Services, Inc.
  15. 15. Page title Page # How to apply for extra help 3.3.3 How to apply for extra help Where to apply for help Your parent may have already received an application form in the mail. It’s called Application for Help with Medicare Prescription Drug Plan Costs (form SSA-1020) [http://www.ssa.gov/prescriptionhelp/Medicare%20App%20Form_1020_INST2.pdf]. Your parent can also get a form by calling 1-800-772-1213 between 7 a.m. and 7 p.m, Monday through Friday, TTY/TDD users should call 1-800-325-0778. To apply, fill out the form and send it to Social Security Administration, Wilkes-Barre Data Operations Center P.O. Box 1020 Wilkes-Barre, PA 18767-9910. They may also apply online on the Web at: www.socialsecurity.gov. Your parent will hear later whether they’ve qualified for extra help. After they’ve applied for help, they’ll still need to sign up for a specific Part D plan. A word about the form The application form asks questions about how much income your parent has and where it comes from (such as pensions, wages, investment income, or help from other people). The form also asks what resources or assets, such as real estate (other than parent’s home) and stocks, they own. It also asks if they are helping to support other people who live with them, such as children or grandchildren. The answers to some questions depend on their living arrangements. Some questions ask for information about the parent and their spouse, if they are married and living together. If they live with their spouse, be sure to answer all of the questions for both parents, even if their spouse isn’t applying for help. Read the form carefully, and be sure you understand what each question is asking before answering. How to fill out the Application for Help with Medicare Prescription Drug Plan Costs (form SSA-1020) A. Neatness counts. Fill out the form with care. Follow the instructions on Page 1. Print with capital letters so answers can be read easily. B. Answer for others. Adult children of Medicare beneficiaries can fill out this form for their parent if they know the Social Security number and financial information. They should give details in Section B on Page 6.
  16. 16. C. Just one parent or two? If parent is single, divorced, or widowed, or if their spouse doesn’t live with them, you can skip Question 2. Question 2 lets you indicate if they are applying as single or as a couple (e.g., perhaps your other parent is too young for Medicare). D. Question 3 is about the value of your parent’s assets. Assets include things like cash, bank accounts, stocks, bonds, and real estate, but not the house they live in. Assets don’t include vehicles, burial plots, or their personal possessions. Add up the total. If it is more than $11,500 for an individual or more than $23,000 for both parents, check the YES box. If the value is less, check NO. Only people who checked NO or NOT SURE need to complete the rest of the form. E. Question 4 collects details about your parent’s specific assets. There are boxes for pennies, but you don’t need to be that exact. It’s OK to round the values to the nearest whole dollar. F. Question 5 wants information about the value of insurance. You can get this information by calling your parent’s insurance agent or by looking at the value table of the policy. G. Questions 6 and 7 ask about money to be used for burial expenses and any real estate they may own. H. Question 8 looks complicated but it’s not. How many relatives are living with your parent and depend on them for at least half their financial support? Don’t count your parent(s). I. Questions 9 collects details about their monthly income. If the amounts change from month to month, give an average based on the past year. Check the NO box if they have no income from that source. J. Question 10 asks if your parent’s income from the sources named in Question 9 has gone down in the past two years. For example, have they stopped receiving income from a rental property, or was their alimony reduced? K. Question 11 wants to know if other people give your parent help with household expenses. If they’re not sure of the value of these services and can’t get that information from these people, enter your best guess. L. Questions 12 through 16 ask questions about money earned from working during the past two years. These questions are only for people who have worked in the past two years, or who live with a spouse who has worked in the past two years. If that doesn’t apply to your parent, skip these questions. Signatures looks intimidating but they just want you to confirm that you double checked figures and you’re telling the truth to the best of your knowledge. Page 7 is a reminder that government agencies share information, so if the information provided doesn’t match with other sources of information, your parent will hear from Social Security for an explanation. Mail the completed application to the address shown. Don’t include any attachments. If the reviewers need any extra information, they will contact your parent. Don’t forget to sign the form. Notification will come by mail. Social Security will review the application and send your parent a letter to let them know if they qualify for extra help. Social Security will call if more information is needed. Remember, your parent will still need to enroll in a Medicare-approved prescription drug plan. The enrollment period for 2006 begins Nov. 15, 2005. © 2006 United HealthCare Services, Inc.

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