Medicare D and the Affordable
Care Act
BUCKY BROADRICK
PHARMD, MA, LAPC
Why am I here?
 Born in Dalton

 Graduated from UGA College of

Pharmacy 2005
 Several Years as pharmacist
 2008-2013 ...
What is Part D?
 Part A, hospital services, is free if either you

or your spouse paid Medicare payroll taxes
for at leas...
When am I eligible?
 You are eligible for Medicare when you turn 65.
 If you are already taking Social Security

benefit...
Enrollment Periods
 General Enrollment for Part B
 Jan 1- March 31- 10% penalty for life for ea 12-month
period delay
 ...
Part C????
 Medicare Advantage Plans

 Monthly Cost in Addition to Part B

Premium
 No need for Part D or MEDIGAP
 Sub...
Medigap
 For traditional Medicare can sign up for a







Medigap supplemental to help cover
deductibles, co-paymen...
BASIC PART D-ESIGN
Coverage Phase

Part D Plan Pays

You Pay

Annual Ded ($310)

$0

100% ($310)

Coverage Period

75% of ...
Phase 1 Deductible….Phase 2 Initial Coverage
 100% of Drug Cost…..$310 in 2014

 Phase 2- 25% of total drug Costs…drug

...
Phase 3-Coverage GAP AKA Donut Hole
 Total Drug cost exceeds $2850

 Cost sharing
 47.5% of covered brands
 72% of cov...
Phase 4- Catastrophic Coverage
 5% of covered drug cost

 Begins when you reach out-of-pocket

threshold ( 4,550 in 2014...
medicare.gov plan finder
 www.medicare.gov
 It’s easy!
Affordable Care Act for Seniors
 First Year- Received a one-time, tax-

free $250 rebate help pay for
prescriptions
 The...
ACA for Families
 Teens /Young Adults….under the age of 26

 Children Pre-existing Conditions
 Under

age 19 for new in...
ACA for Women and Pregnancy
 No longer can deny or exclude coverage to






baby for job-based and individual plans
...
Resources
 www.medicare.gov

 www.healthcare.gov - market place
 www.pcip.gov - pre-existing condition

insurance
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Medicare Part D Selection and Affordable Care Act Info

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Bucky Broadrick, licensed pharmacist and associate counselor for The Rapha House, presented this information recently on Medicare Part D and the Affordable Care Act. Feel free to contact The Rapha House with your questions. To contact us call 706-264-1920 or visit www.theraphahouse.org

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  • If you missed signing up for Part B during that initial enrollment period and you aren't working, you can sign up for Part B during the general enrollment period that runs from January 1 to March 31 and coverage will begin on July 1. But you will have to pay a 10% penalty for life for each 12-month period you delay in signing up for Part B. Those who are still working, though, can sign up later without penalty during a special enrollment period, which lasts for eight months after you stop working (regardless of whether you have retiree health benefits or COBRA). If you miss your special enrollment period, you will need to wait to the general enrollment period to sign up. Open enrollment, which runs from October 15 to December 7 every year, allows you to change Part D plans or Medicare Advantage plans for the following year, if you choose to do so. (People can now change Medicare Advantage plans outside of open enrollment if they switch into a plan given a five-star quality rating by the government
  • Medicare Advantage, which offers comprehensive coverage through private insurance companies. Technically Part C, Medicare Advantage has a monthly cost, in addition to the Part B premium, that varies depending on which plan you choose. With Medicare Advantage, you don't need to sign up for Part D or buy a medigap policy. Like traditional Medicare, you'll also be subject to co-payments, deductibles and other out-of-pocket costs, although the total costs tend to be lower than for traditional Medicare. In many cases, Advantage policies charge lower premiums but have higher cost-sharing. Your choice of providers may be more limited with Medicare Advantage than with traditional Medicare.
  • http://www.cahealthadvocates.org/drugs/overview.html#Types
  • Medicare Part D Selection and Affordable Care Act Info

    1. 1. Medicare D and the Affordable Care Act BUCKY BROADRICK PHARMD, MA, LAPC
    2. 2. Why am I here?  Born in Dalton  Graduated from UGA College of Pharmacy 2005  Several Years as pharmacist  2008-2013 Masters of Arts in Professional Counseling- Richmont Graduate School Chattanooga  Part time at The Rapha House
    3. 3. What is Part D?  Part A, hospital services, is free if either you or your spouse paid Medicare payroll taxes for at least ten years  Part B covers doctor visits and outpatient services-- for most people in 2013 is $104.90/month  Part D, which covers prescription drug costs, the average Part D premium is $30+/ month.  subject to co-payments, deductibles and other out-of-pocket costs.
    4. 4. When am I eligible?  You are eligible for Medicare when you turn 65.  If you are already taking Social Security benefits, you will be automatically enrolled in Parts A and B.  For those who have not started Social Security, sign yourself up for Parts A and B, or Medicare Advantage.  seven-month initial enrollment period – 3 and 3  People still working may want to delay signing up for Medicare, but they will need to follow the rules carefully to avoid significant penalties when they do eventually enroll.
    5. 5. Enrollment Periods  General Enrollment for Part B  Jan 1- March 31- 10% penalty for life for ea 12-month period delay  Still Working- Special Enrollment  8 months after you stop working  Open Enrollment  Every Year October 15- December 7th  Change Part D plan or Medicare Advantage Plan  NOTE: PDP = Prescription Drug Plan  MA-PD- Medicare Advantage Plan w/ Drug
    6. 6. Part C????  Medicare Advantage Plans  Monthly Cost in Addition to Part B Premium  No need for Part D or MEDIGAP  Subject to Co-Payments, Deductibles, and Out-of- Pocket  May LIMIT Providers  Lower Premiums, Higher Cost Sharing
    7. 7. Medigap  For traditional Medicare can sign up for a      Medigap supplemental to help cover deductibles, co-payments and other gaps. You can switch at at anytime Charged or denied if you choose or change >6 months after signing up for part B Identified by letters A through F Plan F most popular, most comprehensive http://www.medicare.gov/find-aplan/questions/medigap-home.aspx
    8. 8. BASIC PART D-ESIGN Coverage Phase Part D Plan Pays You Pay Annual Ded ($310) $0 100% ($310) Coverage Period 75% of 2,450 ($1905) 25% of 2,450 ($635) Coverage GAP (DONUT HOLE) $0 (discount on brands 50%, 28% on generics) 47.50% of Brand Drugs + dispensing fee 72% of covered generics 95% of drug cost - copay Greater of 5% of drug cost or $2.55 generic or $6.35 for brand Drug Plan + COSTS > $2850 Catastrophic Coverage (total annual drug cost
    9. 9. Phase 1 Deductible….Phase 2 Initial Coverage  100% of Drug Cost…..$310 in 2014  Phase 2- 25% of total drug Costs…drug plan pays 75% of Drug Costs
    10. 10. Phase 3-Coverage GAP AKA Donut Hole  Total Drug cost exceeds $2850  Cost sharing  47.5% of covered brands  72% of covered generics  Discount and Subsidy will increase until 2020 til you only pay 25% of drug costs in Donut Hole
    11. 11. Phase 4- Catastrophic Coverage  5% of covered drug cost  Begins when you reach out-of-pocket threshold ( 4,550 in 2014)  Sum of deductible, 25% of coinsurance, and drug costs plus manufacture’s discounts in Donut Hole
    12. 12. medicare.gov plan finder  www.medicare.gov  It’s easy!
    13. 13. Affordable Care Act for Seniors  First Year- Received a one-time, tax- free $250 rebate help pay for prescriptions  The reduction in donut hole cost sharing  Preventive Services  Yearly Wellness Exam  Every Five years- Free Cardio Exam,  Every Year-Mammogram, Colorectal, Cervical, Prostate Screen, Flu Shot
    14. 14. ACA for Families  Teens /Young Adults….under the age of 26  Children Pre-existing Conditions  Under age 19 for new individual and jobbased plans  No Lifetime Limits  Preventive Care- Vaccines for kids, well visits, etc  Accountability to Insurers – premiums on healthcare vs. bonuses,advertising….justify rate hikes
    15. 15. ACA for Women and Pregnancy  No longer can deny or exclude coverage to     baby for job-based and individual plans Starting 2014, pregnancy and newborn care will be covered in all individual, smallbusiness, and Exchange Plans Job-based can’t exclude or deny for pregnancy No-out-of pocket for mammogram and birth control In 2014, can’t charge women more for insurance premiums
    16. 16. Resources  www.medicare.gov  www.healthcare.gov - market place  www.pcip.gov - pre-existing condition insurance

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