Medicare/Medicaid Beneficiaries & Medicare Part D

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Presentation transcript:

Medicare/Medicaid Beneficiaries & Medicare Part D

Beneficiary Issues and Concerns Will I get the drugs I need when I need them? What happens to me if there are “glitches” in the system? I’m in a nursing home – what do I do?

Will I Get the Drugs I Need – When I Need them? The overriding question Random auto-enrollment into 1 of ? plans Will my drug needs be matched with plan formularies? How? Who? How do I “switch” to a plan that covers my drugs? I get a formula denial, now what? And how do I get my drugs while appealing?

Will I get the drugs I need – When I need them? Medicaid v. Medicare New co pays with different rules Amounts Rules Medicare doesn’t cover drugs I used to get under Medicaid Medicaid picks them up so now I have 2 cards

“Glitches” In the system— What happens to me? Formulary Denials Co pays Waiting for Appeals Who’s helping me with my drugs and medical care?

I’m in a Nursing Home – What Do I Do? Random Enrollment Formula Transitioning I take a lot of drugs – what happens to me when my drugs change? What will my nursing home do?

Conclusion Work together to smooth transition not only for systems but for beneficiaries Know that “problems” will arise that will threaten health and well-being of beneficiaries Monitor and address the problems