Medicare Prescription Drug Coverage

What’s Different About Prescription Drug Information? One size does not fit all, more than ever before Distinct messages and desired actions vary by audience More focus on segmenting information into “bite-size” chunks Useful materials needed for expanded local outreach efforts One size does not fit all, more than ever before Distinct messages and desired actions vary by audience More focus on segmenting information into “bite-size” chunks Useful materials needed for expanded local outreach efforts

Target Audiences General Population Employer/Union Population Limited Income and Resources (LI/R) Population Long-term Care Population General Population Employer/Union Population Limited Income and Resources (LI/R) Population Long-term Care Population

General Population Medicare Fee-For-Service –A&B only –Medigap –Private Fee-For-Service (PFFS) Medicare Managed Care –Medicare Advantage Plans (HMO and PPO) Goal: Engage and Enroll Medicare Fee-For-Service –A&B only –Medigap –Private Fee-For-Service (PFFS) Medicare Managed Care –Medicare Advantage Plans (HMO and PPO) Goal: Engage and Enroll

Meet the General Population Original Medicare 13 million Medigap A-K 6.35 million Medigap H-J 1.9 million Prestandardized plans/state 2.75 million Medicare Advantage 4.1 million 3.2 million RX coverage (addl: 800,000 in employer plans) Cost Plans 326,000 Private Fee For Service 77,108 Medicare Savings Accounts *All numbers are estimates

The Total General Population Needs to Know… Coverage starts Jan 2006 Enroll in a plan to get coverage Enroll now to pay lower premiums Waiting to enroll means you can’t enroll until the next enrollment period Compare your current coverage with Medicare Prescription Drug Plans or Managed Care Plans with Prescription Drug Coverage Coverage starts Jan 2006 Enroll in a plan to get coverage Enroll now to pay lower premiums Waiting to enroll means you can’t enroll until the next enrollment period Compare your current coverage with Medicare Prescription Drug Plans or Managed Care Plans with Prescription Drug Coverage

The Fee-For-Service and Medigap Population Needs to Know… You can drop the prescription part of your policy and join a Medicare Prescription Drug Plan (PDP) You can enroll in a PDP and still have Medigap (or PFFS) without drug coverage Most Medigap coverage is not at least as good as Medicare Prescription Drug Coverage (not creditable) You can drop the prescription part of your policy and join a Medicare Prescription Drug Plan (PDP) You can enroll in a PDP and still have Medigap (or PFFS) without drug coverage Most Medigap coverage is not at least as good as Medicare Prescription Drug Coverage (not creditable)

The Managed Care Population Needs to Know… If you currently have drug coverage, you can stay in your plan and have Medicare Prescription Drug Coverage If you do not have drug coverage, you can stay in your plan and add Medicare Prescription Drug Coverage If you currently have drug coverage, you can stay in your plan and have Medicare Prescription Drug Coverage If you do not have drug coverage, you can stay in your plan and add Medicare Prescription Drug Coverage

Key Dates RX Card Enrollee Letter (September*) CMS Selects Plans (9/15/05) Medigap Plans Send Creditable Coverage Notice (9/15/05-11/15/05) Media Ads (~Fall, 2005) Drug Plans Begin Marketing (10/1/05) Plan information on (10/13/05) Medicare & You Pr ing (TBD) Medicare & You Handbook (10/15/05) Medicare Advantage Annual Notice of Change (10/31/05) Media Ads (~Spring, 2006) RX Card Enrollee Letter (September*) CMS Selects Plans (9/15/05) Medigap Plans Send Creditable Coverage Notice (9/15/05-11/15/05) Media Ads (~Fall, 2005) Drug Plans Begin Marketing (10/1/05) Plan information on (10/13/05) Medicare & You Pr ing (TBD) Medicare & You Handbook (10/15/05) Medicare Advantage Annual Notice of Change (10/31/05) Media Ads (~Spring, 2006)

Meet the E/U Population 11.4 million people (33% of the Medicare 65+ population) 11.4 million people (33% of the Medicare 65+ population) This group: Already has coverage and must make a decision Can be reached through their employers or unions Should be encouraged to check with their benefits administrator This group: Already has coverage and must make a decision Can be reached through their employers or unions Should be encouraged to check with their benefits administrator

Meet the E/U Population Includes: People covered by full Employer Subsidy People covered by plans that will supplement Medicare Prescription Drug Coverage SPAP members Crossover group who are eligible for both Employer Subsidy and extra help Crossover group who get coverage from an employer that works with an MA plan Active employees and spouses of active employees Includes: People covered by full Employer Subsidy People covered by plans that will supplement Medicare Prescription Drug Coverage SPAP members Crossover group who are eligible for both Employer Subsidy and extra help Crossover group who get coverage from an employer that works with an MA plan Active employees and spouses of active employees

Meet the E/U Population Employment-based retiree drug coverage 11.4 million Coverage by a plan eligible for the Medicare retiree drug subsidy 9.8 million Enrolling in a Medicare prescription drug plan and receiving additional coverage through employer or union 400,000 Enrolling in a Medicare prescription drug plan and receiving additional financial help through employer or union 1.3 million

Contact your benefits administrator to see if your coverage is as good as Medicare Prescription Drug Coverage (creditable) What you do next depends on that answer You may be able to keep your current coverage If you don’t enroll; you may pay higher premiums later If you do enroll, you can’t get coverage back If you want to stay in an MA plan, you must get drug coverage through that plan. Contact your benefits administrator to see if your coverage is as good as Medicare Prescription Drug Coverage (creditable) What you do next depends on that answer You may be able to keep your current coverage If you don’t enroll; you may pay higher premiums later If you do enroll, you can’t get coverage back If you want to stay in an MA plan, you must get drug coverage through that plan. The E/U Population Needs to Know

If Coverage Is as Good … They Need to Know You can keep current coverage and not worry about paying higher premiums for Medicare Prescription Drug Coverage in the future You can choose to enroll in Medicare Prescription Drug Coverage –But, it is possible you won’t be able to get back into your employer/union coverage You can keep current coverage and not worry about paying higher premiums for Medicare Prescription Drug Coverage in the future You can choose to enroll in Medicare Prescription Drug Coverage –But, it is possible you won’t be able to get back into your employer/union coverage

If Coverage is NOT as Good … They Need to Know You can enroll in Medicare Prescription Drug Coverage Same messages as for General Population You can enroll in Medicare Prescription Drug Coverage Same messages as for General Population

Key Dates Creditable Coverage “Notice” from Employer/Unions (Now - 11/15/05) Fact sheets available on (April 2005) Creditable Coverage “Notice” from Employer/Unions (Now - 11/15/05) Fact sheets available on (April 2005)

Full-benefit dual eligibles, MSP, SSI Income <150% FPL Goal: Engage, Encourage Application, Enroll Full-benefit dual eligibles, MSP, SSI Income <150% FPL Goal: Engage, Encourage Application, Enroll Limited Income and Resources (LI/R) Population

Two Groups Those who automatically qualify for extra help: –Full-Duals with Drug Coverage, MSP, SSI –Goal: Engage, Enroll Those who must apply to receive extra help: –<150% Federal Poverty Level –Goal: Engage, Encourage Application, Enroll Those who automatically qualify for extra help: –Full-Duals with Drug Coverage, MSP, SSI –Goal: Engage, Enroll Those who must apply to receive extra help: –<150% Federal Poverty Level –Goal: Engage, Encourage Application, Enroll

Meet the LI/R Population Eligible for assistance14.4 million Enroll for Assistance10.9 million Full-benefit dual eligibles6.3 million Medicare Savings Programs with income below 135% of FPL 3 million Income under 150% of FPL1.6 million *All numbers are estimates

Your Medicaid coverage ends 1/1/06 Your coverage will come from a Medicare Prescription Drug Plan starting 1/1/06 You’ve been assigned to X plan You can switch plans to meet your needs Your Medicaid coverage ends 1/1/06 Your coverage will come from a Medicare Prescription Drug Plan starting 1/1/06 You’ve been assigned to X plan You can switch plans to meet your needs Those Who Automatically Qualify Need to Know…

Those Who Must Apply Need to Know… Benefits of applying for extra help Apply for extra help (including how to apply) You must enroll in a plan to receive coverage If you don’t enroll, you’ll be assigned to a plan in spring 2006 How their SPAP (if they have one) works with Medicare Prescription Drug Coverage Benefits of applying for extra help Apply for extra help (including how to apply) You must enroll in a plan to receive coverage If you don’t enroll, you’ll be assigned to a plan in spring 2006 How their SPAP (if they have one) works with Medicare Prescription Drug Coverage

Key Dates tool (4/21/05) CMS notice to those who automatically qualify (full-benefit dual eligibles, MSP, except in FL, IL, MD, SC, VT, WI) (mid-May) SSA application to potential eligibles (5/27/05-8/16/05) CMS notice to SSI-only and other deemed in FL, IL, MD, SC, VT, WI (mid-June) tool (4/21/05) CMS notice to those who automatically qualify (full-benefit dual eligibles, MSP, except in FL, IL, MD, SC, VT, WI) (mid-May) SSA application to potential eligibles (5/27/05-8/16/05) CMS notice to SSI-only and other deemed in FL, IL, MD, SC, VT, WI (mid-June)

Key Dates SSA application for extra help available online (7/1/05) SSA begins processing applications (7/1/05) CMS mails plan assignment notice to full-benefit dual eligibles (fall 2005; effective 1/1/06) SSA application for extra help available online (7/1/05) SSA begins processing applications (7/1/05) CMS mails plan assignment notice to full-benefit dual eligibles (fall 2005; effective 1/1/06)

Key Dates Medicaid drug coverage ends; Medicare drug coverage begins (1/1/06) CMS mails plan assignment notice (spring 2006; effective 6/1/06) SSA online help available now! ons/medicareoutreach2/ Medicaid drug coverage ends; Medicare drug coverage begins (1/1/06) CMS mails plan assignment notice (spring 2006; effective 6/1/06) SSA online help available now! ons/medicareoutreach2/

Meet the LTC Population 1.3 million people (4% of the Medicare 65+ population) Short-term LTC residents from hospital or home to a LTC facility from a skilled nursing facility (Part A) stay to Medicaid or private stay from LTC facility to assisted living or home transition from hospice to Part A care *continuity of care is a concern Long-term LTC residents full dual eligibles or deemed (inc. MSP, SSI/Medicaid) 1.3 million people (4% of the Medicare 65+ population) Short-term LTC residents from hospital or home to a LTC facility from a skilled nursing facility (Part A) stay to Medicaid or private stay from LTC facility to assisted living or home transition from hospice to Part A care *continuity of care is a concern Long-term LTC residents full dual eligibles or deemed (inc. MSP, SSI/Medicaid) *All numbers are estimates

The LTC Population Needs to Know… Key Beneficiary Messages Because LTC populations encompass other populations (i.e., limited income, retirees with employer plan benefits, etc.), messages are derived from general/specific population messages and targeted as appropriate. *Outreach Methods Are The Difference Key Beneficiary Messages Because LTC populations encompass other populations (i.e., limited income, retirees with employer plan benefits, etc.), messages are derived from general/specific population messages and targeted as appropriate. *Outreach Methods Are The Difference

Key Dates Release of Long-term Care and Transition Process Guidance (3/16/05) Nursing Home Resident Fact Sheet available at (May 2005) Release of Long-term Care and Transition Process Guidance (3/16/05) Nursing Home Resident Fact Sheet available at (May 2005)

Message Discipline: Never deviate from tested, uniform message

Messaging Overall Messages Drug coverage that helps you pay for the prescriptions you need. Medicare prescription drug coverage is available to all People with Medicare. There is additional help for those who need it most. The Medicare prescription drug coverage pays for brand name as well as generic drugs.

Messaging Choice You can choose between at least two Medicare prescription drug plans and pick a plan that meets your needs.

Current Terminology For Low-Income Subsidy –Extra help with drug plan costs –Limited income and resources –Apply To get Medicare Prescription Drug Coverage –Join, enroll, sign up

Current Terminology Miscellaneous List of drugs the plan covers At least 1% more for every month you waited to get a Medicare prescription drug plan, or you will pay more, or higher premium People with Medicare [and Medicaid] Personalized [Counseling] $3600 out-of-pocket Long-term care facility, like a nursing home Complaint

Terminology Consistency: Please Help Us! Visit often for the most recent preferred terms

Remember This isn’t like traditional Medicare where they will get a Medicare card in the mail To get the new drug benefit, people with Medicare must enroll To get the best deal, they should enroll on time To enroll, they’ll need to choose a plan