1. Medicare Prescription Drug Coverage Tim Cutler, PharmD Marilyn Stebbins, PharmD Clinical Pharmacists Mercy Medical Group - a service of CHW Medical Foundation

2. Goals for Today: Part I  Understand your current prescription drug coverage  Understand your new options for prescription drug coverage  Describe the basic Medicare Prescription Drug Benefit  Know important dates to remember

3. Goals for Today: Part II  Determine if you are eligible for extra help to pay for the costs of your drugs  Know where to go to compare plans  Know your resources –Mercy Medical Group –Other

4. Medicare - What is it?  Medicare is available to: –65 and older –Permanently disabled  Medicare has 4 parts –A: Hospital coverage –B: Outpatient coverage (doctor visits) –C: Medicare Advantage (A and B coverage and often D) –D: Prescription Drug Coverage

5. What is Medicare Part C  Medicare Advantage Plans are part of Medicare  Medicare-covered health care provided by that plan  Plans can include prescription drug coverage  Most plans have extra benefits and lower copayments than traditional Medicare  You may have to use the plans doctors and hospitals  There may be an additional premium for these plans  Includes Managed Care Plans (i.e., Medicare HMO’s)

6. What is Medicare Part D  New Prescription Drug Benefit from Medicare  Starts January 1, 2006  Offers Brand and Generic coverage  Voluntary, must choose to enroll  Stand-alone benefit that can be combined with Part A and B and/or Medicare Supplements

7. What Coverage Do You Currently Have?  Traditional Medicare (Part A and B)  Medicare Supplemental Insurance (Medigap)  Retiree insurance coverage from a current or former employer or union  Medicare Advantage (Secure Horizons, Health Net Seniority Plus, WHA Care Plus, Kaiser)  Medicare and Medi-Cal  Tricare and VA benefits

8. I Have… Original Medicare only or original Medicare and a Medigap supplement WITHOUT drug coverage  I may choose to enroll in a Medicare Prescription Drug Plan And keep my original Medicare the way it is  Or I may choose to join a Medicare Advantage Plan Covers doctor, hospital care, as well as prescriptions *If I choose NOT to enroll by May 15, 2006 I will pay a penalty when I do join

9. I Have… Original Medicare and a Medigap supplement WITH drug coverage  I will receive a letter telling me whether my coverage is as good as Part D  The new Medicare Prescription Drug Plan is likely to be better than your existing policy 1.You can enroll in a Part D Prescription Drug Plan but you must tell your Medigap plan to remove the drug portion of your Medigap policy 2.Or I may choose to join a Medicare Advantage Plan Covers doctor, hospital care, as well as prescriptions

10. I Have… Retiree benefits with drug coverage through my (or my spouse’s) former employer or union  I will receive a letter from my former employer or union by November 15 This letter will tell me whether my coverage is as good as Part D and what I need to do If you do not hear from them, or have questions, call your benefits administrator  Do not sign up for Part D IF your current coverage is equal to or better than your employer or union  Some employers may not continue to offer a drug benefit or it may not be as good as Medicare If this is my situation, I may need to sign up with a Prescription Drug Plan to get medications covered

11. I Have… A Medicare Advantage Plan (Secure Horizons, Health Net Seniority Plus, WHA Care Plus, Kaiser)  Many of these plans will provide more coverage than Part D and at a lower cost  The current Medicare Advantage Plans in our area will now have brand and generic coverage 1. If you are an existing member and want to stay with your current plan, look for information in the mail about the new changes to your benefit and how you can sign up 2. If you would like to join a Medicare Advantage Plan you can request an information packet from the specific plan

12. I Have… Medicare and MediCal  Starting January 1, 2006, you will get your prescription coverage from Medicare instead of MediCal  You will have no premium, no deductible and pay $1 for generic and $3 for brand name medications (30-90 day supply) 1. You will be notified of the plan to which you have been assigned by Medicare  If you like the plan chosen, you will be auto-enrolled on January 1, 2006  You may choose to enroll in a different plan, but you must enroll by December 31, 2005

13. I Have… TRICARE or VA benefits  As long as you still qualify, your TRICARE, VA or FEHB prescription drug coverage is not changing  Contact your benefit administrator before making any changes  If you lose your TRICARE or VA benefit and enroll in a Medicare Prescription Drug Plan, you will not have to pay a penalty

14. What is Medicare Prescription Drug Coverage?  Covers drugs available only by prescription  Prescription drugs, biologicals, insulin  Medical supplies associated with injection of insulin  A prescription drug plan (PDP) or Medicare Advantage prescription drug (MA-PD) plan may not cover all drugs  Brand name and generic drugs will be in each formulary

15. Excluded Drugs  Drugs for –Anorexia, weight loss or weight gain –Fertility –Cosmetic purposes or hair growth –Symptomatic relief of cough and colds  Prescription vitamins and mineral products –Except prenatal vitamins and fluoride preparations  Non-prescription drugs  Barbiturates  Benzodiazepines

16. What is the Cost of Part D?  For minimum standard coverage in 2006, enrollees would pay –Monthly premium of about $25 –First $250 per year for prescriptions (“deductible”) –Part of the cost of prescriptions after $250 –5% of the drug costs (or small co-payment) after paying $3,600 out-of-pocket Cost = $550 per year in deductible and premiums, not including coinsurance

17. Basic Benefit Package Effective 2006  $300 annual premium  Patient pays 5% of drug costs  Patient pays 100% of drug costs  Patient pays 25% of drug costs  $250 deductible $2,850 Gap (“donut hole”)

18. Buyer Beware…  Every Prescription Drug Plan and Medicare Advantage Plan may vary –Monthly premiums –Deductible –Co-payment/Co-insurance Generic versus Brand versus Injectable versus non-covered –Coverage Gap “Donut Hole” –Coverage in the Coverage Gap

19. Important Dates  October 2005 –Medicare & You handbook mailed –Community outreach –Medicare Web site and 1-800-Medicare for plan comparisons  November 15, 2005 –First day you can join a plan  January 1, 2006 –Coverage begins for those who join by December 31, 2005  May 15, 2006 –Last day to join a plan offering prescription drug coverage for 2006

20. Medicare Prescription Drug Coverage Timeline  Join November 15 – December 31, 2005 –Coverage begins January 1, 2006  Join January 1 – May 15, 2006 –Coverage begins the month after you join  Join when first eligible, to pay lowest monthly premium –About $25/month in 2006

21. Goals for Today: Part II  Determine if you are eligible for extra help to pay for the costs of your drugs  Know where to go to compare plans  Know your resources –Mercy Medical Group –Other

22. Help for Those Who Need it Most  It is estimated that 1 in 3 people will qualify for extra help with Medicare Drug costs  Those with lowest incomes pay no premiums or deductibles; small or no co-payments  Those with slightly higher incomes pay a little more  Some people will automatically qualify  Others will get an application from Social Security

23. Eligibility for Extra Help  Income –Below 150% Federal poverty level $1,197 per month for an individual* or $1,604 per month for a married couple* Based on family size  Resources –Up to $11,500 (individual) –Up to $23,000 (married couple living together) 2005 amounts

24. Extra Help for Those with Limited Income and Resources  Level of help varies  However, all should apply that meet criteria  Call 1-800-SSA-1213 (1-800-772-1213) or go to socialsecurity.gov to apply socialsecurity.gov  Complete the application as soon possible  If you qualify, you need to join a plan this fall for your coverage to start January 1, 2006

27. Plan Comparison: What You Will Need  Your Medicare Number (on your Medicare Card)  The date you first enrolled (on your card)  Your zip code  Your medication list Write out the names or get a printout from your pharmacy  Your pharmacy

28. Plan Comparison: Where Do I Go?  Go to medicare.gov if you use a computer and find “Plan Comparison”medicare.gov –Find a family member, friend, or advocate to help if you need it, OR  Call 1-800-Medicare (1-800-633-4227) and a representative can assist you –TTY users should call 1-877-486-2048, OR  Mercy Medical Group patients may make an appointment for assistance with PRICE Clinic, OR  HICAP: 1-800-434-0222