1. The New Medicare Prescription Drug Coverage
April-May, 2006
Medicare D Prescription Drug Coverage Module # 2 Jayashri Sankaranarayanan PhD Assistant Professor Department of Pharmacy Practice, College of pharmacy University of Nebraska Medical Center Phone:
Welcome to module two on the new Medicare Prescription Drug Coverage.
I am Dr. Jayashri Sankaranarayanan, an Assistant Professor from the University of Nebraska College of Pharmacy and will be talking about Medicare for the mini-fellowship online modules administered by the University of Nebraska Geriatrics Education Center.
If you have not completed module one of this unit, please close out of this module, do unit one on “Medicare Basics,” and then return here.
Jayashri Sankaranarayanan, Ph.D.

2. The New Medicare Prescription Drug Coverage
April-May, 2006
PROCESS
A series of modules and questions
Step #1: Power point module with voice overlay
Step #2: Case-based question and answer
Step # 3: Proceed to additional modules or take a break
Our process will be to review the topic of “Medicare: Basics, the New Medicare Prescription Drug Coverage, and Beneficiary scenarios” on PowerPoint modules with voice overlay. This will be followed by case-based questions with answers to explain the right and wrong answers. Then you will have the option to continue with the next module on Medicare Beneficiary Cases or take a break at that time. The learner is recommended to complete a module before disengaging.
When the module and questions are completed, click on “Mark Reviewed” on the main page of the minifellowship to indicate your completion.
Jayashri Sankaranarayanan, Ph.D.

3. The New Medicare Prescription Drug Coverage
April-May, 2006
Objectives
Upon completion, the learner will be able to:
Describe the New Medicare Prescription Drug Coverage (Part D) in terms of:
Eligibility criteria
Enrollment process
Plan’s Cost-Benefit structure (>150% FPL, <150%FPL)
Drugs covered and not covered
Calendar Events
Five important things for enrollment
Actual steps to join and pay
2. List resources and references for continually learning and updating about Medicare Part D
This module was designed to help you to describe the new Medicare Prescription Drug Coverage in terms of Eligibility criteria, Enrollment process, Plan’s Cost-Benefit structure (>150% FPL, <150%FPL), Drugs covered and not covered, Calendar Events, Five important things for enrollment and actual steps to join and pay.
Secondly, you can be a life-long self-learner using the resources and references given at the end of this module, that will help you and beneficiaries continually learn and update yourselves about Medicare Part D.
Jayashri Sankaranarayanan, Ph.D.

4. The New Medicare Prescription Drug Coverage
April-May, 2006
Medicare Basics
Federal health insurance program Who is eligible?
Aged 65 years, disabled under 65, chronic/end-stage renal disease
Medicare
Part A
Hospital Insurance
Automatic at 65
Part B
Medical Insurance
Voluntary
As we saw in Module 1, Medicare was created by Congress in It is a federally established national health insurance program for people 65 years of age and older, some disabled (under 65 years) who have been receiving Social Security for a set amount of time (24 months in most cases) or people with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a transplant). ( I DELETED THE SENTENCE ON CMS, IT IS NOT NEEDED HERE, YOU HAVE OUTLINED THAT PREVIOIULSY) Original Medicare has two parts Part A and B. Medicare pays for mainly hospital services, skilled nursing facilities, and hospice and home health care services through Part A. Part B of Medicare also known as Supplemental Medical Insurance covers outpatient physician visits, and other durable medical equipment. Drugs administered during hospital or physician visits are covered by Part A and Part B respectively.
Most people do not have to pay premium for Medicare Part A. For Medicare Part B (Medical Insurance) people pay a monthly premium ($88 per month in 2006). They also pay an amount for health care each year (a deductible) before Medicare pays its part( I WOULD DELETE THIS PRIOR SENTENCE ON PAYMENT AS THIS WAS OUTLINED IN MOD ONE).
Though Medicare gives high provider choice so a beneficiary can go to a provider anywhere in USA, it does have gaps in coverage for example it does not cover outpatient prescription drugs, annual, eye and dental examinations. Some people have Medigap to cover these gaps in original Medicare coverage while others might have Medicare Advantage (MA) that used to be called Medicare + Choice. The change in name to MA is part of the Medicare Prescription Drug, Improvement and Modernization Act of 2003, also called the Medicare Modernization Act or MMA.
ALSO UNDER MMA, FOR THE FIRST TIME IN 40 YEARS AFTER ITS INCEPTION, MEDICARE IS OFFERING PRESCRIPTION DRUG COVERAGE THAT WILL COVER OUTPATIENT PRESCRIPTION DRUGS FOR BENEFICIARIES STARTING JANUARY 1, 2006.
NEW Prescription Drug Coverage (Jan 1, 2006) under
the Medicare Modernization Act of 2003; ( Voluntary)
Jayashri Sankaranarayanan, Ph.D.

5. Context for New Medicare Drug Law
The New Medicare Prescription Drug Coverage
April-May, 2006
Context for New Medicare Drug Law
Seniors rely heavily on prescription drugs
98% of seniors nationwide take prescription drugs
(46%) take 5 or more prescriptions per month
Many lack prescription drug coverage
43% lack drug coverage for the full year or part year
Drug coverage matters
Among seniors with heart failure, diabetes, or hypertension, those without drug coverage skip doses of medicine at twice the rate of those with drug coverage
Annual Medicare beneficiary out-of-pocket drug
-rising from $600 in 2000,
to $999 in 2003,
to an estimated $1,457 in 2006
About 98% of seniors nationwide take prescription drugs and nearly half take 5 or more prescriptions per month. Thus, seniors rely heavily on prescription drugs. However, about 43% lack prescription drug coverage for the full or part of the year. Since seniors with heart failure, diabetes, or hypertension, those without drug coverage skip doses of medicine at twice the rate of those with drug coverage, we know, drug coverage does matter. We know about 18% of non-institutionalized seniors do not have prescription drug coverage. Further, the annual Medicare beneficiary out- of-pocket drug spending has been rising from $600 in 2000, $999 in 2003, to an estimated $1,457 in 2006.
All these explain the context of the new Medicare Drug Law of Medicare Modernization Act of 2003.
SOURCES: Stuart and Briesacher, estimates based on 2000 MCBS; Kaiser/Commonwealth/Tufts-New England Medical Center 2003 National Survey of Seniors and Prescription Drugs; Out-of-pocket spending data for 2006 from Congressional Budget Office, July 2004.
Jayashri Sankaranarayanan, Ph.D.

6. The New Medicare Prescription Drug Coverage
April-May, 2006
Medicare Prescription Drug Improvement, and Modernization Act of 2003 (MMA)
Fundamental changes in Medicare
Prescription drug coverage; “Seniors to have the choice of a health care plan that provides prescription drugs”
More flexibility;
– managed care plans, (e.g., HMOs, PPOs)
“All seniors to have the option of a subsidized prescription drug benefit”
Budget of $400 billion over 10 years to reshape Medicare
Bush, State of the Union address, 2003
The Medicare Prescription Drug Improvement, and Modernization Act of (MMA) sought to make fundamental changes in Medicare to provide seniors prescription drug coverage that affords wide choice of plans, flexibility in type of plans and subsidized options to help beneficiaries save on prescription drug costs.
A budget of $400 billion is being used to reshape Medicare over 10 years.
Jayashri Sankaranarayanan, Ph.D.

7. The New Medicare Prescription Drug Coverage
April-May, 2006
Medicare Part D
New Medicare outpatient prescription drug coverage
Available to ALL Medicare beneficiaries (with Part A and/or Part B)
&
Provided by Medicare approved private
insurance companies.
Joining a Medicare Drug Plan is:
Beneficiary choice (Voluntary)
but have to enroll (not Automatic)
One of the most important provisions of the Medicare Modernization Act is the creation of prescription drug coverage in the Medicare program.
Since Jan 1, 2006, the new Medicare prescription Drug coverage has been available to all Medicare beneficiaries (with Part A and/or Part B). All Medicare beneficiaries are eligible regardless of income, or health status.
The new Medicare prescription Drug coverage will be provided by health/drug plans from private companies that have been approved by Medicare. Since many of these private companies are competing with each other, this is expected to reduce the overall cost for beneficiaries.
Importantly, joining a Medicare Drug Plan is the beneficiary’s choice and enrollment is VOLUNTARY BUT NOT AUTOMATIC (EXCEPT FOR THOSE WHO ARE COVERED BY BOTH ON MEDICARE AND MEDICAID ( CALLED “DUAL ENROLLED”).
Many beneficiaries have already enrolled to get prescription drug coverage like any other type of insurance like auto or property. ( I RECOMMEND TO DELELTE THIS LAST SENTENCE AS IT DOES NOT ADD INFO)
Jayashri Sankaranarayanan, Ph.D.

8. The New Medicare Prescription Drug Coverage
April-May, 2006
Cost Sharing Principles and Plans
Cost Sharing Out of pocket A. Monthly premium B. Annual deductible C. A fixed co-payment or a percent coinsurance for each drug on the formulary NEBRASKA ~42 prescription drug plans (PDPs) covers outpatient drugs only Few Medicare Advantage - Prescription Drug plans (MA-PDs) covers drugs and other health services
All plans operate on cost-sharing principles meaning the beneficiary pays a monthly premium, annual deductible and a fixed co-payment or a percent coinsurance for each drug on the formulary. As you know, formulary is a list of drugs covered by a plan.
As in other states, in Nebraska beneficiaries can choose from AROUND stand alone prescription drug plans (called PDPs) that offer only prescription drug coverage. Beneficiaries can also choose from a few Medicare Advantage (MA-PDs), WHICH IS A prescription drug plans, that covers prescription drugs and other health services in a single package. The MA-PDs are usually offered by HMOs (Health Maintenance Organizations), and PPOs (Preferred Provider Organizations).
HMO and PPO plans may not be national but may be local or regional plans. They work on the concept of offering low cost options but less provider choice. This may be preferred by beneficiaries who like low cost plans that cover many services including prescription drugs all in one package.
Jayashri Sankaranarayanan, Ph.D.

9. The New Medicare Prescription Drug Coverage
April-May, 2006
There are 2 ways to understand the cost-benefit structure of the new Medicare Part D plans.
One for standard Medicare beneficiaries who are above the 150% federal poverty level and second for those below the 150% federal poverty level also known as those with limited income and resources or low income beneficiaries or those eligible for extra help. The second category also includes the dual eligibles (on Medicare and Medicaid) and those qualifying for extra help.
Remember, we talked earlier about cost sharing principles of the plans. Please note that this slide is about the standard benefit for beneficiaries above 150% federal poverty level. Under the standard cost-benefit structure, most Medicare plans feature first an out of pocket cost of $250 as deductible, after which the insurance kicks in and beneficiary pays 25 percent co-insurance for drug costs between $250 and $2250 and Medicare pays 75%. Then in the coverage gap (popularly known as the donut hole) when the beneficiary’s total drug cost reach $2250, the beneficiary pays 100% of drug costs. (JS, NOTE THE SLIDE SAYS $2,850 AND THE NARRATIVE SAYS $2250, PLEASE RECONCILE). When the beneficiaries reach $5100 in total drug costs and ($3,600 in patient’s drug cost spending), the catastrophic coverage kicks in and beneficiaries pays 5% of the drug costs and Medicare pays 95%. All these costs are considered out-of-pocket costs and will be tracked by the Medicare plan.
Please note that if a beneficiary wants to get protection and coverage from a Medicare plan in the donut hole or in the gap, they can get this coverage by paying higher premiums and/or deductibles.
Jayashri Sankaranarayanan, Ph.D.

10. Medicare Part D benefit for those with limited income and resources
The New Medicare Prescription Drug Coverage
Medicare Part D benefit for those with limited income and resources
April-May, 2006
Annual Income: less than $14,355 (single) / $19,245 (married, living with spouse) and
Limited resources: less than $11,500 (single) / $23,000 (married, living with spouse)
Premium Deductible Co-payment_______
Duals in Nursing homes
or Long term Care or ALFs in NE No No No
Less than 100% FPL*, ** No No $1 per Generic drug
$3 per Brand drug Nil at $3600 Oop
100% - 135% FPL*, **,*** No No $2 per Generic drug
$5 per Brand drug Nil at $3600 Oop
135% -150% FPL*** Based on $ % of drug costs sliding scale for each Rx;
$2 per Generic drug,
$5 per Brand on reaching $3600 Oop
FPL = Federal Poverty Level , ALF = Assisted Living Facility
* Automatically qualify, **Dual (Medicare + Medicaid), Social Security Income, State pays Medicare
premiums,*** Need to apply and qualify for extra help, Oop = Out of pocket expenses
Next, under the Medicare drug benefit for limited income and resources, many people with limited income and resources will get extra help paying for prescription drugs. THE DECISIONS ARE MADE BASED ON on the federal poverty level in , as shown here,
As you can see here, people with the lowest incomes (below 135% federal poverty level, FPL) will pay no premiums or deductibles and have small ($1 and $3 or $2 and $5 per generic and brand drug) co-payments or no co-payments (“duals” in nursing homes/long term care, LTC and assisted living facilities in Nebraska).
Those with slightly higher incomes ( %FPL) will have a premium based on a sliding scale, reduced deductible ($50) and pay a little bit more out of pocket at about 15% coinsurance i.e. pay 15% of the drug costs.
After reaching the catastrophic coverage by spending $3600 in drug costs, the beneficiaries below 135% pay no co-payments while those in %FPL range will pay $2 and $5 co-payments per generic and brand respectively.
Remember though that in this group there are duals (on Medicare and Medicaid) who automatically qualify and are auto-enrolled and then there are some who need to apply to Social Security Administration (SSA) to qualify and then enroll in a plan too.
Jayashri Sankaranarayanan, Ph.D.

11. New Medicare Prescription Benefit
The New Medicare Prescription Drug Coverage
April-May, 2006
New Medicare Prescription Benefit
PDP & MA-PD: Formulary drug selection
The United States Pharmacopeia (USP) created a model formulary with 146 unique therapeutic categories and pharmacologic classes.
The MMA mandated that participating plans must cover at least two drugs per therapeutic category.
More than one drug be covered to treat a condition in most cases
Formularies may have extensive tiering structures employing step therapy, prior authorization, and other methods to control drug spending.
The PDP and MA-PD plan formularies have guidance from United States Pharmacopeia (USP), which was commissioned by Center for Medicare and Medicaid Services to create a model formulary. The United States Pharmacopeia (USP) created a model formulary with 146 unique therapeutic categories and pharmacologic classes.
The MMA mandated that participating plans must cover at least two drugs per therapeutic category and more than one drug be covered to treat a condition in most cases.
Formularies may have extensive tiering structures employing step therapy, prior authorization, and other methods to control drug spending
Jayashri Sankaranarayanan, Ph.D.

12. The New Medicare Prescription Drug Coverage
Drugs covered
The New Medicare Prescription Drug Coverage
April-May, 2006
Drugs available only by prescription
Drugs, biologicals, insulin
Medical supplies associated with supplies of insulin
Brand name and generic drugs
Must cover all or substantially all of:
Anti-cancer
Anti-HIV and AIDS
Anti-psychotics
Anti-convulsants
Anti-depressants
Immunosuppressants after organ transplants
Next, as you know, a Medicare Part D plan’s formulary will cover most outpatient brand name and generic prescription drugs including biologicals, insulin, medical supplies associated with supplies of insulin. The MMA has mandated that a plan’s formularies must cover all or substantially all of the six categories of drugs for AIDS, cancer, depression and other drugs like anti-convulsants and antipsychotics and immunosuppressants.
Jayashri Sankaranarayanan, Ph.D.

13. The New Medicare Prescription Drug Coverage
Drugs not covered
The New Medicare Prescription Drug Coverage
April-May, 2006
Non-prescription drugs
If covered under Part A or Part B
Immunosuppressants following kidney transplantation *
Diabetic testing supplies such as strips, lancets, monitoring devices *
Anorexia, weight loss, or weight gain medications
Fertility promotion medications
Hair growth medications
Cough and cold medications
Prescription vitamins and mineral products (except prenatal vitamins and fluoride preparation)
Nonprescription drugs
Outpatient drugs for which the manufacturer seeks to require that associated tests or monitoring services be purchased exclusively from the manufacturer or its designee as a condition of sale
Barbiturates
Benzodiazepines
* can be covered under Medicare Part B
Medicare Part D plans will not cover non-prescription (OTC) drugs, hair growth or fertility or weight loss or weight gain medications, cough and cold medications, barbiturates, benzodiazepines, and importantly drugs already covered by Part A or B. I suggest that you pause and review this slide familiarize yourself with what is covered.
Jayashri Sankaranarayanan, Ph.D.

14. The New Medicare Prescription Drug Coverage
April-May, 2006
Calendar Events
Standard beneficiaries & Non-duals qualifying for extra help.
Join Nov 15, 2005 to May 15, 2006
Re-enroll Nov 15 to Dec 31 annually
Not a dual eligible but have limited income and resources, have to apply for extra help and enroll into Medicare Part D Plan.
Limited resources: less than $11,500 (single)/$23,000 (married)
(If in doubt, apply to Social Security Administration (SSA))
Dual eligibles
Medicare and Medicaid, Federal-State health insurance program
Must have chosen a plan before Dec 31, 2005 for making own health plan choice
Automatic and Random enrollment, if they don’t choose
Check if “Duals” medicines are covered by the plan
Switch plans anytime.
Now, let me tell you all some important dates to remember – Standard beneficiaries & Non-duals qualifying for extra help could join a plan between Nov 15, 2005 to May 15, and re-enroll every year during Nov 15-Dec 31.
Like any other insurance, beneficiaries can make a decision to continue with current plan or switch plans every year. Remember, non-dual eligibles with limited income and resources, have to apply for extra help and enroll into Medicare Part D Plan. If a beneficiary’s resources are less than $11,500 (single) or $23,000 (married couple) and if they are in doubt about whether they qualify, advise them to apply to Social Security Administration (SSA), who are more than happy to help. I would like to talk a little more about dual eligibles, that is persons with both Medicare and Medicaid. Medicaid is a health insurance program for people with limited income and resources. Medicaid is jointly funded by the federal and state government, and is administered by each state. It can cover children; aged, blind, and disabled people; and some other groups, depending on the state. If eligible for both Medicaid and Medicare, most health care costs could be covered. It is important to know that dual eligible persons will be automatically and randomly enrolled in a basic plan (PDP only) (for which they do not pay any premium or deductible). Dual eligibles have 41 PDPs (in Nebraska) to choose from. However, if they choose an enhanced rather than a basic plan, they may have to pay some part of the premium. If a dual eligible is auto-enrolled into a plan, they have to make sure that their current medications are on the Part D plan they are enrolled into and if not, choose one that covers all their current medications, since the auto- enrollment is random and has not matched the dual’s medications to the plan’s formulary. It is important to know that if a drug is a Medicare Part D drug then it will not be covered by Medicaid. Medicaid will only cover drugs that are not on any Medicare Part D plan formulary. The dual eligibles can switch plans anytime, if their medications change or are not covered by their current plan. If one moves or enters a nursing home, one can switch plans at those times.
Jayashri Sankaranarayanan, Ph.D.

15. The New Medicare Prescription Drug Coverage
April-May, 2006
Calendar Events
Joined November 15, December 31, 2005
Coverage begins January 1, 2006
Joined January 1,2006–May 15, 2006
Coverage begins the month after beneficiaries join
Don’t join a plan by May 15, 2006
Will have to wait until November 2006 to join and will not be able to access benefits until January 2007
and
ii) if currently do not have creditable coverage (equivalent or better than the new Medicare prescription drug plan) then pay 1 percent more as penalty on monthly premium, for every month the individual waited to enroll in a Medicare prescription drug plan
Remember that beneficiaries that enrolled between November 15 to December , their coverage started on Jan, 1, When they join between January 1 and May 15, 2006 their coverage begins the next month of joining. If they do qualify for extra help but are not dual eligible (only on Medicare not Medicaid), then they need to also choose a plan to enroll during Nov 15, 2005 to May 15, 2006 period. If they do not enroll, then they will be automatically enrolled after May 15, 2006.
If currently Ed, (WHAT IS Ed) a beneficiary does not have creditable coverage (equivalent or better than the new Medicare prescription drug plans) and does not join a plan, then Ed has to pay 1 percent more as penalty on monthly premium, for every month the Ed waited to enroll in a Medicare prescription drug plan.
Further, if Ed waited until November 2006 to join, he will have to wait until January 2007 to access the benefits of the new Medicare prescription drug coverage.
Jayashri Sankaranarayanan, Ph.D.

16. The New Medicare Prescription Drug Coverage
Five Important Things
The New Medicare Prescription Drug Coverage
April-May, 2006
Personal information i.e. Medicare Claim Number, Last name, Date of birth, Part A or Part B effective date, Zip-code.
Creditable Coverage (as good as or better than the new Medicare Part D plans) Documentation from current plan
Current Creditable coverage (VA, TRICARE, Employer Union, or FEHBP) = No penalty on late enrollment and talk to current plan before enrolling in a new Medicare plan
No current creditable coverage (Medigap/No drug coverage) - Pay a 1% penalty on the premium for each month you delay enrollment and this stays for the life of the coverage.
List medications or ask pharmacist for a printed list of beneficiary specific drugs.
List co-payment/coinsurance currently paid for each drug, and premium, and deductible under current plan.
List pharmacies and know what plans they contract with.
When you have patients who are Medicare beneficiaries, they will be making many decisions regarding the new Medicare Prescription Drug Coverage and it is important as health professionals to educate them so that they make informed decisions. In their decisions about enrollment, I will now talk about things you can tell beneficiaries to do. This will help beneficiaries be informed. It will also make it a learning experience for beneficiaries and their families. Imagine the advice you can give Jane, the beneficiary to have a folder of information on the following 5 important things . First of all collect your personal information i.e. Medicare Card with Claim Number, name, date of birth, Part A or Part B enrollment date, zip code. Secondly, Jane needs to have documentation from her current plan as to whether they have creditable coverage (which is as good as or better than the new Medicare Plans). If not, Jane needs to call her current plan to get this information. If Jane has creditable coverage like VA, TRICARE, Employer Union, or Federal Health Employees Health Benefit Plan (FEHBP), she need not enroll now and can enroll later without having to pay penalty. However, if Jane does not have creditable coverage now (e.g. Medigap plan) and enrolls beyond the enrollment period, she will have to pay a 1% penalty on the premium for each month she delays enrollment and this penalty remains as long as she has prescription drug coverage. Also Jane needs to keep in mind to always talk to her current plan before enrolling, because enrollment into the new plan may change some of her current good benefits like Employer Union or Retiree coverage. Thirdly, Jane needs to make a list of the medications she takes currently (i.e. 80mg strength of LIPITOR brand name drug and 81 mg strength of Aspirin generic drug). Alternately, Jane can ask her pharmacist for a printed list of her drugs too Fourth, Jane needs to list co-payment and/or coinsurance she is paying for each of her drugs, including the premium, and deductible she pays to her current plan. This will give Jane an estimate of her current drug costs, help her compare with costs of the new Medicare Prescription Drug Coverage plans to evaluate cost effectiveness of the new plans. Fifth, Jane can make a list of pharmacies she visits for filling her prescriptions, and know what plans they contract with to ensure the plan she decides does have access to pharmacy of her choice.
Jayashri Sankaranarayanan, Ph.D.

17. The New Medicare Prescription Drug Coverage
April-May, 2006
How to compare plans?
Compare plans (on to choose ONE based on:
1. Drug coverage – Formulary and medications coverage in gap
2. Cost - Affordability
3. Convenience of pharmacy access
Find a plan that covers ALL the beneficiary’s drugs, or covers their MOST EXPENSIVE drugs
Find a plan that has the beneficiary’s regular pharmacy in the plan’s network
Choose a plan providing immediate coverage to the drugs currently taken and check whether the needed drugs are placed in a higher co-pay tier, or are subject to prior authorization or quantity limits or step therapy requirements.
When Jane compares plans, she makes decisions based on drug coverage, cost, and convenience of pharmacy access.
So beneficiaries like Jane will decide based on 1) whether her drugs are covered in the plan’s formulary and whether she wants drug coverage in the gap, for which you may have to pay a little more, 2) whether the cost of premiums, and deductible are affordable and 3) whether the plan has her regular pharmacy in their preferred network.
Also when Jane is choosing her new Medicare prescription drug plan, she has to make sure that her most expensive drugs are covered, consider whether the plan has any formulary restrictions like high co-payments, prior authorization or step therapy requirements and consider whether the plan has national or regional or local coverage.
Jayashri Sankaranarayanan, Ph.D.

18. The New Medicare Prescription Drug Coverage
April-May, 2006
How to join and pay?
Join a Medicare Prescription Drug Plan:
Contact the drug plan or on the plan’s website
or Call Medicare.
Local Enrollment events - NEBRASKA State Health Insurance Assistance Program (SHIP):
Pay for the coverage
Automatic deduction from your bank account or social security benefits
Direct payment by mailing a check or money order each month.
Just like any other insurance, every year,
i) check whether you qualify for extra help and ii) make enrollment decisions.
When Jane is ready with all information, she can either visit an enrollment center for help with her folder or she can do it herself or take the help of a trusted friend or family person or a State’s Senior Health Insurance Assistance Program (SHIP) Counselor, that offer personalized one-to-one counseling.
Jane can also join a Medicare Prescription Drug Plan through the “Compare Medicare Prescription Drug Plans” link on Medicare’s website, or by calling Medicare. Jane can also join a plan by contacting the drug plan of her choice or through the plan’s website.
Jane can pay for the new Medicare prescription drug coverage by giving permission to her plan to deduct her premium automatically from her bank account or from social security benefits (like her premiums for Part B), or pay directly by mailing a check or money order each month to the plan.
Importantly, like any other insurance, beneficiaries need to check every year whether they qualify for extra help and also make enrollment decisions of continuing or switching plans every year.
Jayashri Sankaranarayanan, Ph.D.

19. The New Medicare Prescription Drug Coverage
April-May, 2006
Resources/References
“Medicare & You 2006” handbook mailed in October of each year.
1-800-MEDICARE ( ), TTY or for free personalized information on enrollment
Paper application through plan offering the drug coverage (mail or fax) or on the plan’s web site or use Medicare’s online enrollment center Compare Medicare Prescription Drug Plans online tool (link) on
NEBRASKA State Health Insurance Assistance Program (SHIP): for free personalized counseling
Local enrollment events
Social Security Administration (SSA) at (TTY ) or for extra help applications by persons with limited income and resources
If the beneficiary has one of this, they can call TRICARE: or VA: or FEHBP: for more details.
Medicare information is available through several key information channels. We give here the website resources and toll free numbers of important agencies that can help you and your patients. One can sign up at enrollment events by calling SHIP to schedule an appointment for free personalized counseling.
To summarize, beneficiaries need to save all documents related to Medicare Prescription Drug Coverage received from their current plan and also need to collect some information to prepare and make an informed decision.
“Medicare & You 2006” handbook mailed in October of each year.
1-800-MEDICARE ( ), TTY or for free personalized information on enrollment
Paper application through plan offering the drug coverage (mail or fax) or on the plan’s web site or use Medicare’s online enrollment center Compare Medicare Prescription Drug Plans online tool (link) on
NEBRASKA State Health Insurance Assistance Program (SHIP): for free personalized counseling
Local enrollment events
Social Security Administration (SSA) at (TTY ) or for extra help applications by persons with limited income and resources
If the beneficiary has one of this, they can call TRICARE: or VA: or FEHBP: for more details.
Jayashri Sankaranarayanan, Ph.D.

20. The New Medicare Prescription Drug Coverage
April-May, 2006
(JS; DO YOU HAVE PERMISSION TO USE THIS CARTOON FROM THE AUTHOR, IF NOT WHEN YOU GO TO PUBLISH THEY WILL NOT ALLOW)
Please note that you can help educate beneficiaries, Jack and Jill on making informed decisions of enrolling into a Medicare prescription drug coverage plan. Please note the above websites. The first from NY Times is a short video which shows how a journalist helped her father choose a Medicare Part D plan. The second link from Medicare website is a demonstration of “how to compare plans,” and will help you understand the details of using the website to choose the most cost-effective plan.
LET’S REVIEW WHAT WE COVERED SO FAR.
This module showed that the new Medicare Prescription Drug Coverage is available to ALL beneficiaries having Medicare part and/or Part B, and that beneficiaries have to enroll voluntarily and it is not automatic (except for dual eligibles). We also studied the Cost-Benefit structures for standard beneficiaries with income greater than 150% FPL and those with limited income and resources (<150%FPL), and drugs covered and not covered. The initial enrollment period was between November 15, 2005 to May 15, and the next enrollment period is from Nov 15-December 31 of each year. We also know the five important things for enrollment and actual steps to join and pay for a Medicare Part D plan. Secondly, to be a life-long self-learner, we discussed the resources and references that will help you and beneficiaries continually learn and update yourselves about Medicare Part D.
This completes the second module on the new Medicare Prescription Drug Coverage. To complete the question for credit for this module, please close out of this module, and advance to the question in blackboard, then answer the question and review the answer. Then, when ready, proceed to module #3 where we will continue our review of various Medicare Part D beneficiary cases.
Add question from word document on Module 2
Jayashri Sankaranarayanan, Ph.D.