Transcript MEDICARE PART D - Oklahoma Society of CPAs

MEDICARE PART D
The New Prescription Drug
Coverage
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
What Medicare Prescription
Coverage Means For You
• Beginning January 1, 2006, new Medicare drug plans
will be available to everyone with Medicare
• Drug plans will be offered through insurance companies
and other private companies approved by Medicare
• Offer insurance coverage for prescription drugs for a
monthly premium
• Premiums costs will vary depending on the plan you
choose
• Plans will also vary in what prescription drugs are
covered
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
Who can join a Medicare
prescription drug plan?
• Anyone with Medicare A and/or Medicare B can join a
Medicare prescription drug plan
• You are not required to join a plan, but everyone eligible
should consider joining a Medicare prescription drug
plan
• Join a plan between November 15, 2005 and May 15,
2006 to guarantee the lowest premium for the plan you
choose
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
What to do if you already have
prescription drug coverage
• Many people may already have creditable
coverage through:
–
–
–
–
Medigap (Medicare Supplemental Insurance)
Your or your spouse’s employer or union
A health insurance policy
Department of Veterans Affairs
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
What to do if you already have
prescription drug coverage
• Many people already have creditable coverage
through:
–
–
–
–
TRICARE
Federal Employees Health Benefits Program
PACE
Your State’s high risk pool
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
What to do if you already have
prescription drug coverage
• Your insurer or other plan provider should have notified
you by November 14, 2005, to let you know if your
current drug coverage is creditable coverage:
– If your current coverage is creditable, you do not need to enroll in
a Medicare prescription drug plan at this time
• Provided you do not have a break in coverage (more than 63 days without
creditable coverage), you will not have to pay a penalty if you decide to
enroll in Medicare prescription drug coverage after May 15, 2006
• Caution: If you decide to enroll in a Medicare prescription drug plan anyway
and drop your current prescription drug coverage, you may not be able to
get this coverage back. Also, if your prescription drug coverage is provided
together with your medical coverage, you may not be able to drop just the
prescription drug benefit
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
What to do if you already have
prescription drug coverage
– If your current coverage is NOT creditable. You need to choose a
Medicare prescription plan before May 15, 2006 to avoid a
penalty
• You can keep your current plan and join a Medicare drug plan to give you
more complete prescription drug coverage
• Just keep your current drug plan. But, if you join later, you will have to pay a
penalty
• Drop your current drug plan and join a Medicare drug plan, but you may not
be able to get your old drug plan back
• Contact your insurer, benefits administrator, or other plan provider if
you did not get information about creditable coverage from them by
November 14, 2005
• Talk to your insurer, benefits administrator, or other plan provider
before you make any changes to your prescription drug coverage.
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
For those receiving both Medicare
and Medicaid Benefits
• Medicaid prescription drug coverage is changing
• Medicare will start paying for you prescription drugs beginning
January 1, 2006
• You will have continuous coverage and pay a small amount out of
your own pocket
• You must join a Medicare prescription drug plan for Medicare to pay
for your drugs
• If you do not join a plan by December 31, 2005, Medicare will enroll
you in a plan to make sure that you do not miss a day of coverage
• Medicare should have let you know the plan it has picked for you in
October 2005. You can switch to another plan at any time
• Medicaid will still pay for your other health costs
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
For NJ PAAD Recipients
• As a PAAD beneficiary, your benefits will continue and will be used
along with the new Medicare prescription drug coverage program
• The Medicare drug coverage will become your primary coverage
and PAAD will be secondary coverage.
• In order to continue your PAAD benefits, you must enroll in a
Medicare drug plan offered in NJ. If you do not select a plan, PAAD
will select one for you.
• The PAAD program will cover all costs, except for the $5.00 copayment
• Follow the instructions you receive directly from PAAD. Selecting
one of the recommended plans will result in no additional cost to you
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
For those with Medicare-Approved
Drug Discount cards
• Medicare-approved drug discount cards are not
insurance
• Cards are temporary until you join a plan that offers the
new Medicare prescription drug coverage
• Discount drug cards expire the earlier of the day before
your new Medicare prescription drug coverage starts or
May 15, 2006
• Once you join a Medicare drug plan, you will
automatically be dis-enrolled from your discount drug
card
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
Medigap vs. Medicare Drug
Plan
Two Reasons to Consider Switching to a
Medicare Prescription Drug Plan
– In almost every case, enrolling in a Medicare
prescription drug plan will save you money
– Your overall coverage for prescription drugs
will generally be better than most (though not
all) Medigap plans
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
Medigap and Medicare
Prescription Plan Options
• You cannot have prescription drug coverage
under both a Medigap policy and a Medicare
prescription drug plan at the same time:
– Option 1: Enroll in a Medicare prescription drug plan
and keep the Medigap policy you have now, but
without the prescription drug coverage
– Option 2: Enroll in a Medicare prescription drug plan
and switch to a different Medigap policy that doesn’t
include prescription drug coverage
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
Medigap and Medicare
Prescription Plan Options
– Option 3: Enroll in a Medicare Advantage Plan that
includes prescription drug coverage
– Option 4: Keep the Medigap policy you have now
with the prescription drug coverage included
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
How much does a Medicare
prescription plan cost?
Like other insurance, people who join a
Medicare prescription drug plan will pay:
• A monthly premium (on average $37 in 2006, but
can change yearly)
• A yearly deductible (up to $250 in 2006), and
• Part of the cost of their prescriptions, including a
co-payment or coinsurance
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
Things to consider before
selecting a plan
• Coverage
• Cost
• Convenience
• Security Now and in the Future
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
Things to consider before
selecting a plan
Coverage
• All Medicare drug plans will cover generic and brandname drugs
• The list of drugs covered by a specific plan is called the
plan’s formulary
• The formulary must include at least two drugs in
categories and classes of most commonly prescribed
drugs to people on Medicare
• The formulary may vary from plan to plan
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
Things to consider before
selecting a plan
Cost
• Monthly premiums
• Deductible – Amount you pay for your prescriptions before your plan
starts to share in the costs
– Some plans offer a $0 deductible
– No plan can have a deductible higher than $250
• Co-payment/Coinsurance – Amount you pay after you have met
your annual deductible
– Some plans offer a fixed amount or percentage of the cost for prescriptions
– Other plans might have different levels or tiers with different costs
– In Many plans, your costs can increase when your prescription costs reach a certain limit
• Coverage Gap – the cost of prescriptions between $2,250 and
$3,600
– During the gap, you usually pay the full cost of your prescriptions
– Some plans offer coverage during the gap
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
Things to consider before
selecting a plan
Convenience
• Check for contracted “network” pharmacies in your area
• Prescription costs (co-pay or coinsurance) may be less at preferred
pharmacy
• Costs may not be covered unless purchased at a network pharmacy
– This is particularly important if you spend a part of the year in another
state
• Some plans offer 60 to 90-day retail pharmacy programs
• Some plans may offer mail-order program
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
Things to consider before
selecting a plan
Peace of Mind Now and in the Future
• As we age, most people need prescription drugs to stay
healthy
• Joining a plan now means you will pay a lower monthly
premium in the future than if you were to wait
• Once you reach $3,600 out-of-pocket for drug costs
during the year, the plan will pay most of your remaining
drug costs
• In some plans, this protection could start even sooner
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
Common Situations
If you …
You might want a
Medicare prescription
drug plan that …
Where to start …
...take specific prescription Covers the drugs you are
drugs that are important to taking now
your health
Look at drug plans that
have included your drugs
on their formularies, then
compare costs
…have prescription drug
costs that total more than
$2,250 a year
Has a higher than average
initial coverage limit and/or
provided some coverage
during the coverage gap
Look at plans that offer
better than the standard
coverage after your costs
total $2,250
...want your drug
expenses to be even
throughout the year
Has a zero or low
deductible, so you aren’t
paying a lot out-of-pocket
at the beginning of the
year
Look at plans with low
deductibles
Common Situations
If you …
You might want a
Medicare prescription
drug plan that …
Where to start …
… use a lot of generic
medicines
Offers generic medicines
for a lower coinsurance or
co-payment than brand
names
Look at plans with tiers
that charge you nothing or
low co-payments for
generic prescriptions
…don’t use any
Gives you the lowest
prescriptions now, but
premium
want coverage for peace
of mind and to avoid future
penalties
Look for plans with zero or
low monthly premiums for
drug coverage. If you
need prescriptions in the
future, all plans still must
cover drugs in all
categories
… like getting all of your
health care coverage from
one insurance company
Look for Medicare
Advantage Plans with
prescription drug coverage
Is included as part of a
Medicare Advantage Plan,
like an HMO or PPO
How do I compare Medicare drug
plans?
• Step 1: Find out which plans cover your drugs
• Drug plans will cover different generic and brand-name drugs in
different drug categories on their drug lists (formulary)
• The drug list (formulary) may not include your specific drug.
However, in most cases, a similar drug that is safe and effective
should be available
• Step 2: Find out the costs of each plan
• Medicare drug plans can vary on how much they charge and how
much they cover. Choose the Medicare drug plans you want to
know more about and compare the following for each plan:
–
–
–
–
Premium
Deductible
Coinsurance or Co-payments
Coverage limits
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
How do I compare Medicare drug
plans?
• Step 3: Find out each plan’s pharmacy and mail
order options
• Medicare will require plans to have convenient pharmacies
for you to choose from. If it’s important to you to stay with
your current pharmacy, find out if you can use your pharmacy
with the drug plan
• Some drug plans also allow mail order prescriptions
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
How do I compare Medicare drug
plans?
• Step 4: Using the attached chart compare the
various plans and make a selection
• Step 5: Enroll in a Medicare Part D plan
• Enroll no later than May 15, 2006 to avoid future late
enrollment penalties.
• Coverage becomes effective:
– January 1, 2006 if enroll by December 31, 2005
– If enroll after December 31, 2005, then plan is effective the 1st
day of the month following the month you join
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
Use this chart to keep track of
Medicare drug plan information
Plan
Name
Does
Plan
cover all
my
drugs?
Monthly
Premium
Amt of coYearly
pay for
Deductible
each
prescription
Can I use
my
pharmacy
Is mail
order
avail?
Use this chart to keep track of
Medicare drug plan information
Plan
Name
Does
Plan
cover all
my
drugs?
Monthly
Premium
Amt of coYearly
pay for
Deductible
each
prescription
Can I use
my
pharmacy
Is mail
order
avail?
How can I get help making this
decision?
If you need help comparing Medicare prescription
drug plans, you can:
• Visit www.medicare.gov on the web. Select Search tools at
the top of the page.
• Call 1-800-MEDICARE (1-800-633-4227). Follow the
instructions to speak to a customer service representative
who will help you get your personalized information. You will
get your results in the mail within 3 weeks.
• Call your NJ State Health Insurance Assistance Program at
1800-792-8820.
• Ask a friend, loved one, or professional to assist you
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
New Jersey Stand-Alone Prescription Drug Plans
* The beneficiary drug premium covers prescription drugs only and does not cover medical or hospital benefits. Beneficiaries are also responsible for their Part B
premium and any premiums for Medigap coverage to meet their individual needs.
Includes contracts/plans approved as of October 10, 2005. The data does not reflect information for PACE organizations, employer sponsored plans, or plans
that were not approved by the "As of" date of the chart.
Description
Organization Nam e
Aetna Medicare
Cost
No
premium
w ith
Benef iciary
Full
Total Drug
Low
Plan
Income
Premium*
Subsidy
Plan Nam e
Aetna Medicare Rx Es s entials
$33.25
Aetna Medicare Rx Plus
$44.21
Aetna Medicare Rx Prem ier
$59.95
CIGNA HealthCare
CIGNATURE Rx Value Plan
$37.04
CIGNATURE Rx Plus Plan
$42.18
CIGNATURE Rx Com plete Plan
$51.36
Coventry AdvantraRx
AdvantraRx Value
$20.68
AdvantraRx Prem ier
$31.74
AdvantraRx Prem ier Plus
$44.34
Firs t Health Prem ier
Firs t Health Prem ier
$25.81
Health Net
Health Net Orange
$21.00
Health Net Orange
$25.69
Horizon Blue Cros s Blue Shield of NJ, Inc Horizon Medicare Rx Plan 1
$29.15
Horizon Medicare Rx Plan 2
$29.64
Hum ana Inc
Hum ana PDP Standard S5884-062
$4.43
Hum ana PDP Enhanced S5884-003
$9.83
Hum ana PDP Com plete S5884-032
$48.50
Medco Health Solutions , Inc
YOURx PLAN
$32.96
MEMBERHEALTH
Com m unity Care Rx BASIC
$32.77
Com m unity Care Rx CHOICE
$40.86
Com m unity Care Rx GOLD
$44.77
PacifiCare Life and Health Ins urance Co
PacifiCare Saver Plan
$19.52
PacifiCare Select Plan
$31.17
PacifiCare Com prehens ive Plan
$35.36
Pres cription Pathway
Pres cription Pathway Bronze Plan Reg 4
$28.71
Pres cription Pathway Silver Plan Reg 4
$38.16
Pres cription Pathway Silver Plan Reg 4
$38.18
Pres cription Pathway Gold Plan Reg 4
$49.71
Pres cription Pathway Gold Plan Reg 4
$49.72
Pres cription Pathway Platinum Plan Reg 4
$66.53
RxAm erica
Advantage Allegiance Plan
$34.38
Advantage Freedom Plan
$35.49
SilverScript
SilverScript
$30.42
SilverScript Plus
$59.11
Sterling Plus Rx
Sterling Pres cription Drug Plan
$58.93
Unicare
Medicare RX Rewards
$24.23
Medicare RX Rewards Plus
$31.91
Medicare RX Rewards Prem ier
$42.57
United Am erican Ins urance Com pany
UA Medicare Part D Pres cription Drug Coverage$35.21
United Healthcare
AARP MedicareRx Plan
$24.24
United Medicare MedAdvance
$28.20
WellCare
WellCare Signature
$17.17
WellCare Com plete
$36.29
WellCare Prem ier
$38.82
Coverage
Includes
Tiered
Drug Deductible
Copayments
Standard
f or
Generic
Zero Reduced
($250)
Drugs
Only
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Number
of Top
Generic
100
and
Drugs on
Brands Formulary
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Convenience
Type of
Additional
Coverage
Of f ered in Drug
Coverage Gap
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85
85
97
99
99
99
74
98
98
98
83
97
91
95
97
97
97
94
90
90
90
77
86
77
89
89
89
89
89
97
86
86
90
95
95
88
88
96
94
97
97
87
84
84
Mail
Order
Offered
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How to join a Medicare Prescription
Drug Plan
Once you have made your selection of the best plan for
your particular situation, you must then enroll in that
particular plan:
• You can join a Medicare prescription drug plan in the
following ways:
– By paper application – Contact the company offering the drug
plan and ask for an application. Once filled out, mail or fax the
form back to the company
– On the plan’s website – Visit the drug plan company’s website.
You may be able to join online
– www.medicare.gov – You can join a plan by using the Medicare’s
online enrollment center
– Call 1-800-MEDICARE – You can join a plan by calling Medicare
and talking with a Medicare customer service representative.
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
Points to Remember
• Use the resources at your disposal for assistance in
selecting the plan right for you.
• Every plan varies in the formula of drugs covered and the
cost associated with them. Choose a plan best suited for
your particular situation.
• Start saving money. Enroll now. Coverage can begin as
early as January 1, 2006. Enroll in a plan before May 15,
2006 to avoid any future penalty
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA
This presentation was prepared by:
Linda A. Hilton, CPA
2 Polonia Court
Monroe Twp, NJ 08831
(732) 416-0815
[email protected]
If you are interested in obtaining a copy of this PowerPoint presentation for your
group or organization, please contact.
© Copyright 2005. All rights reserved. Linda A. Hilton, CPA