The 1-Minute Consult Guide. For Medicare Prescription Drug Coverage

Transcription

1 The 1-Minute Consult Guide For Medicare Prescription Drug Coverage

2 5 Key Messages of Medicare Prescription Drug Coverage Medicare prescription drug coverage is available to all people with Medicare talk to someone you trust about your prescription drug coverage options. Medicare prescription drug coverage helps people with Medicare pay for the prescriptions they need. There is additional help for those people with Medicare who need it most. Medicare prescription drug coverage pays for brand name as well as generic drugs. Visit on the web for more information, or call MEDICARE. This guide is brought to you by

3 The Oath of a Pharmacist * I will apply my knowledge, experience, and skills to the best of my ability to assure optimal drug therapy outcomes for the patients I serve. I will keep abreast of developments and maintain professional competency in my profession of pharmacy. I will maintain the highest principles of moral, ethical, and legal conduct. I will embrace and advocate change in the profession of pharmacy that improves patient care. *Excerpt taken from the Oath of a Pharmacist. June 1994; APhA-ASP/AACP-COD Page 1

4 Other Benefi ciary Resources State Senior Health Insurance Assistance Program (SHIP) Phone: URL: org/site/pageserver?pagename=ships National Association of Agencies on Aging Phone: URL: Access to Benefi ts Coalition Phone: URL: ts.org/ Page 2

5 WHAT What is Medicare and What are the Differences Between Parts A, B and D? Medicare is a federal health insurance program for: People 65 years and older People under age 65 with certain disabilities People of all ages with End-Stage Renal Disease Part A = Medicare Hospital Insurance Part B = Medicare Medical Insurance (physician visits, etc.) Part D = Outpatient Medication Coverage o Part D will begin for the first time on 1/1/06 Page 3

6 What Does Medicare Rx (Part D) Coverage Provide for Me? It provides drug coverage for all people with Medicare (if they sign up) It pays for both brand and generic medications It will offer a choice of plans The coverage is provided by commercial insurance plans known as Prescription Drug Plans (PDP) or Medicare Advantage Plans There will be at least two plans in each region to choose from The cost and coverage of each plan may vary Medicare prescription drug coverage can protect you from high out-of-pocket expenses when paying for your medications If you are Medicare eligible today but are not taking costly medications at this time, you may want to consider enrolling in Medicare prescription coverage as an insurance policy against any future medication needs; it may cost you more if you wait (see Why Should I Enroll in a Plan? ) Page 4

7 What Will This Coverage Cost Me? You may be responsible for a monthly premium Financial help is available for those who need it You may be responsible to cover your annual deductible This may vary based on fi nancial need After you cover your annual deductible, you will pay a portion of the costs of your medications; this is known as coinsurance Medication cost = discounted price negotiated by the plan and passed on to the benefi ciary The price and coinsurance amount for each medication will vary between plans Costs for a plan with standard Medicare prescription drug coverage might look something like this: (these are estimates) o Monthly Premium = $37 o Annual Deductible = $250 o Benefi ciary Share of Drug Cost = 25% o Coverage Gap (benefi ciary share)* = 100% o Catastrophic (benefi ciary share)** = 5% *Benefi ciary covers all medication costs between $2,250 and $5,100 of total annual prescription drug utilization (up to $3,600 out-of-pocket spending) **Benefi ciary covers only 5% of all medication costs above an annual out-of-pocket spending above $3,600 Page 5

8 What if I Already Have Insurance That Covers My Medications? You will have to decide if you should enroll to receive Medicare prescription drug coverage Consider/compare monthly premiums, deductibles and formularies Your insurance plan should notify you if your current coverage is at least as good as Medicare prescription coverage; known as creditable coverage If you have Medigap, you will receive a notice explaining your options If you are a person with Medicaid and Medicare (dual), you will automatically be assigned a Medicare plan If you have an employer plan, determine which options provide better coverage If you have Tricare coverage, there will be no changes If an employer-sponsored or Medigap plan is not as good as the Medicare benefi t, benefi ciaries should consider enrolling into the Medicare plan Persons with Medicaid and Medicare coverage have the right to select a different plan if they choose Page 6

9 Who is Eligible for Medicare Prescription Drug Coverage? Prescription drug coverage is available to everyone who has Medicare Part A (hospital) or Part B (medical) coverage WH0 People 65 years and older People under age 65 with certain disabilities People of all ages with End-Stage Renal Disease Coverage is a choice and most people with Medicare will have to sign up to receive the benefi t Coverage is not free; benefi ciaries will pay part of the costs People with Medicare and Medicaid coverage will be automatically moved into Medicare prescription drug coverage Page 7

10 Who Should Sign Up To Receive Coverage? All Medicare benefi ciaries without prescription drug coverage You will pay a fraction of the full drug costs There will be a monthly premium to consider, but fi nancial assistance may be available All benefi ciaries who are in plans that are not as good as Medicare prescription coverage There may be a penalty if you decide to enroll later Benefi ciaries who want the security of having prescription drug insurance, even if there is no immediate need It can protect against catastrophic medication expenses Some benefi ciaries will enroll in a Medicare prescription drug plan to meet their immediate medication needs Some benefi ciaries will enroll in a plan to provide insurance against future medication needs, such as a new diagnosis, and to protect against high out-of-pocket costs Page 8

11 When Do I Enroll? Open enrollment for eligible benefi ciaries begins November 15, 2005 and will close on May 15, 2006 Beginning in October 2005, plans are allowed to begin marketing to benefi ciaries If you are currently eligible and do not enroll until after the May 15, 2006 deadline, you will pay more Seniors will pay 1% extra in premiums for every month after the deadline (if you are three-months late to enroll, you will pay an extra 3% on your premium every month) WHEN Enrolling by January 1, 2006, will allow you to take full advantage of the savings the plan has to offer In the future, enrollment for newly-eligible benefi ciaries (e.g. someone turns 65 years old) will begin three months before their birth month and will close three months after their birth month Page 9

12 When Will My Coverage Start? For those that enroll in 2005, coverage begins on January 1, 2006 For those that enroll after January 1, 2006, coverage begins on the 1st day of the next month Plan selection covers the calendar year You will have the chance to change coverage once per year Coverage for people with Medicare and Medicaid will automatically begin on January 1, 2006 Enrollment will open again in the fall of each year Page 10

13 Why Should I Enroll in a Plan? A drug plan may offer better coverage, or the same coverage at a better price, than your current insurance plan If you don t currently have drug coverage, a drug plan is an opportunity for you to purchase medications at discounted prices If you don t currently need any medications, enrolling in a drug plan now will protect you against future drug costs you may have WHY Medicare Part D is an additional benefi t to Medicare benefi ciaries that may help you better manage your health Page 11

14 Why are There Differences Between Plans? Plans will differ from each other in product selection, price, and choice of pharmacy in order to respond to the demands of a competitive marketplace Each region of the country is different, so plans will tailor their offerings to the unique needs of the local market States with a large number of rural Medicare benefi ciaries will need different plan offerings than states with big cities As Medicare benefi ciaries have different needs, so too will plans be different to best meet the demands of the market Page 12

15 Where Do I Go To Enroll in a Plan? For most people, enrollment begins on November 15, 2005 You can start by calling MEDICARE or go to You can also enroll by calling a plan s toll-free number or by visiting their website For more information on enrolling or the new Medicare drug benefi t, go to Page 13 WHERE

16 Where Can I Use My Prescription Coverage? Each plan will have a network of pharmacies that you can use Before you enroll, check to make sure the plan you pick allows you to fi ll prescriptions at the pharmacy of your choice Your choice of pharmacy is an important part of deciding which prescription drug plan is best for you Page 14

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19 Helpful Hints for Your Patients They should pick a plan that covers as many of their medications as possible Remind them to bring their new prescription drug plan card with them to the pharmacy after they have enrolled (not their red/white/blue card) Use their prescription drug plan for all prescriptions beginning on the fi rst day it is active This will help them meet their deductible sooner Although they are responsible for the fi rst $250, they will be paying the plan s discounted prices for their medications After they meet the deductible, they will then begin paying a portion of the medication cost At any time, they can call their plan and fi nd out how much they have spent out-of-pocket

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