Medicare Part D and You for (Individuals and Families)

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1 Medicare Part D and You for 2013 (Individuals and Families)

2 What is Medicare Part D? Drug coverage which helps you pay for the medicines you need if you do not have other prescription drug coverage Voluntary insurance like Medicare Part B Except if you have Medicare and Medicaid and have no other drug coverage 2

3 What does Part D cover? Primarily medications which require a prescription from your doctor Some medications are generally not covered Those covered under Medicare Part A when you are in the hospital or a nursing home Over the Counter (examples: vitamins or cough medicine) Medicare and/or the Part D Plan may decide not to cover for safety reasons or other factors 3

4 Who is eligible for Part D? Available for all people with Medicare Those who have Part A or Part B Those who are currently enrolled in a Medicare Advantage Plan 4

5 To Access Resources: Click on the paperclip button above the video player to open links. 5

6 Prescription Drug Plans (PDPs) Plans must offer basic drug coverage Monthly premium Enhanced Benefit PDP Higher monthly premium Generally don t have a deductible May have reduced co-pays Plan may offer additional coverage from a PDP with basic coverage May choose to cover certain over-the-counter medications Plans can be flexible with the coverage they offer 6

7 What are Medicare Advantage Plans? Different type of coverage under the Medicare program Also known as Medicare Part C or Medicare Health Plans Generally cover all your health care They may also provide other coverage for vision, hearing and dental care May have to see specific doctors or go to certain hospitals Generally include Part D drug coverage Medicare Advantage Prescription Drug Plan Your out-of-pocket expenses may be lower than traditional Medicare, but vary based on the services used and their coverage 7

8 Creditable Drug Coverage Union or Employer Sponsored Plans Veterans Administration Tricare Federal Employees Health Benefit Plan (FEHBP) Medicaid only (no Medicare) Receive creditable coverage information each year Keep copies of all correspondence U.S. Department of Veteran Affairs at TRICARE for Life (for military retirees), contact your benefits administrator or go to If individual loses coverage and joins a Medicare drug plan, in most cases, won t have to pay a penalty, as long as individual joins within two months days of losing coverage. Not eligible for Medicare Part D 8

9 What does Part D Cost? Part D Plan Costs include: Monthly Premiums Annual Deductibles Coverage Gap ( Donut Hole ) Co-Payments/ Co-Insurance May have an addition to the monthly premium if your income is Above ~$85,000 if an individual tax return was filed Above ~$170,000 if a joint tax return was filed You will be notified in November of the increased amount you will be required to pay 9

10 The Standard Benefit for 2013 * 1% penalty on premium if you have no coverage and don t enroll Total Drug Cost Medicare Part D Plan Pays You Pay N/A $0 First $320 $0 Premium ~$25 - $35 per month Deductible (up to $320/year) Approximately $3,000 Up to $2,000 Up to $640 Approx. $6,600 $0 100% Donut Hole (up to $4,700) 52.5% discount on covered brand-name drugs and 86% discount on generics Approx. $6,600+ (approx. 95%) (Catastrophic) Small co-insurance or copayment 10

11 Extra Help Extra financial help is available for Part D Limited incomes and financial resources If you have Medicare and meet one of the following conditions you will automatically qualify if: You have full Medicaid coverage in addition to Medicare You receive help from your state Medicaid program paying for your Part B premiums (belong to a Medicare Savings Program). You receive Supplemental Security Income (SSI) benefits. If you have income and other financial assets below certain amounts you may also qualify for extra help 11

12 How do I Know if I Qualify for Extra Help? Individuals may qualify based on two criteria: First criteria is your income in relation to the Federal Poverty Level (FPL) In order to potentially qualify, this equates to an income of approximately less than: $16,335 for a single person $22,065 for a married person living with a spouse and no other dependent 12

13 How do I Know if I Qualify for Extra Help? Second criteria is the asset test Other financial resources which include money amounts of bank accounts, investments or cash for individual and/or spouse Asset test does not include: Monies set aside for burial expenses Any life insurance policy, regardless of value Home where individual resides or property where home is located Vehicles owned Financial help received for food, mortgage, rent, heating fuel or gas, electricity, water, and property taxes 13

14 Help with Drug Plan Costs for 2013 Premium Deductible Co-Pay up to $2,830 Co-Pay to $2,830-$6,440 Over $6,440 Medicare/Medicaid (Skilled facility, i.e., nursing home) $0 $0 $0 $0 $0 Medicare/Medicaid at or below FPL (ALF or community) $0 $0 (G) $1.15 (O) $3.50 (G) $1.15 (O) $3.50 $0 Medicare/Medicaid above FPL-low assets (ALF or community) $0 $0 (G) $2.65 (O) $6.60 Reduced copay $0 < 135% of FPL (plus assets) $0 $0 (G) $2.65 (O) $6.60 (G) $2.65 (O) $6.60 $0 135%-150% FPL (plus assets) Prorated Up to $63 Reduced copays (~15%) Reduced copays (~15%) (G) $3.50 (O) $

15 How do I Apply for Extra Help? Applications available through Completed on-line Hard copy By phone, (TTY ) Must complete an application to see if you qualify Medicare recommends that you apply when you move into a facility or community No cost to apply 15

16 How Do I Enroll? 16

17 People with Medicare Can Enroll Directly with the Medicare drug plan Plans are not allowed to contact you directly Through a personal representative Has authority to act on your behalf This authority comes from state law (e.g., Power of Attorney, guardian) or other applicable law By having others help you Spouse, relative, friend, caregiver, or advocacy group volunteer SHIP (State Health Insurance Program) representative 17

18 Initial Enrollment Period (IEP) If individual enrolls in this month of his/her IEP Coverage Starts Month turning 65 1 month after enrollment 1 month after turning 65 2 months after enrollment 2 months after turning 65 3 months after enrollment 3 months after turning 65 3 months after enrollment 18

19 Initial Enrollment Period Part D You must have Medicare Part A and/or Medicare Part B in order to enroll in a Medicare Part D prescription drug plan 19

20 Annual Enrollment Period Annual Enrollment Period allows you to: Choose another drug plan between October 15 th through December 7 th Coverage under the new plan will begin January 1 st, 2013 If you are staying with the same plan, you do not need to re-enroll 20

21 Annual Enrollment Period Prescription Drug Plans (PDP) Change your Medicare prescription drug plan OR Enroll in a prescription drug plan for the first time Medicare Advantage Plans (MA) During this time can change from original Medicare and enroll in a Medicare Advantage Drug Plan (MA-PD) with drug coverage If the Medicare Advantage Plan does not have drug coverage you can enroll in a PDP If you are enrolled in an MA plan with Medicare drug coverage (MA-PD). You may not enroll in a PDP You must enroll in the MA-PD offered by the MA plan. 21

22 Special Enrollment Period These are special exceptions outside of the initial enrollment and annual enrollment periods Some examples of special enrollment periods: You have Medicare and Medicaid You move from a nursing home to an assisted living community or to your own home You permanently move out of the plan s service area You lose your prescription drug coverage that was at least as good as Medicare s drug coverage 22

23 Resources 23

24

25 Drug Plan Finder Tool 2010 Omnicare, Inc. All Rights Reserved 25

26 26

27 Understanding Medicare Enrollment Periods and Retiree Coverage 27

28 MyOmniview

29 MyOmniview Easy Registration for Resident and/or Family/Responsible Party Medication Profile - a list of your medications Financial information View bills and make on-line payments View payment history Ask a Pharmacist Reference Libraries Drug Information Wellness Center Medicare Beneficiary Center information on Medicare Part D

30 Important Contacts Medicare MEDICARE Social Security (for extra help) SHIP (State Health Insurance Program) Assistance with Part D enrollment and application process Materials from today s presentation or follow-up questions

31 Questions? 31

1Will my Medicare Part D plan be

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