1 Medicare Part D Prescription Drug Coverage Part 3 Version 7.1 August 1, 2013
2 Terms and Conditions This training program is protected under United States Copyright laws, 17 U.S.C.A. 101, et seq. and international treaties. Except as provided below, the training program may not be reproduced (in whole or in part) in hard paper copy, electronically, or posted on any web site or intranet without the prior written consent of AHIP. Any AHIP member company in good standing sponsoring a Medicare Advantage or Part D plan may reproduce the training program for the limited purpose of providing training and education to the company s own employees and contractors on the subject matter contained in the training program. Employees or contractors participating in such training may not further reproduce (in whole or in part) the training program. No changes of any kind may be made to the training program and any reproduction must include AHIP's copyright notice. This limited license is terminable at will by AHIP. The training program is intended to provide guidance only in identifying factors for consideration in the basic rules and regulations governing coverage, eligibility, marketing, and enrollment for Medicare, Medicare supplement insurance, Medicare health plans, and Part D prescription drug plans and is not intended as legal advice. While all reasonable efforts have been made to ensure the accuracy of the information contained in this document, AHIP shall not be liable for reliance by any individual upon the contents of the training program.
3 Learning Objectives After reviewing Part 3 - Medicare Part D Prescription Drug Coverage you will be able to explain: What Part D plans are; Who is eligible for a Part D plan; Part D standard and alternate benefits; Part D management tools, covered drugs, and formulary requirements; Part D True Out-of-Pocket (TrOOP) costs and help for beneficiaries with limited income; Late enrollment penalties and premiums; and How Part D works with other coverage.
4 Training Roadmap: Part 3 Medicare Part D Basics Part D Standard and Alternative Benefits Part D Management Tools Covered Drugs Formulary Requirements Part D Enrollee Costs and Assistance Programs Part D Late Enrollment Penalties and Premiums Part D and Other Coverage
5 Medicare Part D Prescription Drug Program Basics Program began January 1, Coverage of Medicare Part D benefits is provided by private companies. Medicare pays a share of the program costs. The types of Part D plans are: Stand-alone Prescription Drug Plan (PDP) to work with Original Medicare Medicare Advantage-Prescription Drug (MA-PD) Plan: An MA health plan that also covers Part D prescription drugs. Cost-PD Plan A Medicare health plan that covers Part D prescription drugs as an optional supplemental benefit.
6 Medicare Part D Eligibility Individuals entitled to Part A and/or enrolled under Part B are eligible to enroll in Part D plans. The beneficiary must live in the plan s service area. Part D plan coverage is provided through network pharmacies in the Part D plan s service area, except that PFFS plans are not required to use a pharmacy network. Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances in the case of MA-PD plans under MA program rules (e.g., beneficiaries with ESRD or who do not meet the eligibility criteria of a chronic care SNP).
7 Part D Standard and Alternative Benefits
8 Part D Plan Benefits Standard Part D plans must cover at least the Part D standard benefit or its actuarial equivalent. For 2014, the standard benefit requires the beneficiary to pay: $310 deductible 25% of prescription drug costs between $310 and $2,850 = $635 Part of the costs in the Coverage Gap - After total spending on drugs by the beneficiary and the plan reaches $2,850 the beneficiary pays for 72% of generic drug costs and 47.5% of brand name drug undiscounted costs. Drug manufacturers provide a 50% discount on brand name drug costs. A new law enacted in 2010 eliminates the coverage gap by 2020 by reducing the amount beneficiaries pay while in the coverage gap by a small percentage each year until 2020 when they will be responsible for only 25% of brand and generic drug costs. Nominal costs under catastrophic coverage: Once beneficiary expenditures (including drug manufacturer discounts) reach a total of $4,550, the beneficiary is through the coverage gap and reaches catastrophic coverage. On any future prescriptions the beneficiary pays either a co-pay of $2.55 for generic drugs or $6.35 for brand name drugs or a co-insurance of 5%, whichever is greater.
9 Part D Plan Benefits Standard for 2014 (Updated Annually) Total Drug Expenditures $6, (Varies depending on mix of brand-name and generic drugs.) Plan Contributions Drug Manufacturer Discount Enrollee Out-of-Pocket Expenditures $2,850 $310 $0 Plan Payment 28% for generic drugs and 2.5% for brandname drugs Catastrophic Coverage 95% Plan Contribution Drug Manufacturer Discount 50% for brand name drugs: Plan Contribution 75% ($1,905) Enrollee Deductible $310 Copay or 5% Coverage Gap - Enrollee pays 72% of cost of generic drugs and 47.5% of cost of brand-name drugs Coinsurance 25% ($635) Enrollee Out-of-Pocket Expenditures $4,550 - Annual out-ofpocket threshold (The amount of the drug manufacturer discount for brand name drugs is counted as an enrollee out-of-pocket expenditure.) $945 Initial Coverage Limit (Coverage Gap begins) $310 $0
10 Part D Plan Benefits Alternative Part D plan benefits may differ from the standard benefit under specific Medicare rules. In all cases the value of Part D benefits must be at least as good as the standard coverage. Some Part D plans may also include enhanced coverage for an additional monthly premium.
11 Part D Pharmacy Networks Enrollees may fill prescriptions for covered drugs at network pharmacies that contract with plans. Network pharmacies include retail pharmacies and may also include mail order pharmacies. Part D plans may designate preferred pharmacies that offer lower levels of cost-sharing than apply at non-preferred pharmacies. Under certain circumstances, enrollees may fill prescriptions for covered drugs at non-network pharmacies, but likely at higher cost to enrollees. For example: Illness or losing a drug during travel Circumstances resulting in limited access to a drug through innetwork pharmacies
12 Part D Drug Management Tools Covered Drugs and Formulary Requirements
13 Part D Drug Management Tools Part D plans commonly use a variety of prescription drug benefit management tools, including: A formulary: A list of drugs covered by the plan Co-pay tiers: Drugs grouped together by amount of co-pay are in a tier with a set amount for each prescription. Many plans group drugs into 3 or 4 tiers with lower tiers costing less than higher tiers, for example: - Tier 1: Generic drugs - Tier 2: Preferred brand-name drugs - Tier 3: Non-preferred brand-name drugs - Tier 4: High-cost drugs
14 Part D Drug Management Tools, cont d. Part D plans commonly use a variety of prescription drug benefit management tools, including: Step therapy: One or more similar lower cost drugs must be tried before other more costly drugs are tried, if necessary. Prior authorization: Requires the doctor to contact the plan before the plan will cover these prescriptions. The doctor must show the drug is medically necessary for it to be covered.
15 Covered Part D Drugs By law, Part D plans are permitted to cover any prescription drugs and biologicals that: Must be covered by states that provide Medicaid prescription drug benefits Many Part D plans do not cover all of these drugs because in some cases several similar drugs are available to treat the same medical condition. Part D plans include the drugs they will cover on formularies that are developed by pharmacists, doctors, and other experts. Part D plan formularies must include: At least two drugs in each therapeutic category Generic and brand-name drugs.
16 Medicare Part D Medication Therapy Management: An Introduction Medicare Part D Medication Therapy Management (MTM) programs seek to provide individuals taking medication for chronic diseases with an optimal regimen of treatment for their conditions. MTM is a patient-centered and comprehensive approach to improve medication use, reduce the risk of adverse events, and improve medication adherence. MTM program elements include: comprehensive reviews of medications used on an annual basis; Quarterly medication reviews; identification of medication related problems; prescriber and beneficiary interventions to promote coordinated care; and standardized action plans and summaries.
17 Medicare Part D Medication MTM Requirements A Medicare Part D sponsor is required to have a Medication Therapy Management (MTM) program with the exception of MA Private Fee for Service (MA-PFFS) and PACE organizations. The MTM program must be designed: to ensure that covered Part D drugs prescribed to a targeted beneficiaries are appropriately used; and to reduce the risk of adverse events, including drug interactions. The MTM program must be established so that it may: be furnished by a pharmacist or other qualified provider; and distinguish between services in ambulatory and institutional settings. In addition, it must be developed in cooperation with licensed and practicing pharmacists and physicians.
18 Medicare Part D Eligible MTM Beneficiaries To be eligible for the program, a beneficiary must: have multiple chronic diseases for example diabetes, hypertension, and asthma; be taking multiple Part D drugs, and likely to incur drug costs of a specified amount (equal to or greater than $3,017 for 2014). Sponsors have some flexibility in designing their programs such as the minimum number of diseases that qualify a beneficiary for an MTM program. Information about specific criteria is available from each Part D plan and is available on the plan s website. Information on MTM programs is available on the Centers for Medicare and Medicaid Services website (http://www.cms.gov/medicare/prescription-drug-coverage/). Information is also available on the Medicare website (http://www.medicare.gov) and through the Medicare Plan Finder (http://www.medicare.gov/find-a-plan/questions/home.aspx).
19 Drugs Excluded from Part D Coverage By law, Part D plans are not permitted to include the following under their Part D covered benefits: Drugs for weight loss or gain, fertility, cosmetic purposes, symptomatic relief of cough and colds Vitamins Barbiturates (except when used in treatment of epilepsy, cancer, or chronic mental health disorder) Erectile dysfunction drugs (when used for sexual dysfunction) Non-prescription drugs Some off label use drugs Part B covered drugs Part D plans are permitted to offer supplemental benefits that cover certain drugs not covered under Part D.
20 Mid-year Formulary Changes Formulary changes must be approved by CMS Part D plans cannot make any formulary changes during the first 60 days of the contract year, unless it is in response to a drug s removal from the market. After March 1st, Part D plans may make some midyear formulary changes including: Removal of a drug that is being withdrawn from the market by the FDA or manufacturer; Replacing brand name with new generic drugs, but only following 60 days notice to affected enrollees; and Other changes only if the enrollees currently taking the affected drug are exempted for the remainder of the year.
21 Transition Requirements Enrollees initially enrolling in Part D, those switching plans, and current enrollees affected by formulary changes must receive coverage of a single 30-day fill of their non-formulary drugs during the first 90 days after their enrollment, the plan switch, or the formulary change. Enrollees who reside in a long-term care facility must receive coverage for fills of at least 91 days for of their non-formulary drugs, as necessary, following enrollment under the Part D plan. During the transition period: The Part D plan does not apply prior authorization or step therapy rules. The enrollee and his/her physician can request an exception to the Part D plan s formulary to continue coverage of the nonformulary drug or can transition to a formulary drug.
22 Requesting Exceptions for Drugs Enrollees have the right to request a formulary exception for coverage either of non-formulary drugs or of formulary drugs at a less costly formulary tier. If a doctor thinks an enrollee needs a drug that is not on the list, the enrollee or the doctor can apply for a formulary exception. To facilitate their request, a standard form is available on Part D plan websites for enrollees to request a coverage determination, including a formulary exception. Provide access via a secure website or secure address on the website for enrollees to quickly request a coverage determination or appeal a decision; and Require network pharmacies to provide enrollees with a printed notice with the plan s toll-free number and website for requesting a coverage determination.
23 Part D Enrollee Costs and Assistance Programs
24 Part D Enrollee Costs: True Out-of-Pocket Costs (TrOOP) Part D True Out-of-Pocket costs or TrOOP are out-of-pocket costs enrollees incur that count towards the annual out-ofpocket threshold to move into catastrophic coverage. Calculated on an annual basis. Generally, includes payments for Part D prescription drugs: For the annual deductible, cost-sharing above the deductible and up to the initial coverage limit, and above the initial coverage limit up to the annual out-of-pocket threshold After the initial coverage period, a drug manufacturer s discount for brand name drugs counts toward the true out-ofpocket costs. Generally drugs must be on the plan s formulary and purchased at a plan s participating network pharmacy Beginning January 1, 2011 amounts paid or borne by AIDS drug assistance programs and the Indian Health Service count toward TrOOP.
25 Part D Enrollee Costs: True Out-of- Pocket Costs (TrOOP), cont d. Some costs do not count toward the Part D true outof-pocket (TrOOP) cost total including: Costs for drugs not on a Part D plan s formulary, unless the beneficiary receives an exception under which the plan covers the drug; Costs for over-the-counter (OTC) and other non-part D drugs; Costs for covered Part D drugs obtained out-of-network (unless the plan s out-of-network policy applies); Costs paid for or reimbursed to an enrollee by insurance, a group health plan, most government-funded health programs (such as Medicaid), or another third party; Costs for drugs purchased outside the United States.
26 Help for Individuals with Limited Income and Limited Resources If a beneficiary has limited income and resources, he/she may qualify for the low-income subsidy (LIS) and receive extra help from Medicare to cover all or part of the Part D plan premium and cost-sharing. To qualify for extra help, beneficiary income may not exceed 150% of the Federal Poverty Level (FPL). The 150% FPL varies geographically as follows: 48 states - $17,235 (individual)/$23,365 (couple) in Alaska - $21,525 (individual)/$29,070 (couple) in Hawaii - $19,845 (individual)/$26,775 (couple) in Assets up to $13,300 (individual)/$26,580 (couple) in Note: Typically these figures are updated annually.
27 Encourage Individuals with Limited Income/ Resources to Apply to the State Medicaid Office Beneficiaries with limited income and resources should be encouraged to apply for the low income subsidy (LIS) also called extra help through the State Medicaid office or the Social Security Administration (SSA). Beneficiaries may apply at any time. Tell beneficiaries to call MEDICARE ( ) and say Medicaid for the State Medicaid office phone number. If beneficiaries apply to the State Medicaid office for Part D help, the State Medicaid office also will check for eligibility for other low-income assistance programs. Or call SSA at or apply online at: to apply for help with Part D costs. After SSA or the State approves an application for extra help, it is effective the first day of the month in which the individual applied.
28 Other Help For Low-Income Pharmaceutical Assistance Programs Some pharmaceutical manufacturers operate programs directly or indirectly that assist low income individuals in obtaining drugs at reduced or no costs. Some states have assistance programs designed specifically for their residents. Some programs are qualified State Pharmaceutical Assistance Programs or SPAPs that count towards TrOOP and some do not count towards TrOOP. Becoming familiar with your state s programs may help a beneficiary address cost-sharing for prescriptions, particularly in the coverage gap.
29 Assistance Programs What Counts toward TrOOP? Enrollees may receive assistance for Part D costs, but costs paid by many assistance programs do not count toward the true out-of-pocket (TrOOP) cost. Included entities costs do count towards TrOOP for: Qualified State Pharmaceutical Assistance Programs (SPAPs), most charities, non-government and Indian Health Service funded tribal coverage, AIDS Drug Assistance Programs, health savings accounts, flexible spending accounts, and medical savings accounts. Excluded entities costs do not count towards TrOOP for: Medicaid, State Children s Health Insurance Program (CHIP), Federally Qualified Health Centers, Rural Health Clinics, Patient Assistance Programs (PAPs) outside the Part D benefit, TRICARE, Federal Employees Health Benefits Program (FEHBP), Black Lung Funds, and health reimbursement arrangements.
30 Part D Late Enrollment Penalties and Premiums
31 Part D Late Enrollment Penalty If a beneficiary does not enroll when first eligible or there is a subsequent gap in Part D coverage of more than 63 continuous days, he/she may pay a penalty to join a Part D plan later. If there has been a period of at least 63 continuous days following his/her initial enrollment period for Part D during which the beneficiary did not have either Part D or any other prescription drug coverage that was creditable (coverage that expects to pay, on average, at least as much as Medicare s standard Part D coverage expects to pay), when the beneficiary joins a Part D plan, generally the premium will go up by 1% of the national average beneficiary premium for each month he/she did not have such coverage.
32 Late Enrollment Penalty, cont d. In general, the penalty is in effect as long as the beneficiary has Medicare prescription drug coverage. Beneficiaries who qualify for the low-income subsidy are not subject to the late enrollment penalty as long as they are not disenrolled from their Part D or other creditable drug coverage for 63 days or longer.
33 Part D Premium Payment Part D enrollees have three options for paying their Part D premium. (1) Automatic electronic monthly mechanism, such as withdrawal from their checking or savings bank account or automatic deduction from their credit or debit card; (2) Direct monthly billing from the plan; or (3) Automatic deduction from their monthly Social Security Administration (SSA) benefit check. Typically it takes 2-3 months for SSA withholding to begin or end. When withholding begins, it will be for the 2-3 months of premiums owed. If a beneficiary is considering this option, he/she should call the plan first. Generally the beneficiary must stay with the premium payment option for the entire year.
34 Part D and Other Coverage
35 Employer/Union Coverage of Drugs Employer or Union Coverage: Employers/unions will tell their employees whether their prescription drug coverage is creditable (coverage that, on average, equals at least as much as Medicare s standard Part D coverage expects to pay). If coverage is creditable and the beneficiary keeps it, he/she will not incur a premium penalty if he/she later loses or drops the employer coverage and joins a Part D plan. If coverage is not creditable, the beneficiary will need to enroll in Medicare Part D during his/her initial eligibility period to avoid the late enrollment penalty. If a beneficiary has creditable drug coverage through TriCare, the VA, or the FEHBP, he/she can compare that coverage with available Part D plans to decide whether to enroll in Part D.
36 Employer Coverage of Drugs, cont d. The beneficiary should check with the employer or union benefits administrator before making any change. If a beneficiary drops employer/union prescription drug coverage, he/she may not be able to get it back and also may lose health coverage. If the beneficiary retires or otherwise loses employer/union creditable coverage and joins a Medicare Part D plan or otherwise obtains creditable drug coverage within 63 days, there will not be a late enrollment penalty.
37 Beneficiaries in Original Medicare with Medigap Drug Coverage Medigap plans H, I, and J with drug coverage could no longer be sold as of January 1, Some beneficiaries may have decided to keep their Medigap policy with the drug coverage they had before January 1, Insurers are required to notify beneficiaries annually whether or not the prescription drug coverage they have is creditable (coverage that expects to pay, on average, at least as much as Medicare s standard Part D coverage expects to pay).
38 Beneficiaries in Original Medicare with Medigap Drug Coverage, cont d. For beneficiaries who decided to keep their Medigap policy with the drug coverage they had before January 1, They may continue to keep the Medigap policy with drug coverage; OR They may keep their Medigap coverage with the drug portion of the coverage removed and enroll in a Part D PDP plan; OR They may drop their Medigap coverage and enroll in a MA-PD plan or other health plan with a PDP. If these beneficiaries choose a Part D plan now, they must pay a Part D late enrollment penalty unless their Medigap coverage was creditable. Note: See Part 1, Medicare Program Basics, for more information on Original Medicare and Medigap (Medicare supplement insurance).
39 Medicaid Drug Coverage Most prescription drugs that were previously covered by Medicaid are now covered under Medicare Part D. When a Medicaid beneficiary becomes eligible for Medicare, then Medicare, instead of Medicaid, covers the Part D drugs once the beneficiary is enrolled in a Part D plan. Medicaid beneficiaries can compare plans and choose a Medicare Part D plan. If they don t choose a plan, Medicare will select one for them. Medicaid beneficiaries can change Part D plans throughout the year.
40 For Additional Information Medicare s site on Part D prescription drug coverage for beneficiaries. Medicare s information site on Part D prescription drug coverage for Part D sponsoring organizations. Medicare & You Handbook.
Medicare Part D Prescription Drug Coverage Part 3 Version 9.0 June 22, 2015 Terms and Conditions This training program is protected under United States Copyright laws, 17 U.S.C.A. 101, et seq. and international
Medicare Part D Prescription Drug Coverage Part 3 Version 6.0 September 25, 2012 Terms and Conditions This training program is protected under United States Copyright laws, 17 U.S.C.A. 101, et seq. and
PO Box 350 Willimantic, Connecticut 06226 (860)456-7790 (800)262-4414 1025 Connecticut Ave, NW Suite 709 Washington, DC 20036 (202)293-5760 MEDICARE PART D PRESCRIPTION DRUG COVERAGE 2016 Se habla español
Medicare Part D: The Basics April 20, 2007 Cynthia Tudor, Ph.D., Director, Medicare Drug Benefit Group Part D History The Medicare Prescription Drug Improvement and Modernization Act of 2003 (Pub. L. 108-173)
Basic Reimbursement - Medicare Part D Specifics 60889-R8-V1 (c) 2012 Amgen Inc. All rights reserved 2 This information is provided for your background education and is not intended to serve as guidance
Summary of Benefits for SM, Plus SM and Premier SM Available in Maine and New Hampshire A -approved Part D sponsor. Anthem Insurance Companies, Inc. (AICI) is the legal entity who has contracted with the
Health Net orange prescription drug plan Summary of benefits 2009 idaho, utah Benefits effective January 1, 2009 (S5678-064) PDP Option 1 (S5678-063) PDP Value Option 2 Section I INTRODUCTION TO SUMMARY
Prescription Drug Coverage for Medicare Beneficiaries: A Summary of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Prepared by Health Policy Alternatives, Inc. for The Henry
22222 2013 SUMMARY OF BENEFITS Plus Prescription Drug Plans S5670 S5768 Y0022_PDP_2013_S5670_036_S5768_009_S5768_129SBa Accepted FH13SB06VP2 22 SECTION I INTRODUCTION TO SUMMARY OF BENEFITS Thank you for
2013 SUMMARY OF BENEFITS Plus Prescription Drug Plans S5670 S5768 Y0022_PDP_2013_S5670_138_S5768_119_S5768_150_SBb Accepted FH13SB935 SECTION I INTRODUCTION TO SUMMARY OF BENEFITS Thank you for your interest
Version 23 Medicare Prescription Drug Coverage and Medicare Plan Finder What is Medicare? Health insurance for three groups of people 65 and older Under 65 with certain disabilities Any age with End-Stage
POST65NATPCC 2015 Post-65 Medical and Rx Comparison Chart National Group Insurance Options Underwritten by Aetna Emeriti offers two types of medical plans aligning in different ways with Medicare Parts
2016 Group Retiree Medicare Plans Blue Cross MedicareRx (PDP) Medicare Part D Prescription Drug Plans Anthem Blue Cross is a stand-alone prescription drug plan with a Medicare contract. Enrollment in Anthem
New Medicare Prescription Drug Coverage: An Overview for Pharmacies in Oregon Note: All material in this manual is intended for people with Medicare who live in Oregon. It is not indicative of what classes
THE A,B,C,D S OF MEDICARE An important resource for understanding your healthcare in retirement What you need to know for 2014 How Medicare works What Medicare covers How much Medicare costs INTRODUCTION
NATIONAL MEDICARE ADVOCATES ALLIANCE ISSUE BRIEF # 9 APRIL, 2010 MEDICARE PART D GRIEVANCES, APPEALS, AND EXCEPTIONS This issue brief describes the grievance and appeals processes currently in effect for
Bancorp Insurance Medicare Vocabulary Advance Beneficiary Notice (ABN) A notice indicating the cost of a service that Medicare might not cover. Accepting Assignment Your Doctor agrees to accept payment
State Retiree Health Benefits Program Fact Sheet #8A Prescription Drugs Medicare- Eligible Participants As a Medicare-eligible participant in the State Retiree Health Benefits Program, what are my choices
Medicare Part D: 2010 Presented by: Howard Houghton Virginia Insurance Counseling & Assistance Program (VICAP) 1 The Basics Medicare Part D is available to all Medicare beneficiaries regardless of their
Blue Shield 65 Plus (HMO) offered by Blue Shield of California Annual Notice of Changes for 2014 (This 2014 Annual Notice of Changes is effective October 1, 2013 December 31, 2014.) You are currently enrolled
Terminology: Beneficiaries: those who receive benefits through government programs like Medicare Deductible: a fixed monetary amount set by Medicare or a private insurer. You are responsible for all medical
Enrollment Guidance Medicare Advantage and Part D Plans Part 5 Version 6.0 September 26, 2012 Terms and Conditions This training program is protected under United States Copyright laws, 17 U.S.C.A. 101,
Frequently Asked Questions: Medicare Supplement & Medicare Advantage Who is eligible for CBIA s Medicare program? A CBIA Health Connections participant is eligible for either plan if they are qualified
f Your Medicare Health Benefits and Services as a Member of Health Net Value Orange Option 2 This mailing gives you the details about your Medicare health coverage from January 1 December 31, 2009, and
Your Medicare Health Benefits and Services/Prescription Drug Coverage as a Member of Advantra Capital. PPO This mailing gives you the details about your Medicare health and/or prescription drug coverage
Medicare: An Overview Presented by Elaine Wong Eakin Project Manager This special regional educational effort is supported by funding provided by the California HealthCare Foundation Our Focus is dedicated
THE BASICS Participation is voluntary. The income level and assets of beneficiaries determine the level of prescription assistance they will receive. Beneficiaries with incomes over 150% of the Federal
P.O. Box 52424, Phoenix, AZ 85072-2424 SilverScript (Employer PDP) sponsored by REHP 2014 Summary of Benefits SilverScript (Employer PDP) is a Prescription Drug Plan. This plan is offered by SilverScript
2016 One-on-One Prescription Drug Plan (PDP) Presentation Y0070_NA030516_PDP_PRS_ENG CMS Approved 08032015 WellCare 2015 NA_06_15_WC PD6SALPRE67709E 67709 Welcome to WellCare Prescription Drug Plan Thank
Gateway Health Medicare Assured Prime SM (HMO) offered by Gateway Health Plan of Ohio, Inc. Annual Notice of Changes for 2017 You are currently enrolled as a member of Gateway Health Medicare Assured Prime.
Medicare Part D & Ryan White HIV/AIDS Program As of November 2008 The below discussion can guide Ryan White HIV/AIDS programs in understanding implications of the Medicare Part D prescription drug benefit
Prescription Drug Coverage Presented by: Medigap Part D & Prescription Drug Helpline Board on Aging & Long Term Care A Wisconsin SHIP Medicare Part A Prescription Drug Coverage Part A generally pays for
ISSUE BRIEF VOL. 5, NO. 10, 2005 This ongoing series provides information on how to develop programs to educate Medicare beneficiaries and their families. Additional information about this and other projects
Gateway Health Medicare Assured Diamond (HMO-SNP) offered by Gateway Health Plan of Ohio, Inc. Annual Notice of Changes for 2017 You are currently enrolled as a member of Gateway Health Medicare Assured
ATRIO Bronze Rx (Umpqua) (PPO) offered by ATRIO Health Plans Annual Notice of Changes for 2017 You are currently enrolled as a member of ATRIO Bronze Rx (Umpqua) (PPO). Next year, there will be some changes
DRAFT: 4B World Bank Group RMIP DATE: 9/08/15 FAQS for Pre-pre-enrollment mailing Sept 2015 FREQUENTLY ASKED QUESTIONS (FAQs) About Your New Retiree Prescription Drug Plan On January 1, 2016, SilverScript
2015 National Training Program Module 9 Medicare Part D Prescription Drug Coverage Session Objectives This session should help you Differentiate Medicare Part A, Part B, and Part D drug coverage Summarize
Medicare Part B vs. Part D 60889-R8-V1 (c) 2012 Amgen Inc. All rights reserved 2 This information is provided for your background education and is not intended to serve as guidance for specific coding,
Geisinger Gold Classic Rx (HMO) offered by Geisinger Health Plan Annual Notice of Changes for 2016 You are currently enrolled as a member of Geisinger Gold Classic Rx. Next year, there will be some changes
Pharmacy Outreach Program The University of Rhode Island College of Pharmacy Updated October 2014 Medicare provides health insurance for Aged 65 years or older Aged 65 years or less with certain disabilities
First Health Part D Value Plus (PDP) Plan offered by First Health Life & Health Insurance Company Annual Notice of Changes for 2015 You are currently enrolled as a member of First Health Part D Essentials
CENTERS FOR MEDICARE & MEDICAID SERVICES Your Guide to Medicare Prescription Drug Coverage This official government booklet tells you the following: How it works How to get extra help paying for drug coverage
For more information, please call the Emeriti Service Center at 1-866-EMERITI (1-866-363-7484) 2016POST65NATPCC Emeriti Retirement Health Plan 2016 Post-65 Medical & Rx Comparison Chart Group Insurance
City of Boston Medicare Part D Prescription Drugs May 10, 2016 Copyright 2016 by The Segal Group, Inc. All rights reserved. Educational Sessions Schedule Medicare RFP and Prescription Drug Review PEC Meeting
Medicare Part D The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) added voluntary prescription drug coverage to Medicare, the federal health insurance program for seniors
Premera Blue Cross Medicare Advantage (HMO) offered by Premera Blue Cross Annual Notice of Changes for 2016 You are currently enrolled as a member of Premera Blue Cross Medicare Advantage (HMO). Next year,
Cigna-HealthSpring Preferred (HMO) offered by Cigna-HealthSpring ANNUAL NOTICE OF CHANGES FOR 2016 You are currently enrolled as a member of Cigna-HealthSpring Preferred (HMO). Next year, there will be
Advocare Essence (HMO-POS) offered by Security Health Plan of Wisconsin, Inc. You are currently enrolled as a member of Advocare Essence (HMO-POS). Next year there will be some changes to the plan s costs
2014 Medicare Prescription Drug Annual Open Enrollment Questions & Answers The Annual Open Enrollment for Medicare prescription drug (Part D) is October 15, 2013 December 7, 2013. Certain people with Medicare
HEALTH NET SAGE Benton, Clackamas, Columbia, Hood River, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill Counties, Oregon and Clark County, Washington (H5520-007) A COMPLETE EXPLANATION OF YOUR
MEDICARE 101 Understanding the basics of the Medicare Program. Table of Contents 01. 05. 13. 17. 25. 29. The History of Medicare What is Medicare? Who is Eligible? Medigap Plans Medicare Advantage (MA)
Medicare Prescription Drug Benefit Part B vs Part D Home Infusion Perspective Lucy Saldaña, Pharm.D Region IX Pharmacist Christina Leath, JD Health Insurance Specialist Consortium for Medicare Health Plans
Medicare Part D Frequently Asked Questions: Eligibility & Enrollment This list of Frequently Asked Questions regarding eligibility and enrollment issues in the new Medicare Part D prescription drug benefit
Retiree prescription drug program: time to move to an Employer Group Waiver Plan (EGWP)? Gail Levenson and Rich Stover Today s areas of focus Overview of Medicare Part D plan Impact of health care reform
Show-Me Guide Introduction to Part D: Medicare s New Prescription Drug Coverage An educational resource developed and published by UnitedHealth Group Contents What are the big ideas? 2 Is a Part D plan
MODULE 16: MEDICARE AND THE HEALTH INSURANCE MARKETPLACES Objective This module will educate HIICAP counselors about how Medicare is affected (and not affected) by the health insurance Marketplaces. What
800.334.1330 254.773.1330 fax 254.774.7652 4912 Midway Drive Post Office Box 6130 Temple, TX 76503-6130 www.carehealthplan.com A. PLEASE INDICATE WHICH PLAN YOU WISH TO ENROLL IN: Plan #4000 - Supplement
2016 Evidence of Coverage ATRIO Gold Rx (Rogue) (PPO) Member Handbook Serving Medicare Beneficiaries in Josephine and Jackson Counties H6743_017_EOC_16 CMS Accepted January 1 December 31, 2016 Evidence
2017 Legal Notice Medicare Part D Notice of Creditable Coverage For Active Employees Medicare Part D Notice of Creditable Coverage This is an important notice from Prudential about your prescription drug
Kaiser Permanente Senior Advantage Core (HMO) offered by Kaiser Foundation Health Plan of Colorado Annual Notice of Changes for 2016 You are currently enrolled as a member of Kaiser Permanente Senior Advantage
CONTENTS o o o o o o o o o o o o What Are Medicare Advantage (MA) Plans? Who Can Join and When? MA Trial Right Special Election Period How MA Plans Work MA Costs Types of Medicare Advantage Plans Rights
SCOPE OF SALES APPOINTMENT CONFIRMATION FORM To be completed by person with Medicare. Please initial below in the box beside the plan type that you want the agent to discuss with you. If you do not want
2011 SUMMARY OF BENEFITS First Health Part D Prescription Drug Plan (PDP) S5768 S5674 Y0022_2011_1001_046_25 CMS Approval Date: 09/23/2010 FH11SB25 Section I Introduction to Summary of Benefits Thank you
ConnectiCare VIP Employer Group (HMO-POS) offered by ConnectiCare, Inc. Connecticut Business & Industry Association (CBIA) Annual Notice of Changes for 2014 You are currently enrolled as a member of ConnectiCare
This glossary provides simple and straightforward definitions of key terms that are part of the health reform law. A Affordable Care Act Also known as the ACA. A law that creates new options for people
Blue Medicare HMO SM Standard offered by Blue Cross and Blue Shield of North Carolina (BCBSNC) Annual Notice of Changes for 2014 You are currently enrolled as a member of Blue Medicare HMO Standard. Next
MEDICARE PRESCRIPTION DRUG PLANS: INFORMATION FOR CONSUMERS Contents: 1. General Information 2. Dates to Remember 3. Frequently Asked Questions Prepared by Susan V. Murray, MSW, CMSW Medical Social Worker
Understanding Medicare Part D Cynthia Tudor, Ph.D. Acting Director, Medicare Drug Benefit Group Medicare Modernization Act Prescription Drug Coverage The Medicare Modernization Act (MMA) of 2003 provides
2012 Medicare Part D Drug Coverage Consumer Costs Under a Standard 2012 Part D Plan Premiums range from $15.10 to $114.90 per month. The annual deductible is $0 to $320. The deductible is the amount you
January 1 December 31, 2016 Evidence of Coverage: Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Advantra Silver (HMO) This booklet gives you the details about
Today's Options Advantage 200 (PPO) offered by American Progressive Life & Health Insurance Company of New York, Inc. Annual Notice of Changes for 2016 You are currently enrolled as a member of Today's
UPREHS PRIME MEDICARE PART D PRESCRIPTION DRUG PLAN (EMPLOYER PDP) BENEFIT GUIDE Your Medicare Prescription Drug coverage as a Member of the UPREHS Prime Medicare Part D Plan 2015 A $9 copayment gets you
Kaiser Permanente Senior Advantage Essential Plus plan (HMO) offered by Kaiser Foundation Health Plan, Inc., Hawaii Region Annual Notice of Changes for 2015 You are currently enrolled as a member of Kaiser
Advocare Spirit Rx (HMO-POS) offered by Security Health Plan of Wisconsin, Inc. Annual Notice of Changes for 2014 You are currently enrolled as a member of Advocare Spirit Rx (HMO-POS). Next year there
Medicare Part D and You for 2013 (Individuals and Families) 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
Medicare Part D: Things People With Cancer May Want to Know Medicare Part D prescription drug coverage This information is designed to help you decide whether to enroll in a Medicare Part D drug plan and
2015 This is the official U.S. government Medicare handbook. What s important in 2015 (page 12) What Medicare covers (page 35) CENTERS FOR MEDICARE & MEDICAID SERVICES Section 7 Get Information about Prescription
Medicare Prescription Drug Coverage: An Overview for Oregonians Table of Contents Who is Eligible?...3 Prescription Drug Plans and Medicare Advantage Plans...4 Medicare Supplement Insurance Plans (Medigap)...5
Part D payment system paymentbasics Revised: October 204 This document does not reflect proposed legislation or regulatory actions. 425 I Street, NW Suite 70 Washington, DC 2000 ph: 202-220-3700 fax: 202-220-3759
2 Medicare Part D Agenda Medicare Overview Medicare Part B Drug Coverage Medicare Part D: Background Benefits of Medicare Part D Enrollment Coverage Specialty Medications Part D Costs How to Find and Compare
Prescription Drug Benefits This insert will accompany the Medicare- Coordinating Plans Member Handbook for enrollees who are eligible for and have elected these benefits. Important Notice... 1 Using Your
Geisinger Gold Preferred Complete Rx (PPO) offered by Geisinger Indemnity Insurance Company Annual Notice of Changes for 2016 You are currently enrolled as a member of Geisinger Gold Preferred Complete
SilverScript Insurance Company Medicare Prescription Drug Plan Safety. Savings. Service. 2010 Plan Year S5601_10_80008 CMS Approval Date 10/26/2009 2009 SilverScript. All rights reserved. Medicare Overview