Medicare Prescription Drug Coverage
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1 Financial Ratings Series Consumer Guide to Medicare Prescription Drug Coverage spring 2014 GREY HOUSE PUBLISHING
2 CONTENTS Part I: About Medicare Prescription Drug Coverage 3 What is Medicare Prescription Drug Coverage? 6 How Does the Medicare Prescription Drug Coverage Work? 9 Part II: Making a Choice About Prescription Drug Coverage 19 Medicare Prescription Drug Planner and Worksheets 22 Part III: What Happens Once you Enroll? 35 Part IV: Medicare Approved Prescription Drug Plans 45 Appendix 89 State Health Insurance Assistance Programs 91 State Pharmacy Assistance Programs 92 Other Helpful Resources 93
3 Consumer Guide to MedicarePrescriptionDrugCoverage Table 1 Original Medicare vs. Medicare Advantage Listed here are the pros and cons of the two ways to access Medicare benefits. Use this to help determine what works best for you. Original Medicare Pro Cons You can see any doctor, specialist or hospital that accepts Medicare. You can fill your Medicare coverage gaps by purchasing private Medicare Supplement Insurance and Prescription Drug Plan coverage. Medicare Advantage Your in-patient hospital coverage is limited. You do not know in advance how much a doctor visit will cost. You pay 20% of the Medicare-approved amount (assuming the doctor accepts Medicare). Creating a comprehensive package of benefits is up to you. While each insurer has its own set of benefits, generally the following will apply: Pro A higher amount of in-patient hospital costs are covered, so you'll see lower upfront out-of-pocket costs and coverage for unlimited days. You pay a set co-payment for doctor visits so you know in advance your cost obligations (assuming the physician is in the plan's network). You can access preventative care services either at no cost or low cost. You may get additional benefits unavailable through Medicare or even a Medigap policy, such as dental and vision services or health club memberships. You get more comprehensive coverage with one-stop enrollment. Cons You often are limited to a network of doctors, specialists and hospitals. You may need a referral to go to a network hospital and certain doctors. The insurer may choose not to offer coverage in the future, forcing you to make changes that could be confusing. Health plan comparison shopping is challenging, as benefits are not standardized. (Keep in mind that a Medicare Advantage plan may not be offered in the area you live.) 8
4 Consumer Guide to MedicarePrescriptionDrugCoverage How Does the Medicare Prescription Drug Coverage Work? Medicare prescription drug coverage is only available from private companies that have been approved by Medicare. All private companies that are approved to offer Medicare's prescription drug benefit must offer a minimum drug benefit, known as the Standard Medicare Drug Benefit. While plans have to offer prescription drug coverage at least as good as that standard benefit, many have designed their offerings differently, generally offering more benefits. We'll bring you up to speed on Medicare's standard benefit shortly. But first, in order to get Medicare prescription drug coverage you must enroll in a private drug plan. There are two ways to access prescription drug benefits paid for by Medicare-by enrolling in either a stand-alone prescription drug plan or a Medicare Advantage plan. Stand-alone Prescription Drug Plans (or PDP) are Medicare-approved plans that provide coverage only for prescription drugs. Upon enrolling in a PDP, you will receive your Medicare prescription drug benefits and pay a separate Part D premium to the plan. (The plan also receives funding from the government.) You then combine this coverage with your Original Medicare benefits and any other health care coverage. Medicare Advantage Prescription Drug Plans (or MA-PDP) provide you with "one-stop shopping" for all your Medicare benefits, including hospitalization (Part A), medical services (Part B) and prescription drugs (Part D). These plans will also receive money from the government to pay for your benefits. Some plans will charge you a premium while others won't. In both cases, insurers offering Medicare prescription drug coverage are required to provide at least the minimum standard benefit mandated by the Medicare program. See the Index starting on page 50 for a list of stand-alone PDPs and Medicare Advantage prescription drug plans. 9
5 Consumer Guide to MedicarePrescriptionDrugCoverage Medicare Prescription Drug Planner and Worksheets STEP ONE: Check the Premium you pay on your current health care coverage. Original Medicare - Part A and Part B coverage Do you receive benefits directly through the Original Medicare program?... Y / N If yes, you may be paying the Part B premium (there is no premium for Part A) yourself or perhaps you have an employer plan or a Medicare Supplement Insurance Policy that pays the premium. u Record the annual premium amount, if any, you pay: Part A and B: $ Employer or Union Retirement Plan Coverage Do you receive benefits through an Employer or Union plan?... Y / N u Record the annual premium amount, if any, you pay: Employer Plan: $ If yes, the coverage is most likely comprehensive and includes drug coverage. To be sure, check any letters or notices you received from your employer or employer benefit provider. Read them to find out if the drug coverage is being continued AND that it is considered "creditable coverage" (meaning it meets the minimum requirements set by Medicare). Is the drug coverage being continued and is it considered creditable?... Y / N State Pharmacy Assistance Programs Do you receive benefits through a State Pharmacy Assistance Program (SPAP)?... Y / N u Record the annual amount, if any, you pay: SPAP: $ Check any letters or notices you received from your state about how your SPAP drug coverage will be affected by Medicare Part D. Read them to find out if the drug coverage is being continued AND that it is considered 'creditable coverage' (meaning it meets the minimum requirements set by Medicare). Review Part I, page 8 for more information on SPAPs. Is the SPAP being continued and is it considered creditable?... Y / N 22
6 Part IV: Medicare Approved Prescription Drug Plans Organization Website Phone 'Ohana Health Plan Company: WELLCARE HEALTH INS OF ARIZONA INC (AZ) Financial Strength Rating: C+ MA-PDP: HI Abrazo Advantage Health Plan Company: PHOENIX HEALTH PLANS INC (AZ) Financial Strength Rating: B MA-PDP: AZ Access Medicare Company: CUATRO LLC (NY) Financial Strength Rating: E- MA-PDP: NY ActiveSaver MSA or BlueSaver MSA Company: HEALTHNOW NY INC (NY) Financial Strength Rating: A MA-PDP: NY Advantage by Bridgeway Health Solutions HMO SNP Company: NOT AVAILABLE Financial Strength Rating: --- Advantage by Buckeye Community Health Plan Company: BUCKEYE COMMUNITY HEALTH PLAN INC (OH) Financial Strength Rating: B- Advantage by Managed Health Services Company: MANAGED HEALTH SERVICES INS CORP (WI) Financial Strength Rating: C Advantage by Peach State Company: PEACH STATE HEALTH PLAN INC (GA) Financial Strength Rating: C Advantage by Sunshine Health Company: SUNSHINE STATE HEALTH PLAN INC (FL) Financial Strength Rating: E Advantage by Superior HealthPlan Company: SUPERIOR HEALTHPLAN INC (TX) Financial Strength Rating: C ADVANTAGE Health Solutions, Inc Company: ADVANTAGE HEALTH SOLUTIONS INC (IN) Financial Strength Rating: C MA-PDP: IN 50
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