Valuation Issues in Medicare Part D
|
|
|
- Oswald Banks
- 8 years ago
- Views:
Transcription
1 Valuation Issues in Medicare Part D Society of Actuaries Valuation Actuary Symposium September 18, 2007 Topics Introduction/overview Ramifications of uneven cash flow Risk Protection and related issues Enrollment and revenue issues Rules guidance Management reporting Operational issues
2 Speakers Tom Snook, moderator (Milliman) Brian Januzik (CVS Caremark) Darrell Knapp (Ernst & Young) Bill Thompson (Milliman) Part D Overview Really Basic All contracted to private sector Prescription Drug Plans on a competitive bid basis Total bid CMS portion Member premium
3 More Basics on Part D Benefit structure Deductible ($275 in 2008) 75% coverage up to Initial Coverage Limit ($2,510) No coverage (coverage gap or donut hole ) until True Out of Pocket expense limit ($4,050) 95% Catastrophic coverage beyond TrOOP max Part D Benefits Part D Coverage (95%) $5,726 Beneficiary $2,510 $275 Part D Coverage (75%)
4 More Basics on Part D Federal Reinsurance covers 80% of the gross drug costs above threshold (specific stop loss) Low Income Subsidy richer benefits for those who qualify; PDP plans not at risk Cost sharing subsidy Premium subsidy Dual Eligibles subset of Low Income Subsidies More Part D Risk corridors like aggregate stop loss CMS shares in risk for 2006 and 07: +/- 2.5%: 100% PDP plan +/- 2.5 to 5.0%: 75% CMS, 25% plan +/- >5.0%: 80% CMS, 20% plan For 2008, the risk corridors widen: +/- 5.0%: 100% plan +/- 5.0 to 10%: 50% CMS, 50% plan +/- >10.0%: 80% CMS, 20% plan
5 Risk Corridors Acronyms BPT = Bid Pricing Tool GDCA = Gross Drug Cost Above Out of Pocket Threshold CBS = Cumulative Beneficiary Summary DIR = Direct and Indirect Remuneration ICL = Initial Coverage Limit LICS = Low Income Cost Share LIPS = Low Income Premium Subsidy MMRD = Monthly Membership Report Detail PBP = Prescription Benefit Plan PDE = Prescription Drug Event TrOOP = True Out of Pocket EGWP = Employer Group Waiver Plan
6 Issue #1: Uneven Cash Flows Part D Projections and Results Compilation of: Individual PDPs By Income Category By Region By Plan EGWPs
7 Individual PDPs Special Issues Mix of Risks Mismatch of Revenue & Plan Liability Cash Flow Timing (Fed Reins & LICS) Risk Corridors EGWP Differences Richer Plans = More level benefits throughout the year Different Risk Profile Different Geographic Concentration
8 Mix of Risks Averages Don t Work Even Aggregate Risk Scores 2 Beneficiaries, Both with $2,250 in drug spend (Average Gross Rx Spend = $2,250, Average PDP Claim Liability = $1500) 2 Beneficiaries, One with $250 in drug spend, One with $4,250 in drug spend (Average Gross Rx Spend = $2,250, Average PDP Claim Liability = $750) Same Average Gross Rx Spend ($2,250), Very Different Claim Liability Monthly MLR for Two Cohorts w/risk Score of MLR Month
9 Mismatch of Revenue & Claim Liability Mo 1 Mo 2 Mo 3 Mo 4 Mo 5 Mo 6 Mo 7 Total Projected Revenue Total Claims (PMPM) PDP Liability (net of Federal reinsurance) PDP Liability as % Revenue 71% 70% 60^ 51% 47% 40% 38% Federal Reinsurance Cash Flow & Timing Federal Reinsurance Subsidy by Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Monthly Average
10 Cash Flow & Timing Incurred LICS by Month Risk Corridors & Reconciliation Risk Corridors Point in Time vs. Full Year Allocated One for each PDP (102 for Nat l Sponsor) Reconciliation Risk Score LICS Federal Reinsurance Subsody Risk Corridor
11 Risk Corridors & Reconciliation All Numbers PMPM Q1 Q2 Q3 Q4 FY Gross Profit (Pre Risk Corridor) $ (8.29) $ 3.25 $ $ $ PDP A Risk Corridor Adj $ $ $ (14.85) $ (27.57) $ 5.29 Gross Profit (Post Risk Corridor) $ $ $ $ $ Gross Profit (Pre Risk Corridor) $ $ $ $ $ PDP B Risk Corridor Adj $ (9.97) $ 1.57 $ (3.92) $ (14.92) $ (6.74) Gross Profit (Post Risk Corridor) $ $ $ $ $ Gross Profit (Pre Risk Corridor) $ $ $ $ $ Issue #2 Risk Protection
12 Risk Corridors Aggregate Stop Loss Reinsurance Done at Prescription Benefit Plan Level Mark to Market GAAP Non-Level Earnings Steers Results to Strike Zone / Sweet Spot Not Applicable to Employer Group Waiver Plans Not Applicable to Enhanced Portion of Benefit Risk Corridor Simple Example CY 2006 Symmetrical Risk Corridors: CMS participates in gain/loss above the benefit target premium, via symmetrical risk corridors at 2.5% and 5.0% levels Target premium: PDP net risk on the 75% cost share between the front-end deductible and the initial coverage limit plus the 15% cost share above TrOOP (ie, catastrophic coverage limit) CMS mitigates a 5.4% excess of target amount profit margin to a 3.2% excess gain as follows: 100% x 2.5% + 25% x (5.0% - 2.5%) + 20% x (5.4% - 5%) = 3.205%
13 Risk Corridor Formula TA = (DSA + PA) x (1-ACR) FUTA = FUTP x TA SUTA = SUTP x TA FLTA = FLTP x TA SLTA = SLTP x TA AARCCA = (CPPA ARSA DDIRA) / IUR IF FUTA < AARCCA SUTA then RA = FURSR x (AARCCA FUTA) IF SUTA < AARCCA then RA = [FURSR x (SUTA FUTA)] + [SURSR x (AARCCA SUTA)] IF FLTA > AARCCA SLTA then RA = FLRSR x (AARCCA FLTA) IF SLTA > AARCCA then RA = [FLRSR x (SLTA FLTA)] + [SLRSR x (AARCCA SLTA)] IF FLTA AARCCA or FLTA then RA = 0 CMS August 2007 Prescription Drug Event Data Advanced Training LICS & Reinsurance Pass-Through Accounting Settled at CMS Reconciliation LICS = Low Income Cost Share Negative Cash Flow During Deductible and Gap Reinsurance Specific Stop Loss Reinsurance Positive Cash Flow at the Beginning of Year Negative Cash Flow on Employer Group Waiver Plans since CMS funds at Reconciliation
![(AARCCA SLTA)] IF FLTA AARCCA or FLTA then RA = 0 CMS August 2007 Prescription Drug Event Data Advanced Training LICS & Reinsurance Pass-Through Accounting Settled at CMS Reconciliation LICS = Low](/docs-images/43/10383185/images/page_13.jpg "Income Cost Share Negative Cash Flow During Deductible and Gap Reinsurance Specific Stop Loss Reinsurance Positive Cash Flow at the Beginning of Year Negative Cash Flow on Employer Group Waiver Plans")
14 Issue #3 Enrollment & Revenue Enrollment & Revenue Enrollment Differences in 2006 State to Plan: 2006 Phenomenon Plan to Plan Risk Adjusters: Two Retroactive Adjustments per Year Show Impact Before and After Risk Corridor Premium Collection Supplemental Premium
15 Regional Benchmarks Can Impact Enrollment $ $95.00 $90.00 DS + LIS Benchmark $85.00 $80.00 $75.00 $70.00 $ PDP Region Issue #4 Rules Guidance
16 Statutory INT Rules Guidance LICS and Reinsurance payments treated as selffunded (follow SSAP 47) Other amounts treated as retrospectively rated premiums Risk share liability shown as experience rated refund 90 day limit on admission of assets waived GAAP Rules Guidance Primary guidance around reporting on seasonality/risk sharing Two options Use period-to-date experience Project ultimate settlement and pro-rate
17 Interesting Questions Reinsurance given the risk sharing protections, does a quota share reinsurance contract meet risk transfer requirements Right of offset can you offset assets and liabilities to CMS from various plans Rebates if rebates become non-admitted, can you adjust reinsurance and risk share receivables/payables Issue #5 Management Reporting
18 Issue #6 - Operational Issues Newness of Program State to Plan Extension of Transition Period Plan to Plan Direct and Indirect Remuneration CMS Reconciliation
19 Unique Financial Structure Ability to Track by Prescription Benefit Plan Ability to Track by State Ability to Track by Month Prescription Drug Event Direct and Indirect Remuneration Operational Hiccups Monthly Membership Report Detail Plan to Plan Premium Reconciliation Prescription Drug Event State to Plan
20
FOLLOW-UP QUESTIONS FROM THE PART D CASH FLOWS WEBINAR PRESENTED JULY 7 TH, 2015
FOLLOW-UP QUESTIONS FROM THE PART D CASH FLOWS WEBINAR PRESENTED JULY 7 TH, 2015 1. So the goal for 2020 is to continue the Drug Manufacturer responsibility in the GAP at 50% and split the rest between
Medicare Part D Accounting Practice Note
A Public Policy Practice Note Medicare Part D Accounting Practice Note April 2008 American Academy of Actuaries Medicare Part D Accounting Practice Note Subgroup of the Health Practice Financial Reporting
Medicare Part D Prescription Drugs
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
Article from: Health Watch. January 2009 No. 60
Article from: Health Watch January 2009 No. 60 1 Full Medicare Part D Coverage Through the Gap An Endangered Benefit? By Julia Lambert 2 Chairperson s Corner By Jennifer Gillespie 3 Letter From the Editor
Part D payment system
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
Retiree prescription drug program: time to move to an Employer Group Waiver Plan (EGWP)?
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
How To Calculate Revenue From A Medicare Plan
December 17, 2013 Kelly Backes, FSA, MAAA 1. Introduction Whether a Medicare Advantage (MA) plan is just beginning operations or has participated in the market for years, it is critically important to
Health Spring Meeting June 2009. Session # 27 TS: Medicare Advantage: Revenue Payments + Part D Accounting
Health Spring Meeting June 2009 Session # 27 TS: Medicare Advantage: Revenue Payments + Part D Accounting Brian M. Collender, FSA, MAAA Judah Z. Rabinowitz, FSA, MAAA, FCA Moderator: Judah Z. Rabinowitz,
DHS BUDGET REQU~ST FOR FY 2015-2016
DHS BUDGET REQU~ST FOR FY 2015-2016 ($ Amounts in Thousands) Page # of Governor's Executive Budget: APPROPRIATION: Pp. C1.8, E30.5, E30.16, E30.17 Payment to Federal Govt. - Medicare Drug Progr~m l. SUMMARY
Medicare Annual Enrollment Period Choice & Impact Study
2011/2012 Medicare Annual Enrollment Period Choice & Impact Study Table of Contents Report Overview...................................... 3 2011/2012 Choice & Impact Study Results................. 5 Stand-Alone
Retiree Health Care Strategy
Retiree Health Care Strategy Medicare Part D Prescription Drug Coverage for Montgomery County Government Retirees June 4, 2014 Prepared by Consulting Health & Benefits Retirement Medicare Retirees Prescription
Medicare: Humana s Strategic Actuarial Positioning John M. Bertko, F.S.A., M.A.A.A.
Medicare: Humana s Strategic Actuarial Positioning John M. Bertko, F.S.A., M.A.A.A. Vice President and Chief Actuary Humana Inc. 1 Cautionary Statement This presentation is intended for instructional purposes
Actuarial Equivalence for Prescription Drug Plans and Medicare Advantage Prescription Drug Plans under the Medicare Drug Program
A Public Policy Practice Note Actuarial Equivalence for Prescription Drug Plans and Medicare Advantage Prescription Drug Plans under the Medicare Drug Program March 2008 American Academy of Actuaries Actuarial
The Impact of Medicare Part D on the Percent Gross Margin Earned by Texas Independent Pharmacies for Dual Eligible Beneficiary Claims
The Impact of Medicare Part D on the Percent Gross Margin Earned by Texas Independent Pharmacies for Dual Eligible Beneficiary Claims Angela Winegar, M.S., Marvin Shepherd, Ph.D., Ken Lawson, Ph.D., and
Donut Hole Analysis November 2014
Medicare Part D Donut Hole Analysis November 2014 Symphony Health Solutions offers an array of Managed Markets Studies CONSULTING/ANALYTICAL STUDIES Managed Markets Landscape Dynamic Claims Lifecycle Data
AT&T Global Network Client for Windows Product Support Matrix January 29, 2015
AT&T Global Network Client for Windows Product Support Matrix January 29, 2015 Product Support Matrix Following is the Product Support Matrix for the AT&T Global Network Client. See the AT&T Global Network
Revolution or Evolution: What s Happening Next for MedAdv and Prescription Drug Plans
Revolution or Evolution: What s Happening Next for MedAdv and Prescription Drug Plans Issues & Trends in Medicare Supplement Insurance 2012 Conference Presented by: T. Scott Bentley, FSA, MAAA Consulting
Medicare Part D Amounts Will Increase in 2016
April 9, 2015 Medicare Part D Amounts Will Increase in 2016 The Medicare Modernization Act (MMA) requires the Centers for Medicare & Medicaid Services (CMS) to announce each year the Medicare Part D standard
MEDICARE PART D THE BASICS
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
2015 Medicare Low-Income Subsidy (LIS), or Extra Help
2015 Medicare Low-Income Subsidy (LIS), or Extra Help Extra Help with Prescription Drug Costs Medicare LIS Overview Patient Eligibility and Application Process How LIS Affects Patient Responsibility for
COMPARISON OF FIXED & VARIABLE RATES (25 YEARS) CHARTERED BANK ADMINISTERED INTEREST RATES - PRIME BUSINESS*
COMPARISON OF FIXED & VARIABLE RATES (25 YEARS) 2 Fixed Rates Variable Rates FIXED RATES OF THE PAST 25 YEARS AVERAGE RESIDENTIAL MORTGAGE LENDING RATE - 5 YEAR* (Per cent) Year Jan Feb Mar Apr May Jun
COMPARISON OF FIXED & VARIABLE RATES (25 YEARS) CHARTERED BANK ADMINISTERED INTEREST RATES - PRIME BUSINESS*
COMPARISON OF FIXED & VARIABLE RATES (25 YEARS) 2 Fixed Rates Variable Rates FIXED RATES OF THE PAST 25 YEARS AVERAGE RESIDENTIAL MORTGAGE LENDING RATE - 5 YEAR* (Per cent) Year Jan Feb Mar Apr May Jun
Medicare Program; Medical Loss Ratio Requirements for the Medicare Advantage and the
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 422 and 423 CMS-4173-F RIN 0938-AR69 Medicare Program; Medical Loss Ratio Requirements for the Medicare Advantage
Department of Health and Human Services. No. 100 May 23, 2013. Part III
Vol. 78 Thursday, No. 100 May 23, 2013 Part III Department of Health and Human Services Centers for Medicare & Medicaid Services 42 CFR Parts 422 and 423 Medicare Program; Medical Loss Ratio Requirements
Closing the Coverage Gap
MEDICARE PRESCRIPTION DRUG COVERAGE REVISED MAY 2013 Information Partners Can Use on: Closing the Coverage Gap The Affordable Care Act includes provisions to close the Medicare Part D prescription drug
Making Sense of Medicare
Making Sense of Medicare Stephanie M. Turnbull Manager, Member Benefits 1 Highlights Medicare Eligibility Types of Medicare Coverage Medicare Part A Medicare Part B Medicare Part C Medicare Part D Medicare
Medicare Part D Retiree Drug Subsidy (RDS): Impact of Health Care Reform Legislation
RDS vs. EGWP White Paper Medicare Part D Retiree Drug Subsidy (RDS): Impact of Health Care Reform Legislation Is now the right time to switch to an Employer Group Waiver Plan (EGWP)? EGWPWP13R Affinity
Medicare Coverage Gap Discount Program Dispute Resolution
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 CENTER FOR MEDICARE DATE: March 5, 2012 TO: FROM: SUBJECT: Pharmaceutical
Presenter: Darrell D. Knapp, FSA, MAAA
Presenter: Darrell D. Knapp, FSA, MAAA Valuation Boot Camp for Health Actuaries SESSION 2C Darrell Knapp November 3, 2015 Valuation Issues from ACA Premium stabilization programs Transitional Reinsurance
Medicare Managed Care Employer Group Issues
Medicare Managed Care Employer Group Issues Presented by Amy Hafey, Senior Counsel, Legal and Government Relations Robert Raffel, Director, Group Medicare Sales and Account Management Sheila Rankin, Vice
PRIVATE MEDICARE DRUG PLANS: HIGH EXPENSES AND LOW REBATES INCREASE THE COSTS OF MEDICARE DRUG COVERAGE
UNITED STATES HOUSE OF REPRESENTATIVES COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM MAJORITY STAFF OCTOBER 2007 PRIVATE MEDICARE DRUG PLANS: HIGH EXPENSES AND LOW REBATES INCREASE THE COSTS OF MEDICARE
Oxford Health Plans (CT), Inc.
Oxford Health Plans (CT), Inc. Statutory Basis Financial Statements as of and for the Years Ended December 31, 2014 and 2013, Supplemental Schedules as of and for the Year Ended December 31, 2014, Independent
Part D Event (PDE) Cost Information. Barbara Frank, M.S., M.P.H. Director of Workshops, Outreach, & Research University of Minnesota
Part D Event (PDE) Cost Information Barbara Frank, M.S., M.P.H. Director of Workshops, Outreach, & Research University of Minnesota Part D Event (PDE) Cost Information Researchers cannot determine true
Article from: Health Watch. January 2013 Issue 71
Article from: Health Watch January 2013 Issue 71 Similarities between Medicare Prescription Drug Plans and Commercial Exchanges By Shelly S. Brandel and Douglas A. Proebsting The Affordable Care Act (ACA)
What is the Low Income Subsidy? Ginger Rogers Medicare Part D Disability Drug Benefit Helpline Disability Rights Wisconsin
What is the Low Income Subsidy? Ginger Rogers Medicare Part D Disability Drug Benefit Helpline Disability Rights Wisconsin 1 What is the Low Income Subsidy? Also known as LIS or Extra Help Medicare beneficiaries
Prescription drugs are a critical component of health care. Because of the role of drugs in treating conditions, it is important that Medicare ensures that its beneficiaries have access to appropriate
Introductory Guide to Medicare Part C and D
Introductory Guide to Medicare Part C and D Elizabeth B. Lippincott Emily A. Moseley Lippincott Law Firm PLLC Contents Introduction... 3 Instructions on Using the Guide... 3 Glossary and Definitions...
Analysis One Code Desc. Transaction Amount. Fiscal Period
Analysis One Code Desc Transaction Amount Fiscal Period 57.63 Oct-12 12.13 Oct-12-38.90 Oct-12-773.00 Oct-12-800.00 Oct-12-187.00 Oct-12-82.00 Oct-12-82.00 Oct-12-110.00 Oct-12-1115.25 Oct-12-71.00 Oct-12-41.00
Case 2:08-cv-02463-ABC-E Document 1-4 Filed 04/15/2008 Page 1 of 138. Exhibit 8
Case 2:08-cv-02463-ABC-E Document 1-4 Filed 04/15/2008 Page 1 of 138 Exhibit 8 Case 2:08-cv-02463-ABC-E Document 1-4 Filed 04/15/2008 Page 2 of 138 Domain Name: CELLULARVERISON.COM Updated Date: 12-dec-2007
Medicare Made Clear. Helping your employees and volunteers understand Medicare.
Medicare Made Clear Quick Reference Guide Helping your employees and volunteers understand Medicare. Medicare helps nearly 50 million older and disabled Americans save on their health care expenses. But
Self-Insurance: Is it Right For You?
Self-Insurance: Is it Right For You? Presented By: Paul Wirth Kim Capps Presentation Overview Welcome and Introductions Comparison Fully-Insured vs. Self-Insured Administration Options Managed Risk Stop
Medicare Coverage Gap Discount Program to Provide Economic Relief to Medicare Part D Enrollees by Closing the Donut Hole
Medicare Coverage Gap Discount Program to Provide Economic Relief to Medicare Part D Enrollees by Closing the Donut Hole By Cynthia S. Marietta, J.D., LL.M. (Health Law) csmarie@central.uh.edu Introduction
Closing the Coverage Gap
MEDICARE PRESCRIPTION DRUG COVERAGE REVISED MAY 2013 Information Pharmacists Can Use on: Closing the Coverage Gap The Affordable Care Act includes provisions to close the Medicare Part D prescription drug
Danielle R. Moon, J.D., M.P.A. Director, Medicare Drug & Health Plan Contract Administration Group
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Center for Medicare 7500 Security Boulevard, Mail Stop C1-13-07 Baltimore, Maryland 21244-1850 CENTER FOR MEDICARE DATE: May
TERMS USED IN FINANCIAL STATISTICAL REPORTS (FSRs)
TERMS USED IN FINANCIAL STATISTICAL REPORTS (FSRs) Total Member Months - Number of members enrolled in each month. YTD is the sum of the individual month s membership. Revenues: Premiums Capitation payments
Health Insurance Exchange Finance Work Group Meeting August 22, 2012 Wakely Consulting Model Table Summaries - Updated
Table 3 Model Take up rate estimates 2014 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Revised 25.0% 25.0% 18.0% 3.6% 3.6% 3.6% 3.6% 3.6% 3.6% 3.6% 3.6% 3.6% Fast 12.0% 18.0% 20.0% 18.0% 6.0% 4.0% 4.0%
Financial Ratio Operating Statistics SURVEY
2013 Financial Ratio Operating Statistics SURVEY Compare your own numbers to the national norms, and find out where you need to focus to increase your profits. Balance Sheet Prior Year Assets Current Assets
Enhanced Vessel Traffic Management System Booking Slots Available and Vessels Booked per Day From 12-JAN-2016 To 30-JUN-2017
From -JAN- To -JUN- -JAN- VIRP Page Period Period Period -JAN- 8 -JAN- 8 9 -JAN- 8 8 -JAN- -JAN- -JAN- 8-JAN- 9-JAN- -JAN- -JAN- -JAN- -JAN- -JAN- -JAN- -JAN- -JAN- 8-JAN- 9-JAN- -JAN- -JAN- -FEB- : days
The Medicare Drug Benefit (Part D)
THE BASICS The Medicare Drug Benefit (Part D) The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) established a voluntary outpatient prescription drug benefit for Medicare
LGM-Dairy: What is it? New Livestock Gross Margin for Dairy Insurance
Dairy Price Risk Management Livestock Gross Margin for Dairy (LGM-Dairy) Victor E. Cabrera Assistant Professor Extension Dairy Specialist Dairy Science Department Brian W. Gould Associate Professor Ag
State Employees' Group Health Self-Insurance Trust Fund
State Employees' Group Health Self-Insurance Trust Fund Report on the Financial Outlook For the Fiscal Years Ending June 30, 2015 through June 30, 2020 Adopted August 12, 2015, by the Self-Insurance Estimating
Extra Help. Do you have Medicare? Do you live on a limited income? Do you need help to pay for your prescriptions? 1-855-937-2372
Extra Help Do you have Medicare? Do you live on a limited income? Do you need help to pay for your prescriptions? Extra Help If so you may qualify for the Medicare Low Income Subsidy (LIS) Program also
Prescription Drug Coverage for Medicare Beneficiaries: A Summary of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003
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
Medicare Part D. MMA establishes a standard Part D drug benefit, which consists of four components or phases.
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
Dartmouth / SilverScript Retiree Prescription Drug Plan
Dartmouth / SilverScript Retiree Prescription Drug Plan Agenda What s Happening /Why the Change? What is Medicare Part-D? Who is SilverScript? How is this affecting my Dartmouth coverage? What do I need
Cynthia G. Tudor, Ph.D., Director, Medicare Drug Benefit and C & D Data Group Cheri Rice, Director, Medicare Plan Payment Group
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 CENTER FOR MEDICARE TO: FROM: SUBJECT: All Part D Sponsors Cynthia
Human Resources Office Newsletter Special Benefits Edition
Human Resources Office Newsletter Special Benefits Edition OCTOBER 17, 2012 EMPLOYEE BENEFITS AND WELLNESS FAIR The Fall 2012 Employee Benefits Fair will be on October 17th in the University Center, Room
MEDICARE PART D PRESCRIPTION DRUG COVERAGE 2016
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 Rx Drug Benefit. David Moskowitz, R.Ph, MBA. Senior Healthcare Analyst
Medicare Rx Drug Benefit David Moskowitz, R.Ph, MBA. Senior Healthcare Analyst 2001 2004 M O N T H FEBRUARY 27 th Overview of Rx Benefit proposal Challenges Co-pays Deductibles Coverage gap Catastrophic
Medicare Part D Creditable Coverage
Medicare Part D Creditable Coverage What employers need to do If you are an employer (Plan Sponsor) who will be offering prescription drug coverage to any Medicare Eligible individuals in 2012, you are
GAO MEDICARE PART D COVERAGE GAP. Discount Program Effects and Brand-Name Drug Price Trends. Report to Congressional Requesters
GAO United States Government Accountability Office Report to Congressional Requesters September 2012 MEDICARE PART D COVERAGE GAP Discount Program Effects and Brand-Name Drug Price Trends To access this
Medicare Advantage Funding Cuts and the Impact on Beneficiary Value
Medicare Advantage Funding Cuts and the Impact on Beneficiary Value Commissioned by Better Medicare Alliance Prepared by: Milliman, Inc. Brett L. Swanson, FSA, MAAA Consulting Actuary Eric P. Goetsch,
The Medicare Low Income Subsidy (LIS)
The Medicare Low Income Subsidy (LIS) Extra Help with Prescription Drug Costs An overview of the Medicare LIS Patient eligibility and the application process How the LIS affects patient responsibility
2012 Health Meeting June 13-15, 2012
2012 Health Meeting June 13-15, 2012 Session #87 PD: Unpaid Claim Reserving 401: Emerging Issues in Medical Reserves and Liabilities John C. Lloyd, FSA, MAAA William T. O'Brien, FSA, MAAA, FCA Moderator
Marilyn Tavenner Acting Administrator and Chief Operating Officer Centers for Medicare & Medicaid Services
DEPARTMENT OF HEALTH & HUMAN SERVICES Office of Inspector General Washington, D.C. 20201 June 1, 2010 TO: FROM: Marilyn Tavenner Acting Administrator and Chief Operating Officer Centers for Medicare &
NCHS-CMS Medicare Part D Event File
NCHS-CMS Medicare Part D Event File Variable Name Variable Description Type Length SURVEY NCHS Survey linked to CMS Medicare Data CHAR 16 PUBLICID * NCHS Survey Identifier - Participant Identification
By Christina Crain, MSW. Director of Programs
By Christina Crain, MSW Director of Programs What we ll cover Medicare Eligibility Medicaid Eligibility Medicare Parts A, B, C and D New Improvements to Medicare under ACA The Medicare Savings Programs
Medicare Advantage Update
1 Medicare Advantage Update National Council on Teacher Retirement 88 th Annual Convention October 13, 2010 Anne Jones, Humana Today s Discussion Overview of Traditional Medicare and Medicare Advantage
Reporting, Re-Contracting and Settlement
US HEALTH AND LIFE INSURANCE UNDERWRITING ADMINISTRATION Simple. Seamless. SafeGuard Self-Funding Reporting, Re-Contracting and Settlement The SafeGuard Self-Funding Timeline Ÿ Although SafeGuard Self-Funding
Section 5 - Other PSERS Programs
This page intentionally left blank Pursuant to Sec. 8701 et seq. of the Public School Retirees Health Insurance Act 24 Pa. C.S. 8701 et. seq. PSERS sponsors a group health insurance program called the
Briefing Paper. Cape Cod Municipal Health Group
Briefing Paper for the Cape Cod Municipal Health Group Parts of Medicare Medicare Supplement Plans Medicare Advantage Plans Medicare Part D Plans, Employer Group Waiver Plans (EGWPs) Medicare Secondary
TO UNDERSTANDING THE AFFORDABLE CARE ACT
3 STEPS TO UNDERSTANDING THE AFFORDABLE CARE ACT What s Inside Step 1: What Understand what you re buying 4 Step 2: How How can you buy health insurance? 20 STEPS TO UNDERSTANDING THE AFFORDABLE CARE ACT
Quality health plans & benefits Healthier living Financial well-being Intelligent solutions
uality health plans & benefits Healthier living Financial well-being Intelligent solutions Understanding how the Health Insurer Fee and Transitional Reinsurance Contribution will impact you Health care
Medicare Changes 2012: Five Things You Need to Know
Medicare Changes 2012: Five Things You Need to Know In 2010, ju st 1 in 5 Medicare bene f iciar ies over the age of 65 planned to review their Medicare coverage options for 2011. 1 Why is this statistic
E-ALERT Health Care HEALTH CARE REFORM: MEDICARE PART D DONUT HOLE AND PROTECTED CLASSES. Executive Summary. Closing the Medicare Part D Donut Hole
E-ALERT Health Care April 2010 HEALTH CARE REFORM: MEDICARE PART D DONUT HOLE AND PROTECTED CLASSES On March 23, 2010, President Obama signed into law Pub. L. No. 111-148, the Patient Protection and Affordable
PEBP and Medicare. Public Employees Benefits Program
PEBP and Medicare Public Employees Benefits Program 901 South Stewart Street, Suite 1001 Carson City, NV 89701 mservices@peb.state.nv.us www.pebp.state.nv.us 775-684-7000 or 800-326-5496 Twitter@NVPEBP
Sharing risk in Medicare Part D
Sharing risk in Medicare Part D C h a p t e r6 C H A P T E R 6 Sharing risk in Medicare Part D Chapter summary In this chapter In 2013, Medicare spent almost $65 billion on Part D, which uses private
Understanding Medicare and Senior Plan Offerings
Understanding Medicare and Senior Plan Offerings PEC December 15, 2011 December 15, 2011 1 What is Medicare Federally funded Health Insurance for retirees 65 or older* Part A: Hospital Insurance Helps
UPDATED: NOVEMBER 2009 344.1 RESOURCES THIRD PARTY RESOURCES
UPDATED: NOVEMBER 2009 344.1 NOTE: Enrollment in Medicare is a condition of eligibility for Medicaid. Beginning in 2006, persons entitled to Part A and/or enrolled in Part B are eligible for the prescription
Self-Funding and CIGNA Select Solutions. Brian Helmly Rogers Benefit Group
Self-Funding and CIGNA Select Solutions Brian Helmly Rogers Benefit Group 1 Innovative funding options CIGNA offers more funding options for smaller companies than any other national health company. A
Medicare Made Clear An overview of Medicare for Benefi ts Administrators
Medicare Made Clear An overview of Medicare for Benefi ts Administrators Get Answers: Medicare Education Helping your employees understand Medicare Medicare helps nearly 50 million older and disabled Americans
HEALTH INSURANCE EXCHANGES: FEDERAL DEADLINES AND STATE DECISIONS
HEALTH INSURANCE EXCHANGES: FEDERAL DEADLINES AND STATE DECISIONS Annual Meeting: Council of State Governments West July 21, 2012 BOB CAREY RLCAREY CONSULTING AGENDA 1 The Basics: Health Insurance Exchanges
Department of Public Welfare (DPW)
Department of Public Welfare (DPW) Office of Income Maintenance Electronic Benefits Transfer Card Risk Management Report Out-of-State Residency Review FISCAL YEAR 2012-2013 June 2013 (March, April and
Senior s Pharmaceutical Assistance Programs
Senior s Pharmaceutical Assistance Programs The Department of Aging administers three pharmaceutical assistance programs for Pennsylvania seniors. The Pharmaceutical Assistance Contract for the Elderly
Medicare Part D: 2010. Presented by: Howard Houghton Virginia Insurance Counseling & Assistance Program (VICAP)
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
WORKSHEET 1 - MA BASE PERIOD EXPERIENCE AND PROJECTION ASSUMPTIONS
WORKSHEET 1 - MA BASE PERIOD EXPERIENCE AND PROJECTION ASSUMPTIONS MA-2016.1 OMB Approved # 0938-0944 1. Contract Number: 5. Organization Name 9. Enrollee Type: 13. Region Name: N/A 2. Plan ID: 6. Plan
Welcome to the KASA webinar series!
Welcome to the KASA webinar series! Today s topic: What Youth Leaders and Millennials Need to Know about Health Insurance and the Affordable Care Act Presenter: Erin Hemlin, Young Invincibles Hosted by:
CCW Medicare Part D User Guide. October 2015 Version 5.2
CCW Medicare Part D User Guide October 2015 Version 5.2 This page intentionally left blank. Overview The Medicare Part D prescription drug benefit was authorized through the Medicare Prescription Drug,
A basic paycheque will show gross pay, deductions and net pay:
Accounting (HOSP 1860) Learning Centre Payroll Accounting Understanding payroll will help you as an or an. It explains all the deductions that are removed from your paycheque, where the numbers on your
ERRORS & OMISSIONS COVERAGE REQUIRED FOR FIELD ASSOCIATES CONTRACTING WITH SECURITY MUTUAL LIFE
ERRORS & OMISSIONS COVERAGE REQUIRED FOR FIELD ASSOCIATES CONTRACTING WITH SECURITY MUTUAL LIFE E&O PROGRAM AVAILABLE THROUGH CONTINENTAL CASUALTY COMPANY (a member company of the CNA Group of Companies)
Understanding Medicare Part D. Cynthia Tudor, Ph.D. Acting Director, Medicare Drug Benefit Group
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
The ECB s operations amid the financial turmoil: experience and policy lessons
The ECB s operations amid the financial turmoil: experience and policy lessons Francisco Ramon-Ballester Advisor, European Central Bank Office at the International Monetary Fund Mexico DF, 24 April 2008
Express Scripts Medicare TM (PDP) through State of Delaware Medicare Retiree Prescription Plan Frequently Asked Questions
Express Scripts Medicare TM (PDP) through State of Delaware Medicare Retiree Prescription Plan Frequently Asked Questions Section 1 General Information (Questions 1-5) Section 2 Enrollment Information
Status report on Part D
C h a p t e r15 Status report on Part D C H A P T E R 15 Status report on Part D Chapter summary In this chapter Each year the Commission provides a status report on Part D to: provide information on
Medicare Part D & Ryan White HIV/AIDS Program As of November 2008
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
The due date for receipt of proposals remains 2:00 pm on January 30, 2013.
January 23, 2013 SUBJECT: REQUEST FOR PROPOSALS FOR PERFORMANCE OF EXPERT PROFESSIONAL ACTUARIAL VALUATION SERVICES FOR OTHER POST-EMPLOYMENT BENEFITS (RFP#31884) - ADDENDUM # 1 Dear Sir or Madam: The
S e c t i o n 4 - P S E R S P o s t e m p l o y m e n t H e a l t h c a r e P r o g r a m s
S e c t i o n 4 - P S E R S P o s t e m p l o y m e n t H e a l t h c a r e P r o g r a m s Health Options Program... Tab 17 Premium Assistance Program... Tab 18 This page intentionally left blank Pursuant
The Affordable Care Act. What does it mean for you and how we advocate for it?
The Affordable Care Act What does it mean for you and how we advocate for it? Who are Young Invincibles? Agenda Overview of the ACA How does health insurance work? What s included in a health insurance
Crossing the Doughnut Hole: The Effects of the Medicare Drug Coverage Gap for Patients who Require High-cost Medications
Crossing the Doughnut Hole: The Effects of the Medicare Drug Coverage Gap for Patients who Require High-cost Medications AcademyHealth Annual Research Meeting June 29, 2009 Dominick Esposito 1, Margaret
BENEFITS OF PROPOSED DEMOCRATIC MEDICARE DRUG PROGRAM REFORMS IN NEW YORK S 14TH CONGRESSIONAL DISTRICT
UNITED STATES HOUSE OF REPRESENTATIVES COMMITTEE ON GOVERNMENT REFORM MINORITY STAFF SPECIAL INVESTIGATIONS DIVISION OCTOBER 2006 BENEFITS OF PROPOSED DEMOCRATIC MEDICARE DRUG PROGRAM REFORMS IN NEW YORK