Plan representatives and advisors will be available to answer your individual questions..

Transcription

1 Medicare Awareness Day for 2008 Tuesday, October 30, 2007 Frank Van Nostrand from Social Security and Julie Schoen from HICAP will help us Navigate through the new plans. Plan representatives and advisors will be available to answer your individual questions.. TOPICS COVERED IN BOOKLET California Prescription Drug Discount Program Cost Coverage Gap Tips & Cost Saving Strategies Government Programs Medicare Low Income Subsidy (LIS) Medi-Cal Medicare Fraud Patient Assistance Programs (PAPs) List Veterans & Tricare

2 TABLE OF CONTENTS PAGE Additional Information 12 California Prescription Drug Discount Program 8 California State Medicare Part D Drug Profile 3 Cost Coverage Gap Tips 11 Cost Saving Strategies 5 CTAP California Telephone Access Program (Table 17) 33 Disaster Preparedness Task Force (Table 18) 34 Free 411 & Adopt A Family 35 Government Programs Medicare Low Income Subsidy (LIS) 6 Medi-Cal 7 Medicare Fraud Patient Assistance Programs (PAPs) 9-11 Veterans & Tricare 8 PARTICIPANTS TABLE PAGE AARP MedicareRx Plans 1 18 Aetna Health of California 2 19 Arta Medicare Health Plan 3 20 Bankers Life & Casualty 4 21 Blue Cross of California 5 22 Bristol Park Medical Group 6 23 CalOptima 7 24 Healthnet 8 25 HICAP 9 26 MemorialCare Senior Plus Monarch Health Care SCAN Health Plan Secure Horizons Social Security Social Services of Laguna Woods Village Page 2

3 Get help with Medicare questions: call A free service provided by your local HICAP. Resources for Prescription Drug Cost Savings Some of these resources described below can help you decide which prescription drug plan is right for you. Once you have a Medicare Part D Plan that you are happy with, the strategies and programs discussed can be used with your drug plan to reduce outof-pocket costs. If you can keep your Part D drug costs (the total costs paid by you and your plan) to under $200 a month, you will not enter the coverage gap, also called the doughnut hole, which is the gap during which you have to pay the full cost of prescription drugs yourself. See our section Medicare Part D: An Overview, for more information. Free One-on-One Counseling Free, confidential, unbiased Medicare counseling is available from your local HICAP office (there is one in every county). HICAP is the Health Insurance Counseling and Advocacy Program. Either call to be connected with your local HICAP or call the Orange County office at Decision Support Tools California State Medicare Part D Drug Profile This 598-page pdf file compiled through a project of Cornell University s College of Human Ecology, contains an alphabetical listing of 300 most commonly used drugs and their coverage information for all of (Continued on page 4) Page 3

4 (Continued from page 3) California s stand alone prescription drug plans (PDPs). The coverage information for each plan includes: the plan s monthly premium; the full cost of the drug; the initial cost of the drug (before reaching the gap, or donut hole ); the drug s cost during the gap, or donut hole ; the drug cost during catastrophic coverage; what tier the drug is under; and whether prior authorization is required, whether there is a limit on quantity, and whether there is any step therapy for the drug. You can download this PDF. You can also view a list of the drugs reviewed in this Part D drug profile. Medicare To get information about Medicare prescription drug coverage, you can call MEDICARE ( ). TTY users should call Have your Medicare card, a list of the drugs you take, and the name of your pharmacy ready when you call. The Medicare website ( ) has many publications and useful tools to help you, as well as fact sheets, Frequently Asked Questions, and more. Prescription Drug Plan Finder This tool searches for drug plans offered in your area that meet the criteria you enter. Formulary Finder This tool helps you find the plans in your area that cover the prescription drugs that you are taking (or their generic equivalent). Landscape of Local Plans The lists that can be downloaded here will show you the cost and coverage included in each of the 55 PDP plans available throughout the state and in each of the (Continued on page 5) Page 4

5 (Continued from page 4) MA-PD plans that are available in your county. Please note that Medicare is constantly updating their site in order to provide accurate information. Inaccuracies have been found on it. Publications This section of the Medicare website has dozens of fact sheets and tip sheets available for download in English and Spanish. You can also download the "Medicare & You 2007" handbook includes phone numbers of all the plans offered in your geographic area. You can call drug plans for formulary information, although it may be difficult to get the exact information you want. Beware of any heavy-handed marketing or sales of drug plans and keep written records of "promises" made by drug plan representatives (including date, time, promises made and who you spoke with by phone or in person). Cost Saving Strategies Review your plan yearly to be sure it is the least expensive plan that provides the most comprehensive coverage of your drugs. Call your local HICAP at or Medicare at Medicare and ask for assistance to search for a plan. You can also search for plans on the web using the resources mentioned above. Talk to your doctor about switching to generic drugs or other brand drugs that are less expensive. The Consumer Reports Best Buy Drugs website provides reports on various drug categories. (Categories refer to drugs in the same class that are used to treat a specific condition or illness such as high blood pressure, high cholesterol, heartburn, or depression). Each report reviews both the scientific evidence on the prescription drugs effectiveness and Page 5 (Continued on page 6)

6 (Continued from page 5) their prices. It then analyzes and compares the prescription drugs within that specific category to come up with recommendations on the best buy drugs. Recommendations are based on drug effectiveness, safety, and cost. Use your plan s mail order program. You can save about 20-33% of your drug costs, depending on your plan. Ask your doctor for free samples Apply for government or private programs that might reduce your drug costs. Government Programs Medicare Low Income Subsidy (LIS) Program ( Extra Help ) If you have limited income, this extra help can help pay your Part D plan premium, deductible and co-pay costs. Social Security (SSA) is administering the Extra Help (Low-Income Subsidy) for Medicare Prescription Drug Coverage. You can apply online and download instruction sheets in 15 languages on their website: To learn more, see our section about Extra Help. You can call SSA at TTY users should call In Orange County call SSA at Extra Help For Low-Income, Low-asset beneficiaries Assets under $11,710/$23,410 Income less than 150% of FPL $15,315 as an individual ($1,276.25/mo) $20,535 as a couple ($1,711.25/mo) Page 6 (Continued on page 7)

7 (Continued from page 6) The government will pay from 85% to 97% of drug costs Apply with Social Security or apply online at Medi-Cal If you have Medicare and Medi-Cal, you will pay no more than $5.35 for Medicare covered drugs. See our section, Assistance for People with Low Income. Medi-Cal covers some drugs not covered by Part D. To apply for Medi-Cal in Orange County, call CalOptima and say you want to start the application process over the phone. More information is on the web at Can the State Take my Home If I Go on Medi-Cal? The State of California does not take away anyone s home per se. Your home can, however, be subject to an estate claim after your death. For example, your home may be an exempt asset while you are alive and is not counted for Medi-Cal eligibility purposes. However, if the home is still in your name when you die, the State can make a claim against your estate for the amount of the Medi- Cal benefits paid or the value of the estate, whichever is less.thus, if your home is still in your name when you die, it is part of your estate and can be subject to an estate claim. For more information call California Advocates for Nursing Home Reform at (consumers) Page 7 (Continued on page 8)

8 (Continued from page 7) California Prescription Drug Discount Program At Medi-Cal participating pharmacies, you can get drugs at the Medi-Cal rate plus a 15-cent processing fee. This rate may be lower than the Part D rate for certain drugs. What you pay using this discount program may not apply towards your Part D cost sharing. This program should not be used as a substitute for Medicare Part D. To receive benefits, show your Medicare card at Medi-Cal participating pharmacies. More information is on the web. Department of Veteran Affairs Eligibility in this program is based on military service and drugs must be prescribed by a VA physician. The program has an $8 copayment for a 30-day supply of medication at VA pharmacies. If you are a veteran, you may have VA and Part D coverage. You may save by filling some drugs through one program and some through the other. Veterans may also save by having only VA coverage and enrolling in Part D later. Contact (877) or for more information. TRICARE Senior Pharmacy Program Uniformed Services Retirees and their spouses who are over 65 may be eligible. You must have Medicare Part B if you turned 65 after April 1, For more information on TRICARE call (877) or visit Page 8 (Continued on page 9)

9 (Continued from page 8) Patient Assistance Programs (PAPs) Pharmaceutical companies listed below offer Patient Assistance Programs that provide free or low cost drugs to qualified individuals. Each program has its own eligibility criteria and application process. Some provide drugs only if they are not on your plan s formulary or if you are in the coverage gap. Call the company for PAP details. Medicare can tell you which PAP covers your drug, who qualifies and how to apply. Call medicare and ask for assistance, or visit Note: if you get drugs through a PAP, it will not count toward your Part D drug expenses 3M Pharmaceuticals (800) Abott (800) Acon Cares (800) #2 Allergan (800) Alpharma Kadian (866) American Regent Labs Venofer (800) Americares' Solvay Pharmaceuticals, Inc. (800) Amgen Safety Net Foundation (800) #3 Amylin (800) Astra/Zeneca (800) Bayer (800) #1 Berlex Laboratories, Inc. (888) #6 Boehringer Ingelheim Care Foundation (800) Bradley Pharmaceuticals (800) Bristol-Myers Squibb (800) Centocor Patient Assistance: Remicade (866) Page 9 (Continued on page 10)

10 (Continued from page 9) ECR Pharmaceuticals (800) Enzon (888) , #1 Enzon Financial Assistance: Abelcet (800) ESP Pharma (800) Ferndale Laboratories (800) First Horizon (800) Forest Pharmaceuticals (800) GlaxoSmithKline Bridges to Access (866) GlaxoSmithKline Commitment to Access (866) IVAX Patient Assistance (800) Johnson & Johnson (800) Kos Pharmaceuticals (866) #2 Ligand Assistance Program (877) Lilly Cares (800) Medpointe Pharmaceuticals Merck (800) Mission Pharmaceutical (800) Novartis (800) Novo Nordisk, Inc. (866) Patient Assistance Foundation Co-Pay Relie (866) Pfizer, Inc. Connection to Care (800) Pharmion Corporation (866) #4 Proctor & Gamble (800) Reliant Rx (866) Roche (877) Sankyo Pharma Open Care Program (866) #1 Sanofi-Aventis (800) Schering-Plough Commitment to Care (800) Page 10 (Continued on page 11)

11 (Continued from page 10) Shire US (866) SP Cares (800) Takeda Pharmaceuticals (800) TAP Prevacid Patient Assistance Program (800) TogetherRx Access (800) UCB Keppra (800) #7 Watson Iron Reimburse. Assistance Prog. (800) Wyeth Pharmaceutical (800) Clearinghouses There are several clearinghouses for public and private assistance programs that can help you find the PAPs that offer your drug. PhRMA (the Pharmaceutical Researchers and Manufacturers of America) at or Rx Help For Californians at (877) or Coverage Gap Tips If you do enter the coverage gap but are unlikely to spend $3,850 of your money before the end of the year and receive catastrophic coverage, these cost-saving strategies may help. These programs do not coordinate with Part D plans. Expenses do not count towards your Part D cost-sharing. Use prescription discount programs such as AARP MemberRx Choice Card at (800) or Purchase your drugs over the internet (available at a number of sites). Page 11 (Continued on page 12)

12 Check the prices for your prescription(s) at several pharmacies. Some pharmacies such as Costco sell their drugs at much cheaper prices than others. You also do not need to be a member of Costco to use their pharmacy. Re-contact the above-listed PAPs that cover your drugs. Additional Information The websites listed below contain searchable databases with information on prescription drug resources and financial assistance with prescription drug costs. Rx Assist: Patient Assistance Program Center- provides up-todate information on how to access assistance from nearly 100 companies and more than 700 medications. Searches for drugs by: company name, brand name drug, generic name, or drug therapy class. There are also 40 patient assistance programs that can be printed off the web site. BenefitsCheckUp - helps find programs for people ages 55 and over that may pay for some costs of prescription drugs, health care, utilities, and other essential items or services. Rx Hope - provides free prescription drug information. There is a Patient Assistance Information section that gives information about a particular product or company. Needy Meds - has an alphabetical list of approximately 1,000 prescription medications. When you find your medication, there is a link to assistance programs for that specific drug. Health Assistance Partnership (HAP) - lists drug companies that offer assistance. Page updated March 1, California Health Advocates Page 12

13 California Senior Medicare Patrol (SMP) In 1997 California Health Advocates was awarded a grant by the Administration on Aging to educate and train Medicare beneficiaries about fraud and abuse within the Medicare system. California Health Advocates (CHA) developed the California Senior Medicare Patrol (SMP). Since its inception, SMP has trained thousands of seniors and other interested individuals to educate over one-hundred thousand consumers about this national crisis and how they, as individuals, can participate in repairing the program. Although the primary mission of SMP is education, SMP volunteers have been instrumental in helping to recover millions of dollars for the Medicare program. What is Medicare Fraud? Medicare fraud is the intentional deception or misrepresentation of services rendered or equipment offered, with full knowledge that this deception could result in some unauthorized benefit to a person or organization at the expense of the Medicare program and ultimately, Medicare beneficiaries. Where do we see Medicare Fraud? 1) In billing for institutional facilities (Medicare Part A), such as nursing homes, residential facilities, hospitals, and hospices. 2) In billing for physician services or visits to physicians (Medicare Part B). 3) In billing for Durable Medical Equipment (DME), such as wheelchairs, body jackets, incontinence supplies, etc. 4) In improper marketing through telephone, door-to-door sales Page 13

14 and flyers (Medicare Part C (Medicare Advantage) and Part D (prescription drug benefit)). Medicare Fraud is committed when a provider: Submits bills for services not rendered: Common are gang visits, when practitioners visit a nursing home and bill for services for all, or nearly all, residents. The physician may not have rendered the service(s) to all residents but bills as if he or she had OR may render service(s) whether every resident needs it or not. Upcodes a service: Submitting a bill for surgery when only a bandage was placed over a cut, for example. Unbundles services: Submitting separate billing for lab services that include three or four tests combined as one and which are supposed to be billed as one service. This separate billing results in Medicare paying providers more for each service than what would have been paid if they had been billed as a group. Solicits, offers, or receives a bribe or a kickback: Often recruiters or what are called cappers may stop beneficiaries on the street, OR knock on their door and offer money or promotional gifts as incentives to entice them to take a free medical exam. Then the patient is presented with a list for durable medical equipment (DME), or prescribed DME that they do not need. Bills non-covered services as covered services: For example, billing routine toenail clipping (non-covered service) as foot surgery (covered service). (Continued on page 15) Page 14

15 (Continued from page 14) Does not follow Medicare Marketing rules: Offering a Part D prescription plan at no cost to the beneficiary (when a Part D plan does, in fact, charge a premium). Contact the Health Insurance Counseling and Advocacy Program (HICAP) at calmedicare.org: Medicare Information for Californians. California Health Advocates: cahealthadvocates.org What can you do to prevent yourself from becoming a victim of Medicare Fraud? Review your Medicare Summary Notice (MSN) or your Explanation of Medicare Benefits (EOMB). Protect your Medicare card number, as well as your Social Security number. Don t let anyone convince you to see a doctor for a service that you do not need. Don t accept offers of money or gifts for medical care. Ask questions! You have a RIGHT to know about your medical care! Always be aware that Medicare Fraud and Abuse is real! Never accept medical supplies from door- to-door salespeople. Don t be influenced by media advertisements concerning your health. They raise money for someone and don t have your best interests at heart. (Continued on page 16) Page 15

16 (Continued from page 15) Avoid the we know how to bill Medicare scam. As stated earlier, protect your Medicare card number. Educate yourself about Medicare. Know your rights and know what a provider can and can t do for your medical care. Don t give out personal information such as your Medicare number, Social Security number, Bank Account or credit card number over the phone to someone you don t know. How to report Medicare Fraud and Abuse: First, call the provider phone number noted on the Medicare Summary Notice (MSN) and talk to the provider about your concerns. Contact the Medicare Part B Carrier or Part A Fiscal Intermediary by calling Medicare. Once connected to Medicare s automated voice system, say doctor services or hospital stay to be connected with the Part B Carrier or Part A Fiscal Intermediary respectively. If the complaint remains unresolved, contact the Inspector General s Hotline/Medicare Fraud Hotline at HHS-TIPS ( ). For more information or assistance reviewing your MSN call the California Health Insurance Counseling and Advocacy Program (HICAP) at When reporting suspicious activity, have the following information ready: your Medicare card number, physician, supplier, and facility name where the service was provided, the date the service was rendered, and the description of the problem that you are calling about. Page 16 (Continued on page 17)

17 (Continued from page 16) Note: Do not leave your Medicare number on a phone message. Every complaint counts! Every complaint counts and is taken seriously by Medicare. After a complaint is received, the beneficiary is sent an acknowledgment letter from Medicare. The complaint is reviewed and processed. Processing may include requesting medical records from the provider. Medicare then reviews the complaint in light of the history file of complaints against this provider. Upon review, the Medicare contractor may collect an overpayment, open an investigation, or close the case. Incentive Reward Program To inspire Medicare beneficiaries, providers, and others to help monitor the Medicare system and prevent fraud and abuse, the Incentive Reward Program for Fraud and Abuse Information was created under the Health Insurance Portability and Accountability Act in July 1998 which can provide a monetary award for information provided in certain cases. The information must lead directly to the recovery of Medicare money from fraudulent activity, and the provisions can only apply to cases not already under investigation by federal or state agencies or Medicare contractors. There must be a minimum recovery of $100 for reports, and rewards will not exceed 10% of the overpayment recovered or up to $1,000, whichever is less. Page 17

18 AARP MedicareRx Plans Sandra Villalba Page 18

19 Aetna Medicare #729 Page 19

20 Arta Medicare Health Plan Page 20

21 Bankers Life & Casualty Tim Hanson Page 21

22 Blue Cross of California Bianca Herrera Page 22

23 Bristol Park Medical Group Page 23

24 CalOptima Sally Moyer, OneCare Partner Attention: Medicare / Medi-Cal Patients Page 24

25 Healthnet Christian X Hernandez Health Net offers a wide variety of Medicare plans to meet almost every need. Many of our plans offer one or more of the following features: Low or no monthly plan premiums Low or no copayments for physician office visits Low or no copayments for specialist office visits Low or no copayments for urgently needed care Low or no copayments for preferred medications Low or no copayment for your first physical exam per year $0 copayment for Medicare-covered immunizations and preventative screening exams office visit copayment may apply) Optional Supplemental Benefits (Chiro, Dental, Vision) at a low monthly premium (not available in all areas) Page 25

26 J or Laguna Woods Appointment Health Insurance Counseling & Advocacy Program is your unbiased resource for information about Medicare, and related insurance benefits HICAP does not sell, recommend, or endorse any insurance products or plans HICAP is a beneficiary advocate HICAP is a program of the Council on Aging-Orange County (COAOC). Long-Term Care Ombudsman Financial Abuse Specialist Team Linkages Case Management Caring Connections Friendly Visitors California Health Advocates Websites: (Consumers/ General Public) Health Insurance Counseling & Advocacy Program (800) Page 26

27 MemorialCare seniorplus Upcoming Medicare Seminars November 5 from 1-3 p.m. Laguna Hills Saddleback Memorial November 9 from 1-3 p.m. San Clemente Saddleback Memorial Call for more information Page 27

28 Monarch Health Care Page 28

29 SCAN Health Plan Page 29

30 Secure Horizons Rick Finn Page 30

31 Social Security Page 31

32 Social Services Department Established in 1972, the mission of the department is to help residents maintain their independence and enhance their quality of life. All services are available at no charge to residents. Counseling Support Groups Crisis Intervention Nurse Practitioner Resource Referrals Friendly Visitor Program Social Services Department Located on the first floor in the LWV Community Center El Toro Rd. P.O. Box 2220 Laguna Hills, CA Monday through Friday from 8 to 5 p.m. Page 32

33 CTAP Call Center English TTY: (800) Voice: (800) Special Telephone Equipment for Eligible and Qualified Californians who are: Deaf Hard of Hearing Speech Disabled Blind Low Vision Cognitive Impairments Restricted Mobility Hard of Hearing Deaf / Late Deafened Low Vision / Blind Mobility / Manipulation Page 33

34 Disaster Preparedness Task Force Were you prepared? Community Awareness.wild fires have been all around us. Pointers to keep in mind for any disaster. Shelter in place Evacuate ONLY if directed by the Sheriff s Department, Fire Authority Keep doors and windows closed against the smoke Be prepared AHEAD OF TIME to evacuate at a moments notice: Medications and extra water Important Papers Phone numbers for family, Vets, Insurance Company, etc. Pets: Leash, Collar, Food, Water, Water Dish, Medications Pet Carrier Preparedness information is available and survival To Go Bags filled with some emergency items are available for sale in the Disaster Preparedness Task Force Office. Community Center, 1 st Floor Monday Friday 10:00 Noon Paula Page, Chair Betty Rockefeller, Co-Chair Working together, we will survive. Page 34

35 FREE 411 Calls Cell phone companies are charging us $1.00 to $1.75 or more for 411 information calls when they don't have to. Most of us do not carry a telephone directory in our vehicle, which makes this situation even more of a problem. When you need to use the 411 information option, simply dial 1 (800) FREE 411, or 1 (800) without incurring any charge at all! Adopt a Family for a day is a Piece of Cake You are going to provide food for the family to cook for the day. Starting with Oatmeal for Breakfast, Macaroni & Cheese for Lunch, and then canned vegetables, meat, cake mix with icing or a nice bag of candy for Dinner. Little treats like Popcorn, Jell-O etc. would be appreciated too. Your gently used jewelry for Mother and we do like to give a gift for a child. You will be given the name, address and phone number, the ages and sex of the children. There after it will be between the family you adopt and yourself.. This act will bring many hours of joy to YOUR holiday season. For more information call , extension 201 or locally Dottie Fredericks at Page 35

36 The CCA is proud to have brought you Medicare Awareness Day. We try to bring you your positive options. Please, before you make any Medicare changes you are not completely sure of CALL & JUST ASK HICAP at Laguna Woods Appointment Membership Drive We are starting our 2008 Membership drive. All members who join from November 1, 2007 will be credited for their 2008 membership. Send your $10 check to the address above. Friday, November 30 Thur. December 20 January, 2008 Upcoming CCA Events US Congressman John Campbell Reverse Mortgages Legislation & HUD Counseling Rob Merritt, Myra Neben, Cheryl Walker and other Media personnel remember our community! Fun and very informative Manor Insurance February, 2008 March, 2008 Disaster & Emergency Awareness Day Mutual Presidents Day Page 36