oak ridge retiree town hall meeting #2 medicare prescription drug coverage retiree town hall...

Oak Ridge Retiree Town Hall Meeting #2

Medicare Prescription Drug Coverage

Retiree Town Hall Presentation:Comparing Prescription Drug Coverage

November 2005

2Oak Ridge Retiree Town Hall Meeting #2

Today’s Agenda

What’s happening?

Why we’re here today

Considerations as you evaluate coverage

Comparing your Oak Ridge retiree prescription drug coverage to local provider plans

Considerations for limited income and resources individuals

What happens next?


What’s Happening?


What’s Happening?

Medicare Prescription Drug, Improvement, and Modernization Act of 2003 — or the Medicare Modernization Act (MMA) — signed into law on December 8, 2003

Effective January 1, 2006, Medicare will provide optional prescription drug coverage called Medicare Part D It replaces prescription drug discount card, which will phase out by

May 15, 2006 Beginning November 15, anyone with Medicare is eligible to enroll

for this coverage Legislation encourages employers to continue to be the primary

provider of prescription drug benefits for their Medicare-eligible population


What’s Happening? (cont.)

The benefits of this legislation include: Offers prescription drug coverage to Medicare beneficiaries who

don’t have access to adequate prescription drug coverage today Provides enhanced benefits with lower out-of-pocket costs to limited-

income beneficiaries, as defined by the government Gives employers the choice to continue to be the primary provider of

prescription drug benefits ― not intended to replace employer-sponsored coverage that’s as generous or more generous


What’s Happening? (cont.)

Oak Ridge will continue to offer the current prescription drug coverage, which is as generous as or more generous than Medicare Part D for 2006 Anyone who participates in an Oak Ridge retiree medical plan

receives prescription drug coverage automatically Oak Ridge prescription drug coverage does not coordinate with

Medicare Part D coverage This means, for most Medicare-eligible Oak Ridge employees and

retirees, enrolling in Medicare Part D will not provide additional benefits

If you are a Medicare-eligible retiree or LTD recipient enrolled in Oak Ridge coverage and you elect Medicare drug coverage, your Oak Ridge medical and prescription drug coverage will be cancelled


Why We’re Here Today

By now, you may have received mailings from a number of carriers who want to offer you prescription drug coverage These mailings will encourage you to enroll “just to be safe” The companies sending you these mailings do not know that you already

have prescription drug coverage through Oak Ridge

— They are mailing to all Medicare-eligible individuals

Oak Ridge wants you to understand: What Medicare drug coverage means to you as a Medicare-eligible Oak

Ridge retiree or employee That your current prescription drug coverage is as generous as or more

generous than the standard Medicare coverage Enrolling in Medicare Part D will not offer any additional benefits, although

there are some exceptions Enrolling in private Medicare prescription drug coverage for 2006 will

jeopardize your Oak Ridge-provided coverage


Considerations As You Evaluate Coverage


Medicare Part D Terminology

Terms and abbreviations: CMS – Centers for Medicare and Medicaid Services Medicare Part D – also refers to Medicare prescription drug coverage “As generous as or more generous than” – the Medicare phrase applied

to employer-provided coverage that offers a benefit comparable to (or better than) the standard Medicare Part D coverage

Creditable Coverage – verification that an individual has coverage that is as generous as or more generous than standard Medicare Part D coverage

Formulary – a specific list of drugs that are considered “covered” by a health plan or prescription drug plan

Limited Income and Resources – individuals who meet specific criteria established by CMS that qualify them for extra assistance through CMS

TrOOP – True out-of-pocket maximum that is defined as the amount of out-of-pocket costs a retiree would expect to pay if enrolled in a Medicare Part D plan, not including monthly premiums or out-of-pocket costs for catastrophic coverage

10


Considering Other Prescription Drug Coverage

As mentioned, choosing Medicare prescription drug coverage will jeopardize your Oak Ridge retiree medical coverage

However, we understand that you will receive mailings from many providers offering coverage and you may want to compare those plans with your Oak Ridge retiree medical coverage

To help you, we’ll be comparing some of the plans offered in our area during today’s session

In evaluating coverage, we’ll be asking these questions: Does the plan cover all my drugs? How much will this plan cost me? Does the plan have a coverage gap? How does the plan limit my out-of-pocket expenses? Is my pharmacy in the network? Does the plan offer mail order?

11


Does The Plan Cover All Of My Drugs?

Many plans have formularies, which limit the drugs that are covered under the plan

All of the Medicare prescription drug plans include a formulary

In most cases, these formularies limit the number of drugs offered under each class of drugs and may cover a generic rather than brand-name drug

We will not cover specific formularies for each of the plans today Contact each provider if you’d like more information about their

formulary

Your Oak Ridge prescription drug coverage does not include a formulary

12


How Much Will This Plan Cost Me?

The first consideration will be the premium or contribution for joining the plan The national average cost of Medicare prescription drug plans is

$32 per month, but prices will vary, depending on the level of coverage provided in each plan — increased coverage will generally cost more

The next consideration is the deductible that must be met before coverage will begin Most plans require that you pay the full cost up to a certain dollar

limit, after which the plan’s benefits begin The standard Medicare prescription drug plan includes a $250

annual deductible Your Oak Ridge prescription drug coverage requires a $150

deductible for retail pharmacy prescriptions

13


How Much Will This Plan Cost Me? (continued)

Finally, consider what you may pay, in coinsurance or copays, each time you obtain a prescription Coinsurance is a percentage of the cost

— The standard Medicare prescription drug plan includes 25% coinsurance on total annual drug costs up to $2,250 and 5% of the cost after you have spent $3,600 out-of-pocket

— Your Oak Ridge prescription drug coverage includes coinsurance for prescription drugs obtained through a retail pharmacy

Copays are a fixed dollar amount— For example, generic drug copays through a mail order program

may cost $25 for a 90-day supply— Your Oak Ridge prescription drug coverage includes copays for

prescription drugs obtained through mail order

14


Does The Plan Have A Coverage Gap?

A coverage gap – or “doughnut hole” – is like a second deductible

When your total prescription drug costs reach a certain level, you assume the full cost of prescription drugs

You pay for prescription drugs up to another limit of out-of-pocket expenses, upon which the coverage gap closes

The standard Medicare prescription drug coverage plan has a coverage gap that takes effect when your total prescription drug expenses reach $2,250

The standard Medicare plan resumes paying benefits when you reach a total of $3,600 in out of pocket expenses

Your Oak Ridge prescription drug coverage does not have a coverage gap

15


How Does The Plan Limit My Out-of-Pocket Expenses?

A plan may include an out-of-pocket maximum that will limit the amount you pay in coinsurance toward prescription drugs in a given year

The standard Medicare prescription drug coverage has an out-of-pocket maximum of $3,600 each year, after which Medicare catastrophic coverage begins

When you reach that threshold, your coinsurance is reduced from 25% to 5% for prescription drugs for the remainder of that calendar year

Your Oak Ridge prescription drug coverage does not have an out-of-pocket maximum

16


Is My Pharmacy In The Network?

Participating pharmacies vary by plan

You will need to refer to the materials you receive from the insurers offering Medicare prescription drug plans in your area

You should also confirm participation with your local or preferred pharmacy

17


Does The Plan Offer Mail Order?

Mail order availability will vary by plan as well

Confirm that mail order is an option and verify how you can submit prescriptions as well as how prescriptions are mailed to you

In some cases, plans allow you to purchase up to a 90-day supply of your medication through a participating retail pharmacy in addition to mail order

18


Let’s stop for a minute to see if there are any questions?

19


Comparing Your Oak Ridge Retiree Prescription Drug Coverage to Local Provider Plans

20


2006 Prescription Drug Coverage for Oak Ridge Retirees: Snapshot of Benefits under the Retiree Medical Plan

Retail(up to a 30 day supply)

Mail Order (up to a 90 day supply)

Deductible: $150 $0

For In-Network Pharmacy

COINSURANCEBrand name: Plan pays 70%

Participant pays 30% (minimum $10)Generic:

Plan pays 80%Participant pays 20% (minimum $10) COPAYMENT

Brand name: $35Generic: $15

For Non-Network Pharmacy

COINSURANCEBrand name: Plan pays 50%

Participant pays 50% Generic:

Plan pays 50%Participant pays 50%

21


Standard Medicare Part D Drug Benefit: A Visual

*TrOOP is “true out-of-pocket” maximum — amount retiree must pay before catastrophic (95%) benefit begins. Employer and insurance company payments do not count toward satisfaction of TrOOP.

0%

25%

50%

75%

100%

$250 $2,250 $5,100

Retiree pays 100%

of first $250

Retiree pays 25% of next $2,000, up to $500

Ded

uctib

leCo

ins

ura

nce Plan pays 75%

Part D benefits Retiree liability (counts toward $3,600 true out-of-pocket maximum (TrOOP)*

Retiree pays 5% (no maximum)Retiree pays 100% of

next $2,850, up to $3,600total out-of-pocket limit

Retiree out-of-pocket costs$250 $750 $3,600

Annual drug costs

Plan pays 95%

Coi

nsur

ance

Cov

erag

e G

ap

(“D

onut

Hol

e”)

Cat

ast

rop

hic

Ben

efit

22


Comparing Medicare Prescription Drug Plans

We’ll be comparing the following plans: Aetna Medicare Rx Essentials, Plus and Premium Plans Community Care Rx Basic, Choice and Gold Plans Coventry AdvantraRx Value, Premier and Premier Plus Plans Humana PDP Standard, Enhanced and Complete Plans AARP Medicare Rx by UnitedHealthcare

Please note that we have used each of the plan’s summary of benefits to create this comparison

We cannot answer specific details about any of the plans, with the exception of your Oak Ridge coverage

These comparisons were created using information that we believe to be current and accurate; however, you should contact each of the providers directly for the most up-to-date information on any of the plans discussed during today’s session

23


Comparing Oak Ridge Coverage to Aetna Medicare Prescription Drug Plans

Oak Ridge Aetna Medicare Rx Essentialssm

Aetna Medicare Rx Plussm

Aetna Medicare Rx Premiersm

Monthly Premium Per Person

Included in your Retiree Medical contributions

$38.86 $50.45 $66.75

Annual Deductible $150 (retail only)

$250(retail and mail order)

$0 $0

Coinsurance or Copayment for prescription drugs obtained at participating retail pharmacy (30 day supply)

Brand name: Plan pays 70%You pay 30%

(minimum $10)Generic:

Plan pays 80%You pay 20%

(minimum $10)

Brand name:$25 copay

Generic:$5 copay


Generic:$7 copay

Non-Preferred Brand name:

$40 copay

Preferred Brand name:

$20 copay

Generic:$2 copay

Coinsurance or Copayment for prescription drugs obtained at non-participating retail pharmacy (30 day supply)


Generic:Plan pays 50%You pay 50%

Not covered except in case of emergency, traveling outside network or drug unavailable elsewhere

24






Coinsurance or Copayment for prescription drugs obtained through mail order (90 day supply)

Brand name: $35 copayGeneric:

$15 copay


Generic:$10 copay


Generic:$14 copay


$80 copay


$40 copay

Generic:$4 copay

Coinsurance or Copayment for prescription drugs during coverage gap ($2,250 in total prescription drug costs until you reach $3,600 in out-of-pocket covered prescription drug costs)

Coverage gap does not apply

Coverage for retail and mail

as noted

You pay 100% for all drugs

Brand name:You pay 100%

for all drugs

Generic:$7 copay – retail

$14 copay – mail

Brand name:You pay 100% for

all drugs

Non-Preferred Generic:

$40 copay – retail

$80 – mail

Preferred Generic:

$2 copay – retail

$4 copay – mail

25






Coinsurance or Copayment for prescription drugs once you reach $3,600 in out-of-pocket expenses

Out of pocket limit does not

apply


as noted

The greater of:

Brand name:

$5 copay

Generic:

$2 copay

Or 5% of drug cost

The greater of:

Brand name:

$5 copay

Generic:

$2 copay

Or 5% of drug cost

The greater of:

Brand name:

$5 copay

Generic:

$2 copay

Or 5% of drug cost

26


Comparing Oak Ridge Coverage to Community Care Rx Basic Prescription Drug Plan

Oak Ridge Community Care Rx Basic

Community Care Rx Choice

Community Care Rx Gold



$33.31 $41.41 $45.23


$250(retail)

$250(retail)

$100(retail)





(minimum $10)

Formulary Brand name:


Formulary Preferred Brand

name:Plan pays 75%You pay 25%

Formulary Generic:$0 copay


$40 copay

Formulary Preferred




$50 copay

Formulary Preferred



27









In addition to paying the copayment/coinsurance listed on the prior page, you pay the difference between the cost of the drug if the prescription was filled at a participating pharmacy and what the out-of-network pharmacy charged for the drug



$15 copay




name:Plan pays 75%You pay 25%


Formulary Brand name:$120 copay

Formulary Preferred


Formulary Generic:

$12 copay


$150 copay


name:$75 copay

Formulary Generic:

$12 copay

Mail order not available but 90-day supply can be obtained at participating pharmacies

28








Coverage for retail and mail as

noted

You pay 100% of the cost of all prescription drugs through coverage gap



apply


noted

The greater of:

Non-Preferred Brand name:$5 copay

Formulary Preferred Brand name or Generic:$2 copay

Or 5% of drug cost

29


Comparing Oak Ridge Coverage to Coventry Advantra®Rx Prescription Drug Coverage

Oak Ridge AdvantraRx Value Plan

AdvantraRx Premier Plan

AdvantraRx Premier Plus



$22.86 $33.99 $43.85


No deductible No deductible No deductible





(minimum $10)

Non-Formulary Brand name:You pay 100%


$36 copay

Formulary Generic:

$15 copay

Non-Formulary Brand name:

$53 copay


$20 copay


Non-Formulary



$20 copay


90 day supply available at participating pharmacies – copay equals three times 30 day supply copay

30









Not covered except in case of emergency, traveling outside network or drug unavailable elsewhere.

You pay the difference between what the plan would pay if the prescription was filled at a participating pharmacy and what the out-of-network pharmacy charged for the drug



$15 copay

Non-Formulary Brand name:You pay 100%


$72 copay

Formulary Generic:

$30 copay

Non-Formulary Brand name:$106 copay


$40 copay

Formulary Generic:

$10 copay

Non-Formulary



$40 copay


31









noted




apply


noted

The greater of:



Or 5% of drug cost

32


Comparing Oak Ridge Coverage to Humana Prescription Drug Coverage

Oak Ridge Humana PDP Standard

Humana PDP Enhanced

Humana PDP Complete



$14.08 $22.48 $67.16


$250(retail only)

No deductible No deductible





(minimum $10)





Preferred Generic:



$60 copay


$30 copay

Preferred Generic:$7 copay

($0 copay until total drug costs

reach $250)


$60 copay


$30 copay



reach $250)

90 day supply available at participating pharmacies – copay equals three times 30 day supply copay

33




Humana PDP Enhanced

Humana PDP Complete





You pay the difference between what the plan would pay if the prescription was filled at a participating pharmacy and what the out-of-network pharmacy charged for the drug



$15 copay





Preferred Generic:




$75 copay

Preferred Generic:

$17.50 copay ($0 copay until total drug costs

reach $250)

Non-Preferred Brand name: $150 copay


$75 copay

Preferred Generic:


reach $250)

34




Humana PDP Enhanced

Humana PDP Complete




noted

You pay 100% for all drugs Retail and mail order copays apply through

coverage gap



apply


noted

The greater of:



Or 5% of drug cost

35


Comparing Oak Ridge Coverage to AARP Medicare Rx Prescription Drug Coverage

Oak Ridge AARP Medicare Rx by UnitedHealthcare



$27.28


No deductible


Brand name: Plan pays 70%

You pay 30% (minimum $10)Generic:

Plan pays 80%You pay 20% (minimum $10)


Preferred Brand name:$28 copay


90 day supply available at participating pharmacies – copay equals three times

30 day supply copay

36








You will generally pay more for prescriptions filled at a non-participating retail pharmacy.



$15 copay




37







noted

You pay 100% for all drugs



apply


noted

The greater of:



Or 5% of drug cost

38


An Example: Comparing Oak Ridge Coverage to Humana Prescription Drug Coverage

Let’s review an example of how the costs might play out for a retiree.

Joe has a few medical conditions that require regular medication; 3 of them are brand-name Joe fills these three times at his pharmacy and then uses mail order

for the rest of the year (three 90-day supplies) Each of these drugs costs $100 for a 30-day supply or $300 for a 90-day supply

— 2 of those are on Humana’s Preferred Brand name list.

He also takes one drug that is a generic but does not take this regularly – he expects to refill that drug five times during the year at his pharmacy. The retail cost for this drug is $30 for a 30-day supply.

We’ll assume that Joe only uses participating pharmacies.

If Joe did not have any coverage, his total prescription drug costs would be $3,750.

39



Oak Ridge Joe Pays Total Drug Cost

Humana PDP Enhanced

Joe Pays

Annual Deductible

$150 (retail only)

$150 No deductible $0



(minimum $10)


(minimum $10)

30% x {$900 Minus $150

deductible} =

30% X $750 = $225

1 Generic ($10) X 5 refills = $50

3 Brand names

($100) X 3 refills =

$900



$60 copay


$30 copay



reach $250)

1 Non-Preferred

Brand name ($60) X 3

refills = $180

2 Preferred Brand name

($30) X 3 refills = $180

1 Generic ($7) X 5 refills =

$35

Subtotal $425 $1,050 $395

40



Oak Ridge Joe Pays Total Drug Cost

Humana PDP Enhanced

Joe Pays



$15 copay

3 Brand name X 3

refills ($35) = $315

3 Brand name

($300) X 3 refills = $2,700

Joe hits Coverage Gap when

Total Drug Costs reach $2,250



$75 copay

Preferred Generic:


reach $250)

1 Non-Preferred

Brand name ($150) X 3

refills = $450


($75) X 1 refill = $75

Coverage Gap Hit – Joe pays for remaining $1,500 in drug

costs

Subtotal this page

Subtotal prior page

$315

$425

$2,700

$1,050

$2,025

$395

Grand total

Premium Cost

$740

Included

$3,750 $2,420

$270

41



42


Medicare Part C

Originally known as Medicare+Choice plans, now called Medicare Advantage or Medicare Health plans

These plans deliver Medicare benefits through coordinated care plans (HMOs, PPOs) or private fee-for-service plans

— May include additional benefits such as dental, vision, hearing screenings and prescription drugs

— Must live in the geographic service area where the plan provides service— Premiums vary by plan

Available to:— Individuals entitled to Part A and enrolled in Part B— 65 and older— Disabled Medicare beneficiaries

– Except new enrollees with ESRD We’ll discuss the Medicare prescription drug coverage offered by some of the local

Medicare Advantage plans The premium we note for each is for the prescription drug coverage only – however,

many of these plans require additional premiums for medical coverage

43


Comparing Medicare Advantage Prescription Drug Coverage

There are several providers who offer Medicare Advantage plans in the Oak Ridge area

These plans include Medicare prescription drug coverage as part of their overall medical coverage

We’ll be comparing prescription drug coverage for the following Medicare Advantage plans: BlueCross BlueShield of Tennessee’s BlueAdvantagePlus Cariten Senior Health John Deere SecurePlus

44


Comparing Oak Ridge Coverage to BCBS of Tennessee’s BlueAdvantagePlus Prescription Drug Coverage

Oak Ridge BlueAdvantagePlus



$37.98


No deductible





Formulary Non-Preferred Brand name:$64 copay

Formulary Preferred Brand name:$32 copay


90 day supply available at participating pharmacies – copay equals three times 30

day supply copay

45







Only covered in special circumstances: in case of emergency, traveling outside network or drug unavailable elsewhere. 10-day supply only at the following copays:






$15 copay




46







noted




apply


noted

The greater of:



Or 5% of drug cost

47


Comparing Oak Ridge Coverage to Cariten Senior Health Prescription Drug Coverage

Oak Ridge Cariten Senior Health (PPO & HMO)



$39.24 – PPO or HMO


$100(retail)





Multi-source Brand name, Non-Preferred Brand name and Non-Preferred

Injectables:$50 copay

Other Preferred Brand name and Preferred Injectables:$30 copay


All Generics except omeprazole:$5 copay

48







Not covered except in case of emergency, traveling outside network or drug unavailable elsewhere



$15 copay

Multi-source Brand name, Non-Preferred Brand name and Non-Preferred Injectables:

$150 copay

Other Preferred Brand name and Preferred Injectables:$90 copay


All Generics:$15 copay

90-day supply can be obtained at participating pharmacies or through mail-order pharmacy

49




Coinsurance or Copayment for prescription drugs during coverage gap ($2,250 in total prescription drug costs until you reach $3,600 in out-of-pockets covered prescription drug costs)



noted




apply


noted

The greater of:



Or 5% of drug cost

50


Comparing Oak Ridge Coverage to John Deere’s SecurePlus Prescription Drug Coverage

Oak Ridge John Deere’s SecurePlus Medicare

Part D Basic Alternative

John Deere’s SecurePlus Medicare

Part D Enhanced Alternative



$29.29 $43.90


No deductible No deductible



You pay 30% (minimum $10)

Generic:Plan pays 80%

You pay 20% (minimum $10)

Non-Formulary Brand name, Formulary Brand name and

Generic:$10 copay

All drugs: Plan pays 75%You pay 25%

51



Oak Ridge John Deere’s SecurePlus Medicare Part D Basic

Alternative

John Deere’s SecurePlus Medicare Part D

Enhanced Alternative




Not covered except in case of emergency, traveling outside network or drug unavailable elsewhere. You can obtain a 30 day supply:

Non-Formulary Brand name, Formulary Brand

name and Generic:$10 copay

Not covered except in case of emergency, traveling outside network or drug unavailable elsewhere. You can obtain a 30 day supply:


name and Generic: Plan pays 75%You pay 25%



$15 copay

One month (30-day supply) available at mail

order:


name and Generic:$10 copay

One month (30-day supply) available at mail

order:


name and Generic:Plan pays 75%You pay 25%

52



Oak Ridge John Deere’s SecurePlus Medicare Part D Basic

Alternative

John Deere’s SecurePlus Medicare Part D Enhanced

Alternative

Coinsurance or Copayment for prescription drugs during coverage gap ($2,250 in total prescription drug costs until you reach $3,600 in out-of-pockets covered prescription drug costs)


Coverage for retail and mail as noted

Coverage gap begins at $1,825 and you pay 100% of the cost of all prescription drugs through coverage gap

Coverage gap begins at $2,250 and you pay 100% of the cost of all prescription drugs through coverage gap


Out of pocket limit does not apply

Coverage for retail and mail as noted

The greater of:



Or 5% of drug cost

53


An Example: Comparing Oak Ridge Coverage to Cariten Senior Health Prescription Drug Coverage Prescription Drug Coverage

Let’s review an example of how the costs might play out for a retiree.

Joe has a few medical conditions that require regular medication; 3 of them are brand-name Joe fills these three times at his pharmacy and then uses mail order

for the rest of the year (three 90-day supplies) Each of these drugs costs $100 for a 30-day supply or $300 for a 90-day supply

— 2 of those are on Cariten’s Preferred Brand name list.

He also takes one drug that is a generic but does not take this regularly – he expects to refill that drug five times during the year at his pharmacy. The retail cost for this drug is $30 for a 30-day supply.

We’ll assume that Joe only uses participating pharmacies.

If Joe did not have any coverage, his total prescription drug costs would be $3,750.

54


An Example: Comparing Oak Ridge Coverage to Cariten Senior Health Prescription Drug Coverage

Oak Ridge Joe Pays Total Drug Costs

Cariten Senior Health (PPO &

HMO)

Joe Pays

Annual Deductible

$150 (retail only)

$150 $100(retail)

$100



(minimum $10)


(minimum $10)

30% x {$900 Minus $150

deductible} =

30% X $750 = $225


3 Brand names

($100) X 3 refills =

$900

1 Generic

($30) X 5 refills = $150

Other Preferred

Brand name and Preferred Injectables:$30 copay


$15 copay


1 Other Preferred Brand name ($30) X 3

refills = $90


($15) X 3 refills = $90

= $180


Subtotal $425 $1,050 $305

55


An Example: Comparing Oak Ridge Coverage to Cariten Senior Health Prescription Drug Coverage

Oak Ridge Joe Pays Total Drug Costs

Cariten Senior Health (PPO &

HMO)

Joe Pays



$15 copay

3 Brand name X 3 refills ($35) =

$315

3 Brand name

($300) X 3 refills = $2,700

Joe hits Coverage Gap when Total Drug

Costs reach $2,250

Other Preferred

Brand name and Preferred Injectables:$90 copay


$45 copay


1 Other Preferred Brand name ($90) X 3

refills = $270


($45) X 1 refill = $45

Coverage Gap Hit – Joe pays for remaining $1,500 in drug

costs

Subtotal this page

Subtotal prior page

$315

$425

$2,700

$1,050

$1,815

$275

Grand Total

Premium Cost

$740

included

$2,210

$471

56



57


Special Considerations for Limited Income and Resources Individuals

58


Who Should Enroll in a Medicare Prescription Drug Plan?

Those without drug coverage For people without the benefit of

employer-sponsored coverage

Those who qualify for “extra help” The Social Security Administration

has identified people who may qualify for assistance in paying for drugs based on their income and assets ― applications were mailed directly to people in May 2005

Medicare prescription drug plans are designed for people who need them most…

…but it’s completely up to each individual to decide what prescription drug coverage option makes the best financial sense for his or her family.

59


Who’s Eligible for Extra Help?

“Limited income and resources” defined as: Income less than 150% of federal poverty level

— $14,355 for individuals in 2006— $19,245 for couples in 2006

Limited liquid assets— $11,500 for individuals— $23,000 for couples in 2006

The Social Security Administration is sending applications to those who may qualify for the extra benefit

If you receive an application, you should complete it. Submitting this application does not enroll you for Medicare drug coverage

However, according to the Medicare and You 2006 Handbook, if you apply and qualify for assistance, you will automatically be enrolled in the plan for which you are considered eligible

60


What Does “Extra Help” Cover?

Oak Ridge <100%* <135%** <150%***



$0 $0 Subsidy phased out at 150%


$0 $0 $50





(minimum $10)


$3 copay



$5 copay




Formulary Generic:


* Income must be less than $9,570 for individuals/$12,830 for a couple. Must also be eligible for Medicaid.** Income must be less than $12,920 for individuals/$17,321 for a couple. Liquid assets <$6,000 ind; $9,000 couple*** Income must be less than $14,355 for individuals/$19,245 for a couple. Liquid assets <$11,500 ind; $23,000 couple

61


What Does “Extra Help” Cover?

Oak Ridge <100% <135% <150%




as noted


$3 copay



$5 copay




Formulary Generic: Plan pays 85%You pay 15%



apply


as noted


$3 copay



$5 copay



$5 copay


62


But Keep in Mind…

If you become enrolled in a plan offered to individuals with limited income and resources, you will lose your Oak Ridge retiree medical coverage

Medicare or, if you are eligible, Medicaid will be your sole source of medical coverage

Weigh the potential out-of-pocket costs — both your medical and prescription drug coverage — before filing your application For example, consider your Medicare inpatient deductible if you

anticipate being hospitalized in the coming year

You may also want to discuss this with your local Social Security office

63


What’s Happens Next?

64


What’s Next?

For 2006, a special Medicare Part D enrollment period will be held For individuals eligible by November 15: November 15, 2005 –

May 15, 2006 Individuals eligible later: If an individual becomes eligible for

Medicare after May 15, 2006, there will be an initial open enrollment period for both Parts B & D

In later years, from November 15 to December 31 for next benefit year (January 1 – December 31)

65


The Key Question…

If I already have coverage through Oak Ridge, does it makes sense for me to enroll in a private Medicare prescription drug plan in 2006?

The answer…

In most cases, no! Remember the reason ― Oak Ridge already provides drug coverage that is expected to pay out at least as much as — and in most cases more than — a standard Medicare prescription drug plan

Most retirees are better off under Oak Ridge’s plan, unless: You are eligible for “extra help” or on Tricare (the plan for military retirees and spouses), Remember, if you are Medicare-eligible and elect Medicare Part D coverage, your continued

coverage through Oak Ridge will be dropped

66


Oak Ridge Retiree Prescription Drug Coverage: Overview

Your Oak Ridge retiree medical plan includes prescription drug coverage Anyone enrolled in the Oak Ridge retiree medical plan receives

prescription drug coverage automatically Medical and prescription drug coverage is integrated; you cannot

enroll in one without the other

Oak Ridge prescription drug coverage is “creditable coverage,” which is defined by CMS as being “on average” at least as generous as the standard benefit Protects your right to leave the Oak Ridge retiree medical plan and

join another “certified” plan or Medicare prescription drug plan within 63 days without incurring a penalty on the Medicare Part D premium for coverage— Those without “creditable coverage” are penalized 1% of the

monthly Medicare Part D premium for each month enrollment is delayed past their initial enrollment period

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Key Points to Remember

The Oak Ridge retiree medical plan includes prescription drug coverage. This means anyone who’s enrolled in an Oak Ridge retiree medical plan receives prescription drug coverage automatically Medical and prescription drug coverage are combined and a person can’t

enroll in one without the other

For 2006, your Oak Ridge coverage is at least as generous as private Medicare prescription drug coverage

Your Oak Ridge prescription drug coverage does not coordinate with private Medicare prescription drug coverage This means you do not need to enroll in Medicare Part D to keep your

Oak Ridge coverage In fact, if you enroll in Medicare Part D, you will lose your Oak Ridge

retiree medical coverage

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Where to Get More Information

OneCall By phone at 574-1500 or 1-877-861-2255

— CSRs available Monday through Friday, 7:00 a.m. to 5:00 p.m. ET

Via the internet at http://www.y12.doe.gov — Employee & Retiree Benefits

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Thanks for Coming!

oak ridge retiree town hall meeting #2 medicare prescription drug coverage retiree town hall...

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