Your MedicarePrescription Drug Coverage

Module 9A

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Today’s Medicare

Promotes a healthy lifestyleCovers preventive servicesProvides more choicesHelps people with Medicare live longer,

healthier livesOffers prescription drug coverage

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Medicare Prescription Drug Coverage

Coverage began January 1, 2006Sometimes called Medicare Part DAvailable to all people with Medicare Provided through

Medicare Prescription Drug PlansMedicare Advantage and other Medicare plansSome employers and unions

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Eligibility

Have Medicare Part A and/or Part BNeed Part A and Part B to get Medicare

Advantage Plan with drug coverage

Live in plan’s service areaJoin a Medicare drug plan to get coverage

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When You Can Join

Initial Enrollment Period7-month period when people first get Medicare

Annual Coordinated Election PeriodNovember 15 – December 31 each year

Special Enrollment PeriodIn some situations

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Waiting to Enroll

Waiting to enroll could mean a penalty1% premium increase for every full month you

waitFor as long as you have Medicare drug coverageUnless you have other drug coverage at least as

good as Medicare drug coverage• Creditable coverage

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Late Enrollment PenaltyIEP ended 5/15/06 and first enrolled 12/06

Coverage began 1/1/07Will pay 7% higher premium per month

7 months x 1% = 7% penalty• 06/06 – 12/06

7% x $27.35 = $1.91/month penalty in 2007• National base premium is $27.35/month in 2007• Can change each year

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Creditable Drug Coverage

Coverage at least as good as Medicare’sIf you have other drug coverage

Will get information from other plan

If you keep creditable drug coverage No penalty if you wait to enroll

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Medicare Drug Plans

Medicare drug plans varyCost—How much you have to pay Coverage—What drugs they coverConvenience—Which pharmacies they use

Important to get coverage before you need itPeace of mind

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Things to Consider

What is your current health insurance coverage?Do you have prescription drug coverage? Is your current drug coverage as good as

Medicare’s? How does your current coverage work with

Medicare?

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What If…

Medicare & State Pharmacy ProgramMedicare & AIDS Drug Assistance

ProgramMedicare & Health Savings AccountsMedicare & Patient Assistance Program

What You Need to Know

Cost

Module 9A

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Medicare Prescription Drug Costs

For coverage in 2007, you will generally payMonthly premium, varies by planPossible deductible, no more than $265Copayments or coinsurance

• May depend on how much you have spent that year

Very little after paying $3,850 out of pocket

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Extra Help With Drug Costs

People with lowest income and resourcesPay no premiums or deductiblesHave small or no copayments

Those with slightly higher income and resourcesHave a reduced deductiblePay a little more out of pocket

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Income and Resource Limits Income

Below 150% Federal poverty level• $1,276.25 per month for an individual* or• $1,711.25 per month for a married couple*• Based on family size

ResourcesUp to $11,710 (individual)Up to $23,410 (married couple)

• Counts savings and stocks• Does not count home you live in• Includes $1,500/person funeral or burial expenses

*Higher amounts for Alaska and Hawaii

2007 amounts

2007 amounts

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Qualifying for Extra Help

You may automatically qualify if you have Medicare andYou get full Medicaid benefitsYou get Supplemental Security Income (SSI)Medicaid helps pay your Medicare premiums

All others must applyApply online at www.socialsecurity.gov orCall 1-800-772-1213

What You Need to Know

Coverage

Module 9A

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Which Drugs Are Covered?

Available only by prescriptionDrugs, biologicals, insulin Medical supplies for injecting insulin

Syringes, needles, alcohol swabs, gauze

Brand-name and generic drugs

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Coverage Varies

Plans have formularies May not include all Medicare-covered drugs

• Usually cover similar drugs that are safe and effective

May have different levels (“tiers”)• Choosing generic drugs can save money

Plans must make sure people can get the treatment they need

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Coverage Varies

Plans may have rules for covering some drugsPrior authorizationStep therapyQuantity limits

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What if Your Prescription Changes?

You and your doctor should work with planFind a drug that is on the formulary

If you need a drug not on the plan’s formularyCan request an exceptionIf plan denies your exception request

• Can appeal

What You Need to Know

Convenience

Module 9A

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Pharmacies

Medicare drug plans work with certain pharmaciesWill send you a pharmacy directoryYou generally must use plan’s pharmacies

Some plans also offer mail orderCheck with the plan

Be sure it has pharmacies convenient to you

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Choosing a Plan

Step 1: Collect information Any current prescription drug coveragePrescription drugs, dosages, and how often you take them

Step 2: Compare Medicare drug planswww.medicare.gov 1-800-MEDICARE (1-800-633-4227)State Health Insurance Assistance Program (SHIP)

Step 3: Call plan with any questions

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Joining a Plan

Enroll directly with the planInternet

• Plan’s website• www.medicare.gov

TelephonePaper application

• Mail or fax to plan

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For More Information

Medicare & You handbook www.medicare.gov 1-800-MEDICARE (1-800-633-4227)

TTY users call 1-877-486-2048 State Health Insurance Assistance Program (SHIP) Social Security Administration

www.socialsecurity.gov1-800-772-1213

• TTY users call 1-800-325-0778

This training module provided by the

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