Transcript Welcome, Retirees! - Rochester Institute of Technology

Medicare Prescription Drug
Benefits
Employee Workshop
November 2005
11/8/05
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Purpose of This Workshop
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To help you help someone else
To give you an overview
To help get you started
To give you some resources
NOTE: We are not the experts!
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What is Medicare?
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Different than Medicaid (low income)
Health insurance program for
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People age 65 and older
People under age 65 with certain disabilities, and
People of all ages with End-Stage Renal Disease
(permanent kidney failure requiring dialysis or a kidney
transplant)
Part A – Hospitalization Insurance
Part B – Medical Insurance
Part C – Medicare+Choice (Medicare Advantage)
Part D NEW – Prescription Drug Coverage
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Medicare Premiums
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Part A
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Part B
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No monthly premium, part of FICA tax
deducted from Social Security check
$88.50 per month for 2006
Part D
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~$32 per month for 2006
Will vary if enroll in private plan
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Medicare if 65+ Year Old is Covered by
Active Employee Plan
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Part A begins even if working and is
secondary (employer coverage pays first)
Part B enrollment can be delayed with no late
sign up penalty
Part D enrollment can be delayed with no late
sign up penalty if coverage is considered
“creditable” – at least as good as Medicare
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Employer must send a notice by November 15,
2005
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Medicare Part D: What is it?
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Currently, Medicare does not cover most
outpatient prescription drugs
Medicare Modernization Act of 2003 adds this
coverage as of January 1, 2006
Centers for Medicare and Medicaid Services
(CMS) in charge of Part D
Part D coverage is voluntary coverage
Most enrollees will pay a premium
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Exception for lower income people
Penalty for late enrollment (1% per month), if not
enrolled in a plan that is at least equivalent, on
average, to Part D
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Medicare Part D: Standard Plan Design
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Premium: You pay a monthly premium in addition to
your Medicare Part B premium – the estimated average
monthly premium is $32
Deductible: You pay the first $250 in drug costs before
the plan begins to pay
Coinsurance: You pay 25% of your drug costs from
$250 to $2,250; Medicare will pay 75%
100% Self-Pay Portion, called “The Donut Hole”: You
pay 100% of your drug costs from $2,250 to $5,100
Catastrophic Coverage: After your total drug costs
reach $5,100 and you have paid $3,600 in out-of-pocket
costs, you pay only 5% of any costs above $5,100 for
the rest of the year; Medicare will pay the other 95%
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Medicare Part D: Standard Plan Design
Stop-Loss Member reaches $3,600 in
True Out-of-Pocket costs
The infamous
“donut hole”
Catastrophic
Coverage
Plan Pays
95% of Costs
Beneficiary
Pays Next
$2,850 in Rx
Spending
5% Cost-Sharing (or
$2/$5 Copays)
Above Stop-Loss
100% Paid by
Retiree
Estimated Average
Monthly Premium
$32
Initial Coverage Limit
$2,250
Beneficiary Paid
Plan Paid
50% of Costs
75% Paid by
Paid
Plan
by Insurer
($1,500)
($2,113)
25% Co-Insurance
Paid by Retiree
($500)
$250 Deductible paid by Retiree
2006
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Graphic by
Preferred Care
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When Can Someone Join?
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Between November 15, 2005 and May 15,
2006
If join by December 31, 2005, coverage will
begin January 1, 2006
Otherwise, coverage will be effective the first
of the month after the month person joins
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Medicare Part D: Private Plans
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Many private companies will offer prescription drug coverage that
qualifies under Medicare Part D.
The companies will likely charge you a premium for this
coverage.
According to CMS, there will be private drug plans in every
region (21 in NYS).
Some private plans will offer
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premiums below $30 per month
plans with no deductibles, or deductibles lower than Medicare’s
standard $250 deductible
plans with coverage that exceeds Medicare’s standard design in
other ways
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Medicare Part D: Low Income Benefits
Category 1:
 you have both
Medicare and full
Medicaid coverage
 your annual income is
below $9,570 if
you’re single
 your annual income is
below $12,830 if you
are a married couple
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Monthly Premium
$0
Annual Deductible
$0
Coinsurance
Not applicable
Generic drug cost
$1 copay
Brand drug cost
$3 copay
Cost if you’re in a
nursing home
$0
Cost once drug
expenses reach
$3,600 in a year
$0
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Medicare Part D: Low Income Benefits
Category 2:
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you do not qualify for
Category 1
 you have Medicare
 your annual income is below
$12,920 ($17,321 for a
married couple)
 your assets are below $7,500
($12,000 for a married
couple)
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Monthly Premium
$0
Annual Deductible
$0
Coinsurance
Not applicable
Generic drug cost
$2 copay
Brand drug cost
$5 copay
Cost if you’re in a
nursing home
$0
Cost once drug
expenses reach
$3,600 in a year
$0
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Medicare Part D: Low Income Benefits
Category 3:
 you do not qualify for
Category 1 or 2
 you have Medicare
 your annual income is
below $12,920
($17,321 for a married
couple)
 your assets are below
$11,500 ($23,000 for a
married couple)
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Monthly Premium
$0
Annual Deductible
$50
Coinsurance
15% between
$50 and $3,600
Generic drug cost
after $3,600
$2
Brand drug cost
after $3,600
$5
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Medicare Part D: Low Income Benefits
Category 4:
 you do not qualify for
Category 1, 2 or 3
 you have Medicare
 your annual income is
below $14,355
($19,245 for a
married couple)
 your assets are below
$11,500 ($23,000 for a
married couple)
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Monthly Premium
Sliding Scale
Annual Deductible
$50
Coinsurance
15% between
$50 and $3,600
Generic drug cost
after $3,600
$2
Brand drug cost
after $3,600
$5
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Prescription Drug Choices
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Keep employer-provided or union-provided
coverage, if available
Elect coverage under Medicare Part D standard
benefits through CMS
Elect coverage under Medicare Part D low income
benefits if qualified
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Apply through Social Security Administration
Elect coverage under a private plan that qualifies
under Medicare Part D
Keep EPIC as secondary coverage if qualified (NYS
only)
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Medicare Part D: Your next steps
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If person has coverage from a former employer or union, find out
what their Rx benefit will be for 2006
 Will coverage be continued?
 Will coverage be changed?
 Is coverage creditable? (notice to be sent by November 15)
 What is the type of medical coverage (Medicare HMO or
Medicare Advantage plan – see warnings on later slide)
Determine whether you fit any of Medicare’s low income
categories
Learn which private plan choices are available
Verify that the plan you want covers the drugs you take
Determine whether there is a specific pharmacy network
Compare expected out-of-pocket costs under each available
option
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Medicare Part D: Your next steps (cont’d)
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If you have Power of Attorney (POA)
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You can enroll person in a Medicare prescription drug plan
You can fill out application to get extra help (low income) on
his/her behalf as well
You do not have access to private health information. You
would need the person to complete a HIPAA form
(authorizing the release of private health information to
you); obtain from insurance carrier
Enroll between Nov. 15 and May 15 for 2006, if
appropriate
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What do RIT retirees need to know?
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RIT will continue to offer RIT Rx in 2006
 Copays increasing to our standard plan design: $10/$25/$40 for
generic/formulary/non-formulary drugs
RIT Rx is at least as generous as Medicare Part D
 No late enrollment penalty for Part D later
RIT retirees do not need to take any action
RIT retirees in Preferred Care Gold or Medicare Blue Choice
should definitely not enroll in a Medicare prescription drug plan
FYI: RIT is applying to receive the employer subsidy available
from Medicare
Retiree enrollment: October 31-November 18
 Retiree meetings being held
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Some Friendly Warnings!
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Medicare Advantage Plans (HMOs, like Preferred Care Gold and
Medicare Blue Choice):
 Must choose that plan’s Rx coverage (if any)
 If they elect a standalone Medicare Rx plan, CMS will disenroll
them from the Medicare Advantage plan, and they will have only
Medicare Parts A&B for medical coverage for 2006!
Watch out for fraud/scams:
 No one trying to enroll you in a plan can come to your door
uninvited
 No one can ask you to enroll before Nov. 15th
 No one can ask you for personal information during marketing
activities
 Never give out personal information until you are certain the
person or product is approved by Medicare
 If you have questions or concerns, call 1-800-MEDICARE
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For More Information
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Read the Medicare & You 2006 handbook mailed to Medicare eligibles in
October (includes plans in the person’s region)
Contact Medicare
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To apply for the low income benefit, contact the Social Security
Administration at 1-800-772-1213/v or 1-800-325-0778/TTY; information
about the low income benefit is available on the SSA website:
www.ssa.gov.
Call the State Health Insurance Assistance Program for face to face
assistance; New York State number is (800) 333-4114
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go to www.shiptalk.org or contact Medicare to find the phone # for other states
Contact AARP
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www.medicare.gov
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Select Search Tools to get personalized information
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Select Frequently Asked Questions to get answers to common questions
Call 1-800-MEDICARE (1-800-633-4227)/v and 1-877-486-2048/TTY
www.aarp.org/medicarerx
Call 1-888-OUR-AARP (1-888-687-2277)
Look for local Medicare-related events
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Your Questions??
NOTE: We are still not the experts!
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