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Medicare Prescription Drug Insurance Medicare Part D. Presented By: Dupage County Senior Services 630-407-6500. Agenda. What is Medicare Part D? Extra Help (financial assistance) for people with limited income and resources

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medicare prescription drug insurance medicare part d

Medicare Prescription Drug InsuranceMedicare Part D

Presented By:

Dupage County Senior Services 630-407-6500

  • What is Medicare Part D?
  • Extra Help (financial assistance) for people with limited income and resources
  • How Medicare Part D will apply to you, depending on your current drug coverage
  • How Medicare Part D will work with state programs (Senior Care and Circuit Breaker Pharmaceutical Assistance)
  • Questions
medicare 2006
Medicare 2006
  • Part A-Hospitals
  • Part B-Physicians and equipment
  • Part C-Medicare Advantage plans
  • Part D (NEW)-Prescription Drug Assistance
what is medicare part d
What is Medicare Part D?
  • A government-sponsored insurance program for ALL people with Medicare Part A and/or Part B
  • Designed to decrease drug costs for recipients
  • Not intended to pay 100% of drug bills
  • Provides extra help for low income recipients
medicare part d
Medicare Part D
  • Medicare will contract with private companies (17 Companies)
  • Prescription Drug Plans-Formularies
  • Medicare and You Handbook-More Information about plans
  • Pick a Plan that covers your prescriptions
enrollment period
  • November 15, 2005 through May 15, 2006
  • Penalty if you enroll after May 15, 2006
postponing enrollment
Postponing Enrollment
  • Higher premiums for people who wait to enroll
    • Exception for those with coverage as good as a Medicare prescription drug plan
  • Premium will increase 1% for every month that eligible but did not enroll
how the plans work
How the Plans Work
  • Must offer standard drug benefit
  • Can be flexible and offer supplemental or enhanced benefits
  • May offer several levels or tiers
standard medicare prescription drug coverage cost
Standard Medicare Prescription Drug Coverage &Cost
  • $32.20 per month
  • $250 yearly deductible
  • Medicare covers 75% of Drug cost

up to $2,250

  • $2,251 to $5,100 Client pays 100% of cost
  • $5,100.01 and up Medicare pays 95% of cost
medicare plan options in illinois
Medicare Plan Options in Illinois
  • 9 plans will offer benefits nationwide
  • 1 plan will cost less than $20/month
  • 6 plans will cost under $24.99/month
  • 8 plans will cost under $29.99/month
  • 14 plans will cost under $34.99/month
extra help
Extra Help
  • People on Limited Income are eligible for extra help to cover the cost.
  • “Extra Help” will pay for Premiums and Deductible
  • Complete an “Extra Help” Application
to get this extra help
To Get This Extra Help
  • Qualify for Extra Help
    • If resources are
      • Less than $11,500 (single)
      • Less than $23,000 (married)


      • Limited income
        • Less than $14,355(single)
        • Less than $19,245(married)
how will medicare part d apply to you
How Will Medicare Part D Apply to You??
  • The new Medicare prescription drug program will apply to individuals differently depending on current drug coverage.
medicare and medicaid
Medicare and Medicaid
  • Prescriptions will now be paid for by Medicare
  • You do not need to fill out an extra help application
  • You will need to pick a plan
  • If you do not enroll in a plan before Dec.31st, 2005, one will be randomly assigned to you.
medicare and ssi disability or medicare savings plans
Medicare and SSI/Disability orMedicare Savings Plans
  • You will automatically be eligible for “extra help”
  • You do not need to fill out application
  • You will need to pick a plan
medicare and retirement plan
Medicare and Retirement Plan
  • You will receive a letter in the fall from your benefits administrator to let you know if your plan is as good or better than Medicare.
  • Must be notified before Nov. 15th
  • You make the decision to stay with your current plan or change to Medicare D
  • If plan is as good as Medicare you will not be charged penalty for enrolling at a later date
  • Be sure to keep letter in a safe place
medicare and medigap h i and j plans
Medicare and Medigap (H,I and J Plans)
  • Supplemental plans with Drug Coverage
  • Will need to choose either to keep current plan or enroll in Medicare D
  • These plans are not considered to be as good as Medicare Part D.
  • Higher premiums will apply after May 15th, 2006.
medicare drug discount cards
Medicare Drug Discount Cards
  • Current cards are valid until enrolled in Medicare Part D or May 15, 2006.
illinois cares rx
Illinois Cares RX
  • Gov. Rod Blagojevich enacted Illinois Cares Rx, which Leaves No Senior or Person with Disabilities Behind, in June 2005.
  • It is the most comprehensive plan in the nation
  • Illinois Cares Rx will continue SeniorCare and the pharmaceutical portion of Circuit Breaker starting Jan. 1, 2006
  • Illinois continues to lead the nation in providing prescription drug benefits
groups of illinois cares rx
Groups Of Illinois Cares RX
  • Group 1 (Old Senior Care)

covers all classes of medically necessary drugs.

$19,140 for single/ $25,660 for couple

  • Group 2 (Old Circuit Breaker)

covers only specific drug classes:

Alzheimers, Arthritis, Cancer, Diabetes, Glaucoma, Cardiovascular Disease, Lung and Smoking related diseases, Osteoporosis, Parkinsons, Multiple Sclerosis

$21,218 for a single/ $28,480 for couple

illinois cares rx1
Illinois Cares RX
  • Begins January 1, 2006
  • No enrollment fee
  • Co-payments
    • $2 generic
    • $5 brand name
  • $1750 in drugs then client pays 20% of cost of the prescription and any applicable co-payments
illinois cares rx2
Illinois Cares RX
  • Everyone currently on Senior Care or Circuit Breaker Must submit Extra Help application to Social Security in order to continue coverage
    • *If you are not eligible for Extra Help, you will still be eligible for the state program*
illinois cares rx continued
Illinois Cares RX Continued
  • Everyone currently on Senior Care and Circuit Breaker Pharmaceutical Assistance
    • will be automatically enrolled in Illinois Cares RX
    • You MUST enroll in one of the following Medicare prescription drug plans that coordinates with Illinois Cares Rx:
      • AARP Medicare Rx of United Health Care or
      • PacifiCare Saver Plan
  • Protect Yourself
  • Never give out personal account information or Social Security number to anyone over the phone or internet.
  • Ask for the person’s phone number and call them back. If you can call them back then its legitimate.
  • No door to door solicitations can occur
  • Telemarketers must comply with DO NOT CALL LISTS. (1-888-382-1222)
  • Fraud concern contact Attorney General

(Lisa Madigan’s office) at 1-800-243-0618

payments for medicare plans
Payments for Medicare Plans
  • Payments for plan premiums can be either deducted from Social Security check or paid directly to plan monthly.
ways to enroll
Ways to Enroll…
  • 1-800-MEDICARE (1-800-663-4227)
  • Contact individual plan for an enrollment form
  • Enrollment events in your area
  • Contact local agencies for assistance
phone numbers for help
  • Dupage County Senior Services
    • 630-407-6500
  • Medicare
    • 1-800-Medicare( 1800-633-4227)
  • Senior Health Insurance Program(SHIP)
    • 1-800-548-9034
  • Illinois Department on Aging
    • 1-800-252-8966
  • Social Security Administration
    • 1-800-772-1213