Medicare Prescription Drug InsuranceMedicare 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 • 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 • Part A-Hospitals • Part B-Physicians and equipment • Part C-Medicare Advantage plans • Part D (NEW)-Prescription Drug Assistance
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 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 • 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 • 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 • $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 • 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 • 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 • Qualify for Extra Help • If resources are • Less than $11,500 (single) • Less than $23,000 (married) AND • Limited income • Less than $14,355(single) • Less than $19,245(married)
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 • 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 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 • 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) • 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 • Current cards are valid until enrolled in Medicare Part D or May 15, 2006.
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 • 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 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 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 • 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
SCAMS… • 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 plan premiums can be either deducted from Social Security check or paid directly to plan monthly.
Ways to Enroll… • www.medicare.gov • 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) • www.medicare.gov • Senior Health Insurance Program(SHIP) • 1-800-548-9034 • www.idfpr.com • Illinois Department on Aging • 1-800-252-8966 • www.state.il.us/aging/ • Social Security Administration • 1-800-772-1213