1 / 26

Medicare Part D and The Local Choice Health Benefits Program

Medicare Part D and The Local Choice Health Benefits Program. Prescription Drug Options for January 1, 2006. What’s Happening?. Effective January 1, 2006, Medicare Will Offer a Prescription Drug Benefit (Part D) Sign Up between Nov. 15 th and May 15 th without penalty.

layne
Download Presentation

Medicare Part D and The Local Choice Health Benefits Program

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Medicare Part D and The Local Choice Health Benefits Program Prescription Drug Options for January 1, 2006

  2. What’s Happening? • Effective January 1, 2006, Medicare Will Offer a Prescription Drug Benefit (Part D) • Sign Up between Nov. 15th and May 15th without penalty. • TLC Rx Benefits End 1/1/2006

  3. Surveys Indicate… Most participants: • Are Aware of Medicare Part D • But Have Minimal Knowledge of the Part D Benefit • Do Not Understand the Value of Part D • Are Concerned about the impact of Part D on their Health Plan Coverage

  4. Medicare Part D – The Standard Benefit

  5. Actual Drug Cost

  6. Part D Concerns • Formulary • Non-covered classes of drugs • Deductible • “Donut” hole

  7. The Good News • Potential for Significantly Lower Premium • Option to Elect Medical-Only Coverage under TLC with PDP of your choice • More Flexibility - Choices Based on your individual Needs • Premium Savings will help to pay for possible non-covered drugs

  8. The Bad News • Formulary • Non-covered classes of drugs

  9. Protections – Formulary Restrictions • At least two drugs in each therapeutic category and class • Notification requirements before formulary deletions • Exceptions process • Appeals process

  10. What Drugs Are Excluded?In Medicare D • Drugs for anorexia, weight loss or weight gain • Drugs used to promote fertility • Drugs used for cosmetic purposes • Drugs for symptomatic relief of cough and colds • Prescription vitamins and mineral products • Non-prescription drugs • Barbiturates (Phenobarbital, Seconal – sedatives prescribed for anxiety and insomnia) • Benzodiazepines (Ativan, Valium, Xanax – CNS Depressants))

  11. TLC Had 3 Choices • Do Nothing • Apply for Federal Subsidy • Eliminate Drug Coverage

  12. Pros Maintain Current Benefit Structure—No Formulary Retirees could Drop TLC Drug Coverage and Enroll in a Part D Plan Coverage is Creditable—No Penalty Cons Value of Medicare benefit is lost within the program (?COB) No premium savings Likely premium increase based on trend Adverse selection High co-payments TLC Choice: Do Nothing

  13. Pros Maintain Current Benefit Structure—No Formulary Retirees could Drop TLC Drug Coverage and Enroll in a Part D Plan Coverage is Creditable—No Penalty Cons No Savings to TLC No Savings to Retirees Continued Premium Increases High Co-payments Adverse Selection Administrative Costs Choice: Apply for Federal Subsidy

  14. Pros Standard Part D Benefits is Effective for Many Retirees Part D Average Premium is approximately $32.20/month Medical-only premium is Less than Half of Current Premium Cons Some Retirees (high cost/non-covered) could see Increased Cost Enrollment/Selection of Part D plan by Retirees Choice: Eliminate Drug Coverage

  15. Summary of Choices

  16. Why?(A Review of the “Pros”) • Best Application of Part D Value • Greatest Positive Impact on Premium • Potential for Significantly Lower Co-payments • Choice • Opt-out still Available • Choose Plan that Best Fits Needs

  17. Your TLC Plan Drug Costs Now • $200 per month in premium for 2005/$2,400 per year • Co-payments

  18. 2006 Premiums

  19. The Consensus The Greatest Value of the Medicare Part D Benefit is Realized for TLC Retirees by Eliminating Rx Coverage

  20. Retiree Choices • Keep Current Plan Coverage Without Prescription Drug Coverage (medical only) and Enroll in a Separate Medicare Part D Plan • Drop TLC Coverage and Enroll in another Medicare Supplemental or Medicare Advantage Plan

  21. New TLC Medical Only Plan Choices • NEW! – Medicare Complementary – (grandfathered) • NEW! – Advantage 65 • NEW! – Advantage 65 with Dental/Vision

  22. Tools Medicare Choices • Medicare & You 2006 • www.medicare.gov • 1-800-MEDICARE • 1-(800) 633-4227 • www.eldercare.gov • 1 (800) 677-1116 • Area Offices on Aging • www.vda.virginia.gov • State Health Insurance Assistance Program (SHIP) • (800) 552-3402

  23. What Will I Need? • Names of Drugs Currently Taking • Cost of Drugs (Not Just Co-Pay) • www.thelocalchoice.virginia.gov and click on: • Carrier Contacts • Medcohealth.com • Be sure to add “plan pays” and “you pay” • 41 PDPs and 26 Medicare Advantage Plans available in Virginia

  24. Determine What Matters Most to You • Cost • Coverage • Convenience

  25. Retiree Group To-Do List • Read Materials / Use Tools • Compare Options • Choose Coverage for 2006 • Remember: TLC Rx Coverage Ends 1/1/2006

  26. Questions

More Related