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October 2005

October 2005. Part D: Medicare Prescription Drug Coverage. Effective: January 1, 2006 Called “Medicare Prescription Drug Plans’ Eligibility for Part D Must be entitled to Part A or enrolled in Part B ( Have Medicare Card) Voluntary. Joining a Plan.

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October 2005

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  1. October 2005

  2. Part D: Medicare Prescription Drug Coverage • Effective: January 1, 2006 • Called “Medicare Prescription Drug Plans’ • Eligibility for Part D • Must be entitled to Part A or enrolled in Part B (Have Medicare Card) • Voluntary

  3. Joining a Plan • Medicare beneficiaries who want Medicare prescription drug coverage must choose a plan • Many people with limited incomes and resources will get extra help • Join November 15 – December 31, 2005 • Coverage begins January 1, 2006 • Join January 1 – May 15, 2006 • Coverage begins the month after you join • Join when first eligible, to pay lowest monthly premium • About $32/month in 2006 • Coverage and costs vary

  4. How the Plans Work • Must offer basic drug benefit • Standard benefit • May offer supplemental benefits • Enhanced benefit • Can be flexible in benefit design • May begin marketing in October 2005 • Must follow marketing guidelines

  5. Successful Transitions to Medicare Prescription Drug Coverage How will CMS ensure the Medicare prescription drug coverage will be appropriate for Medicare beneficiaries, particularly for vulnerable populations like the dual eligibles?

  6. Providing Extra Help:Low-income Subsidy • Those with lowest incomes pay no premiums or deductibles; small or no copayments • Those with slightly higher incomes pay a little more • Some people will automatically qualify • Full benefit dual eligible; • SSI recipient; or • Medicare Savings Program • Others may have received an application from Social Security • Medicare beneficiaries with income below 150% FPL who meet an asset test

  7. Ensuring Continuity of Coverage: Auto-Enrollment • Medicaid prescription drug coverage for full-benefit dual eligibles ends 12/31/005 • Full-benefit dual eligibles will be automatically enrolled in a prescription drug plan effective January 1, 2006 if they do not select a plan • Notices will be sent informing duals of plan they will be autoenrolled in late-October • Full-benefit dual eligibles have a SEP so that they change plans any time

  8. Auto-enrollment – Timing of Events During October • CMS one-time notification to PDPs • CMS one-time notification to State Medicaid Agencies of those auto-enrolled into PDPs Late October • CMS mails notices to beneficiaries auto-enrolled into PDPs • Start monthly auto-enrollments November – December • State Medicaid Agencies send Notice of Action to full duals (that Medicaid coverage is ending for prescription drugs) December 31 • Last chance to change before auto-enrollment takes effect

  9. Establishing Appropriate Safeguards • Drug Plan Qualifications • Access • Choice • Brand Name and Generic • Pharmacies • Affordable cost

  10. PDP Organizations WA ME MT ND 16 VT 20 NH MN OR NY MA 18 WI 20 17 SD ID MI CT 17 RI 17 WY NJ 18 PA 17 IA OH 19 NE DE 17 18 IN NV IL MD 16 UT WV 17 DC VA 16 16 CO KS MO 17 KY CA 15 15 NC 18 16 TN 16 OK SC 16 18 AR AZ NM 15 18 17 AL GA MS 18 15 TX LA 16 20 AK FL 11 18 HI 20

  11. PDP Organizations per Region

  12. LIS PDP Organizations per Region

  13. Regions and Plan Premiums

  14. National Prescription Drug PlanOrganizations Aetna Life Insurance Company Connecticut General Life Insurance Company Coventry Health and Life Insurance Company Medco Containment Life Insurance Company Memberhealth, Inc. Pacificare Life and Health Insurance Company Silverscript Insurance Company Unicare United Health Care Insurance Company Wellcare Health Plans

  15. “Medicare Covers America”Campaign Strategy • Multi-level approach • National • Regional • State/local • SPAPs Multi-channel approach • Media • Direct mail • Grassroots outreach • Partnerships

  16. Resources • Medicare Rx trifold brochure • Medicare Rx informational flyer • Getting Started brochure • Parade Magazine’s insert – Sunday, September 25 • Medicare & You Handbook • Mailed in early October • Web tools

  17. Web Tools • Prescription Drug Plan Finder • Formulary Finder • Landscape of Local Plans • All available at www.medicare.gov or www.cms.hhs.gov

  18. Preparing StatesOutreach and Education • Workgroups • State Issues Workgroup • State Pharmacy Assistance Program (SPAP) Workgroup • Bi-Monthly All-state calls • Special all-state calls • Like the state mental health facility call on 9/16 • MMA_States listserve • Meetings and workshops • Regional • National Conference April 2005

  19. Challenges for States • Preparing for low-income subsidy eligibility determinations • Identifying full benefit dual eligible individuals • Helping CMS educate Medicaid recipients about upcoming changes • Making changes on such a short timeline

  20. Looking Forward • Challenge: Care coordination and continuity of care now that drugs are not included in Medicaid • SNPs look to be a valuable way to coordinate care as we look forward

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