medicare prescription drug coverage
DESCRIPTION
Medicare Prescription Drug Coverage. What’s Different About Prescription Drug Information?. One size does not fit all, more than ever before Distinct messages and desired actions vary by audience More focus on segmenting information into “bite-size” chunks - PowerPoint PPT PresentationTRANSCRIPT
Medicare Prescription
Drug Coverage
Medicare Prescription
Drug Coverage
What’s Different About
Prescription Drug Information?
What’s Different About
Prescription Drug Information?
• One size does not fit all, more than ever before
• Distinct messages and desired actions vary by audience
• More focus on segmenting information into “bite-size” chunks
• Useful materials needed for expanded local outreach efforts
• One size does not fit all, more than ever before
• Distinct messages and desired actions vary by audience
• More focus on segmenting information into “bite-size” chunks
• Useful materials needed for expanded local outreach efforts
Target AudiencesTarget Audiences
• General Population• Employer/Union Population• Limited Income and Resources
(LI/R) Population• Long-term Care Population
• General Population• Employer/Union Population• Limited Income and Resources
(LI/R) Population• Long-term Care Population
General PopulationGeneral Population
• Medicare Fee-For-Service– A&B only– Medigap– Private Fee-For-Service (PFFS)
• Medicare Managed Care– Medicare Advantage Plans (HMO and PPO)
Goal: Engage and Enroll
• Medicare Fee-For-Service– A&B only– Medigap– Private Fee-For-Service (PFFS)
• Medicare Managed Care– Medicare Advantage Plans (HMO and PPO)
Goal: Engage and Enroll
Meet the General PopulationMeet the General PopulationOriginal Medicare 13 million
Medigap A-K 6.35 million
Medigap H-J 1.9 million
Prestandardized plans/state 2.75 million
Medicare Advantage 4.1 million
3.2 million RX coverage
(addl: 800,000 in
employer plans)
Cost Plans 326,000
Private Fee For Service 77,108
Medicare Savings Accounts
*All numbers are estimates*All numbers are estimates
The Total General Population Needs to Know…
The Total General Population Needs to Know…
• Coverage starts Jan 2006
• Enroll in a plan to get coverage
• Enroll now to pay lower premiums
• Waiting to enroll means you can’t enroll until the next enrollment period
• Compare your current coverage with Medicare Prescription Drug Plans or Managed Care Plans with Prescription Drug Coverage
• Coverage starts Jan 2006
• Enroll in a plan to get coverage
• Enroll now to pay lower premiums
• Waiting to enroll means you can’t enroll until the next enrollment period
• Compare your current coverage with Medicare Prescription Drug Plans or Managed Care Plans with Prescription Drug Coverage
The Fee-For-Service and Medigap Population
Needs to Know…
The Fee-For-Service and Medigap Population
Needs to Know…
• You can drop the prescription part of your policy and join a Medicare Prescription Drug Plan (PDP)
• You can enroll in a PDP and still have Medigap (or PFFS) without drug coverage
• Most Medigap coverage is not at least as good as Medicare Prescription Drug Coverage (not creditable)
• You can drop the prescription part of your policy and join a Medicare Prescription Drug Plan (PDP)
• You can enroll in a PDP and still have Medigap (or PFFS) without drug coverage
• Most Medigap coverage is not at least as good as Medicare Prescription Drug Coverage (not creditable)
The Managed Care Population Needs
to Know…
The Managed Care Population Needs
to Know…
• If you currently have drug coverage, you can stay in your plan and have Medicare Prescription Drug Coverage
• If you do not have drug coverage, you can stay in your plan and add Medicare Prescription Drug Coverage
• If you currently have drug coverage, you can stay in your plan and have Medicare Prescription Drug Coverage
• If you do not have drug coverage, you can stay in your plan and add Medicare Prescription Drug Coverage
Key DatesKey Dates• RX Card Enrollee Letter (September*)• CMS Selects Plans (9/15/05)• Medigap Plans Send Creditable Coverage Notice
(9/15/05-11/15/05)• Media Ads (~Fall, 2005)• Drug Plans Begin Marketing (10/1/05)• Plan information on www.medicare.gov (10/13/05)• Medicare & You Premailing (TBD)• Medicare & You Handbook (10/15/05)• Medicare Advantage Annual Notice of Change
(10/31/05)• Media Ads (~Spring, 2006)
• RX Card Enrollee Letter (September*)• CMS Selects Plans (9/15/05)• Medigap Plans Send Creditable Coverage Notice
(9/15/05-11/15/05)• Media Ads (~Fall, 2005)• Drug Plans Begin Marketing (10/1/05)• Plan information on www.medicare.gov (10/13/05)• Medicare & You Premailing (TBD)• Medicare & You Handbook (10/15/05)• Medicare Advantage Annual Notice of Change
(10/31/05)• Media Ads (~Spring, 2006)
Meet the E/U Population
Meet the E/U Population11.4 million people
(33% of the Medicare 65+ population)11.4 million people
(33% of the Medicare 65+ population)
This group:• Already has coverage and must make a
decision• Can be reached through their employers or
unions• Should be encouraged to check with their
benefits administrator
This group:• Already has coverage and must make a
decision• Can be reached through their employers or
unions• Should be encouraged to check with their
benefits administrator
Meet the E/U Population
Meet the E/U Population
Includes:
• People covered by full Employer Subsidy
• People covered by plans that will supplement Medicare Prescription Drug Coverage
• SPAP members
• Crossover group who are eligible for both Employer Subsidy and extra help
• Crossover group who get coverage from an employer that works with an MA plan
• Active employees and spouses of active employees
Includes:
• People covered by full Employer Subsidy
• People covered by plans that will supplement Medicare Prescription Drug Coverage
• SPAP members
• Crossover group who are eligible for both Employer Subsidy and extra help
• Crossover group who get coverage from an employer that works with an MA plan
• Active employees and spouses of active employees
Meet the E/U Population
Meet the E/U Population
Employment-based retiree drug coverage
11.4 million
Coverage by a plan eligible for the Medicare retiree drug subsidy
9.8 million
Enrolling in a Medicare prescription drug plan and receiving additional coverage through employer or union
400,000
Enrolling in a Medicare prescription drug plan and receiving additional financial help through employer or union
1.3 million
• Contact your benefits administrator to see if your coverage is as good as Medicare Prescription Drug Coverage (creditable)
• What you do next depends on that answer• You may be able to keep your current
coverage• If you don’t enroll; you may pay higher
premiums later• If you do enroll, you can’t get coverage
back• If you want to stay in an MA plan, you must
get drug coverage through that plan.
• Contact your benefits administrator to see if your coverage is as good as Medicare Prescription Drug Coverage (creditable)
• What you do next depends on that answer• You may be able to keep your current
coverage• If you don’t enroll; you may pay higher
premiums later• If you do enroll, you can’t get coverage
back• If you want to stay in an MA plan, you must
get drug coverage through that plan.
The E/U Population Needs to Know
The E/U Population Needs to Know
If Coverage Is as Good … They Need to Know
If Coverage Is as Good … They Need to Know
• You can keep current coverage and not worry about paying higher premiums for Medicare Prescription Drug Coverage in the future
• You can choose to enroll in Medicare Prescription Drug Coverage– But, it is possible you won’t be able to
get back into your employer/union coverage
• You can keep current coverage and not worry about paying higher premiums for Medicare Prescription Drug Coverage in the future
• You can choose to enroll in Medicare Prescription Drug Coverage– But, it is possible you won’t be able to
get back into your employer/union coverage
If Coverage is NOT as Good … They Need to Know
If Coverage is NOT as Good … They Need to Know
• You can enroll in Medicare Prescription Drug Coverage
• Same messages as for General Population
• You can enroll in Medicare Prescription Drug Coverage
• Same messages as for General Population
Key DatesKey Dates
• Creditable Coverage “Notice” from Employer/Unions (Now - 11/15/05)
• Fact sheets available on www.medicare.gov (April 2005)
• Creditable Coverage “Notice” from Employer/Unions (Now - 11/15/05)
• Fact sheets available on www.medicare.gov (April 2005)
Full-benefit dual eligibles, MSP, SSIIncome <150% FPL
Goal: Engage, Encourage Application, Enroll
Full-benefit dual eligibles, MSP, SSIIncome <150% FPL
Goal: Engage, Encourage Application, Enroll
Limited Income and Resources (LI/R) Population
Limited Income and Resources (LI/R) Population
Two GroupsTwo Groups
• Those who automatically qualify for extra help:– Full-Duals with Drug Coverage, MSP,
SSI– Goal: Engage, Enroll
• Those who must apply to receive extra help:– <150% Federal Poverty Level– Goal: Engage, Encourage
Application, Enroll
• Those who automatically qualify for extra help:– Full-Duals with Drug Coverage, MSP,
SSI– Goal: Engage, Enroll
• Those who must apply to receive extra help:– <150% Federal Poverty Level– Goal: Engage, Encourage
Application, Enroll
Meet the LI/R PopulationMeet the LI/R Population
Eligible for assistance 14.4 million
Enroll for Assistance 10.9 million
Full-benefit dual eligibles 6.3 million
Medicare Savings Programs with income below 135% of FPL
3 million
Income under 150% of FPL 1.6 million
*All numbers are estimates
• Your Medicaid coverage ends 1/1/06
• Your coverage will come from a Medicare Prescription Drug Plan starting 1/1/06
• You’ve been assigned to X plan• You can switch plans to meet
your needs
• Your Medicaid coverage ends 1/1/06
• Your coverage will come from a Medicare Prescription Drug Plan starting 1/1/06
• You’ve been assigned to X plan• You can switch plans to meet
your needs
Those Who Automatically Qualify Need to
Know…
Those Who Automatically Qualify Need to
Know…
Those Who Must Apply Need to Know…
Those Who Must Apply Need to Know…
• Benefits of applying for extra help• Apply for extra help (including how
to apply) • You must enroll in a plan to receive
coverage• If you don’t enroll, you’ll be assigned to
a plan in spring 2006• How their SPAP (if they have one)
works with Medicare Prescription Drug Coverage
• Benefits of applying for extra help• Apply for extra help (including how
to apply) • You must enroll in a plan to receive
coverage• If you don’t enroll, you’ll be assigned to
a plan in spring 2006• How their SPAP (if they have one)
works with Medicare Prescription Drug Coverage
Key DatesKey Dates
• Web tool www.medicare.gov (4/21/05)• CMS notice to those who automatically
qualify (full-benefit dual eligibles, MSP, except in FL, IL, MD,
SC, VT, WI) (mid-May)• SSA application to potential eligibles
(5/27/05-8/16/05)• CMS notice to SSI-only and other deemed in FL, IL,
MD, SC, VT, WI (mid-June)
• Web tool www.medicare.gov (4/21/05)• CMS notice to those who automatically
qualify (full-benefit dual eligibles, MSP, except in FL, IL, MD,
SC, VT, WI) (mid-May)• SSA application to potential eligibles
(5/27/05-8/16/05)• CMS notice to SSI-only and other deemed in FL, IL,
MD, SC, VT, WI (mid-June)
Key DatesKey Dates
• SSA application for extra help available online (7/1/05)
• SSA begins processing applications (7/1/05)
• CMS mails plan assignment notice to full-benefit dual eligibles
(fall 2005; effective 1/1/06)
• SSA application for extra help available online (7/1/05)
• SSA begins processing applications (7/1/05)
• CMS mails plan assignment notice to full-benefit dual eligibles
(fall 2005; effective 1/1/06)
Key DatesKey Dates
• Medicaid drug coverage ends;
Medicare drug coverage begins (1/1/06)
• CMS mails plan assignment notice (spring 2006; effective 6/1/06)
• SSA online help available now!
http://www.ssa.gov/organizations/medicareoutreach2/
• Medicaid drug coverage ends;
Medicare drug coverage begins (1/1/06)
• CMS mails plan assignment notice (spring 2006; effective 6/1/06)
• SSA online help available now!
http://www.ssa.gov/organizations/medicareoutreach2/
Meet the LTC Population
Meet the LTC Population
1.3 million people
(4% of the Medicare 65+ population)
Short-term LTC residents• from hospital or home to a LTC facility• from a skilled nursing facility (Part A) stay to Medicaid • or private stay from LTC facility to assisted living or home• transition from hospice to Part A care
*continuity of care is a concern
Long-term LTC residents • full dual eligibles or deemed (inc. MSP, SSI/Medicaid)
1.3 million people
(4% of the Medicare 65+ population)
Short-term LTC residents• from hospital or home to a LTC facility• from a skilled nursing facility (Part A) stay to Medicaid • or private stay from LTC facility to assisted living or home• transition from hospice to Part A care
*continuity of care is a concern
Long-term LTC residents • full dual eligibles or deemed (inc. MSP, SSI/Medicaid)
*All numbers are estimates
The LTC Population Needs to Know…
The LTC Population Needs to Know…
Key Beneficiary Messages
Because LTC populations encompass other populations (i.e., limited income, retirees with employer plan benefits, etc.), messages are derived from general/specific population messages and targeted as appropriate.
*Outreach Methods Are The Difference
Key Beneficiary Messages
Because LTC populations encompass other populations (i.e., limited income, retirees with employer plan benefits, etc.), messages are derived from general/specific population messages and targeted as appropriate.
*Outreach Methods Are The Difference
Key DatesKey Dates
• Release of Long-term Care and Transition Process Guidance (3/16/05)
• Nursing Home Resident Fact Sheet available at www.medicare.gov (May 2005)
• Release of Long-term Care and Transition Process Guidance (3/16/05)
• Nursing Home Resident Fact Sheet available at www.medicare.gov (May 2005)
Message Discipline: Never deviate from tested, uniform
message
Messaging
Overall Messages• Drug coverage that helps you pay for the
prescriptions you need.
• Medicare prescription drug coverage is available to all People with Medicare.
• There is additional help for those who need it most.
• The Medicare prescription drug coverage pays for brand name as well as generic drugs.
Messaging
Choice
You can choose between at least two Medicare prescription drug plans and pick a plan that meets your needs.
Current Terminology
For Low-Income Subsidy– Extra help with drug plan costs– Limited income and resources – Apply
To get Medicare Prescription Drug Coverage– Join, enroll, sign up
Current Terminology
Miscellaneous• List of drugs the plan covers • At least 1% more for every month you waited
to get a Medicare prescription drug plan, or you will pay more, or higher premium
• People with Medicare [and Medicaid] • Personalized [Counseling]• $3600 out-of-pocket • Long-term care facility, like a nursing home • Complaint
Terminology
Consistency: Please Help Us!
Visit often for the most recent preferred terms www.cms.hhs.gov/partnerships/tools/materials/preferredterms.pdf
Remember
• This isn’t like traditional Medicare where they will get a Medicare card in the mail
• To get the new drug benefit, people with Medicare must enroll
• To get the best deal, they should enroll on time
• To enroll, they’ll need to choose a plan