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Medicare Drug Benefit: Part D in Minnesota

Minnesota Road ShowsMay and June 2005

Posted 6-14-05

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Overview

• Summary of the 2003 Medicare Prescription Drug and Modernization Act (MMA)

• Extra Help (LIS)• Policy impacts in Minnesota• Roles

MMA: Overview

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MMA

• Most dramatic changes to Medicare since its original passage in 1965

• 415 pages!• Comprised of 12 Titles• Signed into law December 8, 2003

MMA: Overview

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MMA• Created

• New Medicare Advantage options• New Medigap plans K & L

• Established• Medicare Prescription Drug Discount

Card• Transitional Assistance Program

• Established the Voluntary Prescription Drug Benefit Program (Medicare Part D)

MMA: Overview

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MMA• Established subsidy for employers and

unions that maintain retiree prescription drug coverage (28%)

• Sets a new moratorium on implementation of the therapy caps through 2005

• Increased Medicare Part B deductible annually ($110 in 2005)

• Applies higher Medicare Part B premiums to people above income thresholds as of 1/1/07

MMA: Overview

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New Part B Preventive Care

• Cardiovascular Screening Blood Tests

• Diabetes Screening Tests

• “Welcome to Medicare” physical

MMA: Overview

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Medicare Drug Discount Cards

• Offers discounts on prescription drugs• Interim relief• “Transitional Assistance” or “the credit”• $600/yr (prorated beginning 4/1/05)• Available to low-income Medicare

beneficiaries (135% of FPL or less)• It’s not too late to sign up!

MMA: Overview

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Medicare Advantage

• New ways to integrate and package Part A and B • May include new Part D drug benefit

• Replaces Medicare+Choice and offers more health coverage choices

MMA: Medicare Advantage

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Medicare Advantage Options

• Managed Care Plans• Preferred Provider Organization

(PPO)• Private Fee-for-Service Plans• Special Needs Plans (new)• Medical Savings Accounts

MMA: Medicare Advantage

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Current Minnesota Medicare Advantage Plans

• Medicare managed care health plans• HealthPartners• UCare

• Medicare Private Fee For Service plans• Humana• Sterling• Unicare

MMA: Medicare Advantage

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Future Minnesota Medicare Advantage Plan

Possibilities

• Local Medicare Advantage plan (MA-PD) – Part A, B and D

• Specialized MA plans for Special Needs Beneficiaries (MSHO, MnDHO)

• Medicare Advantage PFFS with Part D• Regional MA-PD – PPO like (Part A, B,

and D)

MMA: Medicare Advantage

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Other Options (not Medicare Advantage) for Part D Coverage

• Private Prescription Drug Plans (Part D only)

• Medicare Cost Plan (Part A, B and maybe D)

MMA: Medicare Advantage

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Medicare Prescription Drug Benefit: Part D

January 1, 2006A New Year,

A New Medicare Benefit!

MMA: Part D

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Medicare Prescription Drug Benefit

• Insurance coverage for prescription drugs• Helps lower the out-of-pocket cost of drugs• Voluntary benefit• Medicare Part D drug coverage supplants

Medicaid drug coverage for people with both benefits

• Beneficiaries must take action by choosing a plan (with some exceptions)

• Initial enrollment period• November 15, 2005 through May 15, 2006

MMA: Part D

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Medicare Prescription Drug Benefit

• Coverage is provided by a Medicare approved:• Prescription Drug Plan (PDP)• Medicare Advantage plan with

prescription drug coverage (MA-PD)• Can also be provided by a Medicare Cost

Plan • Plans may offer more than one option;

alternative plans must be of at least equal value to the Part D standard benefit

MMA: Part D

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Medicare: Prescription Drug Benefit

• There must be at least 2 prescription drug plans available in every region

• One of these plans may be a MA-PD (regional Preferred Provider Organization)

MMA: Part D

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ME

VT

NHMA

RICT

NY

PA NJ

DEMDDCVA

NC

SC

GA

FL

ALMS

LATX

NM

AZOK

AR

TN

KY

OH

WV

MI

INIL

WI

MO

KSCOUT

NV

CA

ID

WA

OR

AK

HI

Note: A Medicare Advantage (MA) region is one color. A difference in shading indicates that there are multiple Prescription Drug Plan (PDP) regions nested within the MA region No change indicates that the MA and PDP regions are the same. For example, Wisconsin and Illinois are in one MA region; they are each a separate PDP region. Each territory is its own PDP region.

MN

IANE

SD

NDMT

WY

MMA: Part D

Our Region

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Our Region (MA 19 and PDP 25)

• 1.9 million Medicare beneficiaries• 559,000 beneficiaries below 135% of

FPG• 157,000 beneficiaries below 150% of

FPG• 242,000 dual eligible beneficiaries• 12% variation in drug spending across

states within the region (nationally there is a 43% difference)

MMA: Part D

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Medicare Prescription Drug Benefit

• Beneficiaries who do not take action to choose a plan during their enrollment period

AND • Do not have other pharmacy

coverage that is equal in value to the standard Part D benefit risk having to pay a higher drug plan premium

MMA: Part D

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Creditable Coverage• It is other pharmacy coverage that is at least equal

in value to the standard Part D benefit is called creditable coverage

• Can be in employer or union retiree plans, Veterans benefits, Federal Employees Health Benefit Plan, TriCare.

• Plans must tell their enrollees if the coverage is creditable.

• If the coverage is creditable, then the beneficiary who keeps this coverage and does not enroll in Part D will not pay a higher premium as a result of delaying enrollment in Part D.

• If the coverage is not creditable, the beneficiary who decides to delay enrollment in Part D, may pay a higher premium.

MMA: Part D

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Formulary• List of drugs that will be covered by

the plan• Formularies will vary from plan to plan• Required to provide a minimum of 2

drugs from every therapeutic class• There are some excluded classes of

drugs • Appeal rights

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Medicare Part D Standard Benefit

• An approved plan offers negotiated discount prices based on a formulary with cost sharing

• Cost-sharing for standard benefit in 2006:• Premium of $37 per month/$444 per year• Annual deductible of $250• Coinsurance of

• 25% on first $1999 of drug costs• 100% on next $2,850 in annual drug costs• 5% or co-pays when drug costs reach $5,101

annually

MMA: Part D

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5%95% Catastrophic Benefit

100%

75%25%

$250 Deductible

Premiums - est. $37/mo.

$2,251 - $5,100

$251 - $2,250

$0 - $250

Over $5,100

Drug Costs

Beneficiary CostsPart D Plan

Part D Standard BenefitNo Subsidy

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Standard Benefit – True out of pocket costs (TROOP)

• $250 annual deductible• $500 (25% of drug costs $251-$2250)

• Plan pays $1500• $2,850 (100% of drug costs $2251-$5100)

• Plan pays $0

• Reach $3,600 annual TROOP, catastrophic coverage begins• Plan pays 95%• Beneficiary pays 5%

MMA: LIS

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Extra Financial Help• Low-Income Subsidy (LIS)• Provides help with Medicare Part D out-of-

pocket costs• Subsidy may be full or partial, depending on

income, resources and family size• Some will automatically get the full subsidy:

• Medicare and full Medicaid benefits (Full Benefit Duals)• Medicare and are enrolled in a Medicare Savings

program (QMB,SLMB,QI)• Medicare and supplemental security income (SSI)

MMA: LIS

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Extra Help: Partial Subsidy• Beneficiaries (Non-Medicaid and Non-SSI) with

income between 135% and 150% FPL

• Assets no more than $10,000 individual, $20,000 couple

• Cost-sharing• Premium on sliding fee scale• $50 deductible• 15% coinsurance on drug costs up to $5,100• $2/$5 copays on drug costs above $5,100 (catastrophic

level)

MMA: LIS

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Catastrophic BenefitCo-Pays $2/$5

15% 85%

$50 Deductible

Sliding Scale Premiums

$51- $5,100

$0 -$50

Over $5,100

Drug Costs

Beneficiary Costs

Part D Plan

Part D Partial Subsidy•Lower Premiums•Lower Deductible•Lower Coinsurance•No Doughnut Hole

will vary

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Extra help: Full Subsidy• Beneficiaries with income below 135% FPL• Assets not greater than $6,000 single/$9,000 couple• Cost-sharing

• No premiums• No deductible or coinsurance• No drug costs in doughnut hole except co-

payments• $1/$3 for income at or below 100% FPL• $2/$5 for income above 100% FPL

• Help with Medicare Prescription Drug Plan Costs• Does not enroll a beneficiary in a Medicare Drug

Plan

MMA: LIS

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Full benefit duals, Medicare Savings program enrollees and SSI recipients

• Automatic full subsidy• No need to complete an application• Cost-sharing

• No premiums• No deductible• Co-payments

• $1/3 for income at or below 100% FPL• $2/$5 for income above 100% FPL

• No co-payments above $5,100• No co-payments for full benefit duals in nursing

homes or ICF/MR

MMA: LIS

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Catastrophic Benefit100% PlanNo copays

Co-Pays

Co-Pays

$1/$3 <100% FPL

$2/$5 >100% FPLNo premiums

No deductibles

$0 - $5,100

Over $5,100

Beneficiary Costs

Part D Plan

Part D Full SubsidyNo PremiumsNo DeductibleNo CoinsuranceNo Doughnut Hole

Drug Costs

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Low-Income Subsidy Groups in MN – No application needed

• Automatically eligible full subsidy

• SSI beneficiaries

• Medicare Savings group enrollees• Qualified Medicare Beneficiaries (QMB) • Service Limited Medicare Beneficiaries (SLMB)• Qualified Individuals 1 (QI-1)• QMB or SLMB on the MN Prescription Drug Program

• Medicaid full benefit duals including• Elderly• Disabled• Employed disabled (MA-EPD)• Elderly waiver enrollees• Parents/caretakers• Enrollees with a spenddown

MMA: LIS

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Sliding Scale Premium Assistance

FPL & Assets % of Premium Subsidy Amount

Income at or below 135% FPL, and with assets that do not exceed $10,000 (individuals) or $20,000 (couples)

100% ($37)

Income above 135% FPL but at or below 140% FPL, and with assets that do not exceed $10,000

(individuals) or $20,000 (couples)

75% ($27.75)

Income above 140% FPL but at or below 145% FPL, and with assets that do not exceed $10,000

(individuals) or $20,000 (couples)

50% ($18.50)

Income above 145% FPL but below 150% FPL, and with assets that do not exceed $10,000 (individuals)

or $20,000 (couples)

25%($9.25)

*Numbers are for 2006

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Current Monthly Federal Poverty Level (FPL) Amounts

100 % FPL

120% FPL

135% FPL

150% FPL

200% FPL

$ 798 $958 $1077 $1197 $1596

QMB SLMB QI-1 Extra Help/LIS

•Based on a household size of 1

•FPL amounts change each July

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Why Connect to MSP?

Medicare Part B monthly premium in 2006 will be $89.20 (currently $78.20)

Medicare Part B annual deductible in 2006 will be $125.40 (currently $110)

All MSPs will be eligible for Part D LIS/extra help (up to 135% of FPL)

Not all LIS will be eligible for MSP, but many will be (LIS up to 150% of FPL)

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Why Connect to MSP?

MSP helps pay for cost-sharing/premiums for Part B

Part B includes physician services and some outpatient drugs not covered by Part D

Prescription drug coverage under Part D will require a physician order (Part B)

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MMA: Enrollment Timeline

Enrollment Period for Part D Plans

Application Period for Low-Income Subsidy(Deemed - Automatically eligible)

Nov 152005

July 12005

Start of ProgramJan 12006

May 152006

Full benefit dual eligibles lose coverage under Medicaid for drugs that could be covered under Part D

MMA: Part D

July 12005

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The Timeline (subject to change)• April – November 15, 2005: Employers and

unions notify retirees about creditable coverage• May 27-August 15, 2005: SSA mailing to potential

low income subsidy beneficiaries begins• May 16, 2005: CMS mailing to “deemed” eligibles

begins• July 1, 2005: SSA begins processing low income

subsidy applications and notifying beneficiaries about eligibility

• September 1, 2005: CMS mails out Medicare and You handbooks to all beneficiaries

• September 2005: Part D plans announced• September 1-November 15: Medigap companies

issue creditable coverage notices

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The Timeline (subject to change)• October 1, 2005: Marketing of Part D plans begin• October 1, 2005: CMS begins mailing “you’ve been

enrolled” notices to deemed beneficiaries• October 13, 2005: CMS launches online enrollment center

for drug coverage• November 15,2005 - May 15, 2006: Initial Enrollment

period for Part D• December 31, 2005: Medicaid drug coverage for dual

eligibles ends• January 1, 2006: Medicare Part D coverage begins• April 1, 2006: CMS enrollment reminder mailing “Last

chance to enroll without penalty”• May, 2006: Facilitated enrollment for MSP begins

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The Timeline (subject to change)

• October, 2005: CMS begins ongoing routine mailings of “deemed” status to new MSP enrollees

• November 1, 2005: CMS begins ongoing routine monthly auto-enrollment for new full dual eligibles

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Decisions will depend on status• Find out if someone is:

Dual eligible? Medical Assistance–Employed Persons with

Disabilities (MA-EPD) enrollees? MSHO/MnDHO enrollee? State Pharmacy Assistance Program (SPAP)

enrollee? HIV/AIDS beneficiary with Medigap coverage? Retiree with Rx coverage? Medicare Supp. policyholder with Rx Coverage? Medicare Cost Plan enrollee? Medicare Advantage Private Fee for Service

enrollee? Local Medicare Advantage enrollee? No Rx coverage at all?

MMA: Part D

Medicare Part D Subsidy

Overview

Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003

• Drug Discount Card– 5/3/04—12/31/05

• Part D Program– Effective 1/1/06– Voluntary

• Part D Subsidy– Help for beneficiaries with low income

and limited resources on premium, deductible, and co-payments

What is the subsidy?

•Extra help to pay for Medicare Prescription Drug Benefit

•Premiums•Deductibles•Co-payments

Who is eligible for the subsidy?

•Medicare beneficiaries with income and resources below 150% of Federal Poverty Level

Deemed Population• People who are automatically

eligible for the subsidy

– Medicare and Medicaid

– Medicare Savings Programs (QMB, SLMB, QI)

– SSI and Medicare

• Do not have to complete an application

• States work with CMS to process subsidy for deemed population

Not Deemed Population

•Medicare beneficiaries who have limited resources and low income

•DO NOT have SSI; or Medicaid; or a Medicare Savings Program

•Must apply for a subsidy

Subsidy Application Process

•Scannable application

• Internet application July 1

•Phone with SSA

•At SSA office

•Offsite with SSA or other organization

SSA’s Mailing• Begins May 27, ends mid-August

• Includes:

– Cover letter

– Scannable application

– Pre-addressed, postage paid return envelope

• By terminal digits

• 360,000 packages in Minnesota

Application Tips

•Do NOT photocopy application!

•Use #2 pencil or black ink.

•Keep numbers, letters, and Xs inside boxes.

•Fold only once, horizontally.

Submitting the Application

• File early!• Do not send proofs.• Mail: Social Security

AdministrationWilkes-Barre Data Operations Center

P.O. Box 1020Wilkes-Barre, PA 18767-1020

• Internet beginning July 1, 2005• Will receive a receipt

Scannable Applications

• SSA will provide to SHIP through

local office

• Request in advance

• Do not download from Internet!

• Internet application July 1

For More Information

Social Security Administration:– www.socialsecurity.gov

– 1-800-772-1213

Center for Medicare and Medicaid Services:

– www.medicare.gov– 1-800-633-4227

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Policy Impacts in Minnesota

MMA: Policy Impacts

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MMA: Minnesota’s Medicare Population

677,000 Medicare beneficiaries in MNOf those:

• 50% have no drug coverage• 120,000 have income below 135% of

federal poverty level (FPL)• 93,000 are eligible for both Medical

Assistance and Medicare (dual eligibles)• 7,700 are enrolled in the state’s PDP

program

MMA: Policy Impacts

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Minnesota Medical Assistance

Coverage• Starting 1/1/06 Medical Assistance will not cover Part D drugs

for full benefit duals• Some exceptions: Medical Assistance will continue to cover

over the counter, benzodiazapines, barbituates and a few others

Cost-sharing• All full benefit duals and MSP will be deemed eligible for LIS• Duals will pay copays for drugs• Medicare Drug Benefit does not have a monthly cap on copays • No copays for full benefit duals in a medical institution, nursing

facility or ICF/MR

MMA: Policy Impacts

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Minnesota Medical Assistance

• Automatic enrollmentFull benefit dual eligibles, NOT including MSP enrollees will be randomly enrolled in a Part D plan before January 1, 2006 if they do not select a plan

• To PDP (if in FFS Medicare) • To an MA-PD (if in Medicare

Advantage plan) • Ability to opt-out of the plan• Can choose another plan at any

time

MMA: Policy Impacts

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Minnesota Medicare Saving Programs and MN PDP

• Automatically eligible for LIS• No need to complete SSA

application • Need to select a plan before 1/1/06

to continue drug coverage• Goal: plan selection by 12/31/05• If no plan selection is made –

• Facilitated enrollment in a Plan will be done in May, 2006

MMA: Policy Impacts

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MSHO and MnDHO• MSHO & MnDHO managed care plans will

qualify as Medicare Advantage Special Needs Plans

• MSHO & MnDHO enrollees • will receive coordinated prescription

drug benefits from one plan• do not need to do anything before

1/1/06 because they automatically have coverage for the Medicare Prescription Drug Benefit through their MSHO/MnDHO plan.

MMA: Policy Impacts

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Tribal Health Care• Tribes in Minnesota with their own

pharmacies will no longer receive a payment from Medical Assistance for prescription drugs provided to their dual eligible members.

• MMA requires Medicare Part D plans to include tribal pharmacies in their network by offering them contracts.

MMA: Policy Impacts

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MA-EPD

• All MA-EPD enrollees will be deemed eligible for LIS, regardless of income

• MA-EPD enrollees must pay their MA-EPD premium but will not have to pay the Part D premium

• MA-EPD enrollees will have a $1-$5 copay, depending on income

MMA: Policy Impacts

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Minnesota’s Prescription Drug Program (PDP)

• All enrollees qualify for Medicare Drug Benefit

• All enrollees will be deemed eligible for LIS

• All enrollees will need to choose a plan before the end of the year to continue their drug assistance after 1/1/06

• Facilitated plan enrollment begins May, 2006

• Proposed: PDP ends on 12/31/05

MMA: Policy Impacts

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Health Plans in Minnesota

• Medicaid Managed Care Plans will no longer cover drugs for duals

• MSHO & MnDHO managed care plans may qualify as Medicare Advantage Special Needs Plans and continue to offer coordinated pharmacy benefits

• Plans may offer new Medicare Advantage Plans as of 1/1/06

MMA: Policy Impacts

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Medicare Products in Minnesota

• Medicare Cost Plans and Medicare Advantage Private Fee For Service Plans may provide Part D, but it is not required.

• Medicare Cost Plan Contracts extended to 12/31/07• In MN, BCBS of MN (formerly First

Plan), HealthPartners and Medica offer Cost plans

MMA: Policy Impacts

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Medicare Products in Minnesota

• MMA prohibits the sale of new Medicare supplemental policies with drug coverage on or after 1/1/06• In MN, applies to Extended Basic Medsupp

and Medicare Select plans• Plans must issue creditable coverage notices• Beneficiaries enrolled in a Medsupp with

drug coverage before 1/1/06, may keep coverage

MMA: Policy Impacts

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Policy Impacts: Key Points

• Medical Assistance (Medicaid) will no longer cover drugs for dual eligibles (MA and Medicare) that are included in the Part D benefit

• Medicare product options will change for next year

MMA: Policy Impacts

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Roles and Minnesota Partners

MMA: Roles and Partners

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Centers for Medicare & Medicaid Services (CMS) Responsibilities• Medicare Policy• Beneficiary Assistance• Marketing and Education• Benefit and Low Income Subsidy deeming

policy for duals and Medicare Savings Program enrollees

• Employer retiree policies and standards for creditable coverage

• Contract Standards for PDP and Medicare Advantage plans

MMA: Roles and Partners

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CMS Tools

• Letters to Beneficiaries• Outreach & education materials• Regulations• Contract Approvals• 1-800-MEDICARE and www.Medicare.gov• Regional Office participation• SHIPs• State Medicaid Agencies

MMA: Roles and Partners

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Social Security Administration (SSA) Responsibilities

• Low Income Subsidy (LIS) application development

• LIS training• LIS application assistance • LIS eligibility determinations

MMA: Roles and Partners

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SSA Tools

• Low Income Subsidy (LIS) application• Scannable paper application • Over the phone application• Web based application 7/1/05

• LIS sign up events• SSA regional office staff

• 30+ new hires in Minnesota

MMA: Roles and Partners

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SHIP Responsibilities

• Outreach & Education• Low Income Subsidy (LIS)

application assistance• Plan enrollment assistance

MMA: Roles and Partners

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SHIP Tools

• Senior LinkAge Line® • 1-800-333-2433

• Partners with Disability Linkage Line™

• Train the Trainer events (Road Shows)

• Trained Volunteer force

MMA: Roles and Partners

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Minnesota Department of Commerce Responsibilities

• Conform state law to MMA changes• Medicare supplement (Medigap)

insurance• No K and L in MN in 2006

• Licensing of Medicare Prescription Drug Plans

MMA: Roles and Partners

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Minnesota Department of Human Services (DHS) Responsibilities

• Conform state Medicaid law to Medicare drug benefit requirements

• Change State Pharmacy Assistance Program (MN Prescription Drug Program-PDP) to reflect Medicare drug benefit changes

• Notify enrollees of policy changes• Offer Low Income Subsidy (LIS) Enrollment

Assistance• Provide data to CMS• Conduct Medicare Savings Program

screenings• Pay CMS the majority of costs for duals

MMA: Roles and Partners

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Department of Human Services (DHS) Tools

• DHS staff• DHS outreach grants

• State Pharmacy Assistance Program• Medical Assistance for Employed

Persons with Disabilities

• County agencies

MMA: Roles and Partners

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Employer Responsibilities

• Notify their retirees of creditable coverage

• Make decision about continuing the drug benefit

• Make decision about Medicare drug subsidy for employers

MMA: Roles and Partners

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Health Plan Responsibilities (MA)

• Educate their enrollees (PMAP and Medicare), family members and representatives of changes

• Decide what to offer in 2006 (MA, SNP, etc.); submit application to CMS

• Provide a CMS approved product for at least one year

• Market to all eligible individuals

MMA: Roles and Partners

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Health Plan Tools (MA)• Notices to enrollees about changes and

options• Marketing materials• Provide Community Education sessions• Provide other forms of communication

about changes and options• phone banks • internet • articles in newsletters

MMA: Policy Impacts

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Medigap Responsibilities

• Provide notice of creditable coverage

• Make decision about continuing Medigap drug coverage to existing beneficiaries

MMA: Roles and Partners

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Beneficiary Responsibilities

• Understand the benefit• Make a decision about applying for

Low Income Subsidy (LIS)• Make a choice about a drug plan

beginning in November

MMA: Roles and Partners

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Resource Gaps

• Education (for beneficiaries and their families—adult children, conservators, etc.)

• Low Income Subsidy (LIS) application and Medicare drug plan enrollment assistance

• Assurance that eligible people take action

MMA: Roles and Partners

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Minnesota’s Collective Effort: Call to Action

• Broad based statewide outreach campaign = Call to Action• Organizational education and

outreach to key stakeholder groups

• MN Tool Kit• Statewide Part D e-mail exchange

listserv• Road Shows

MMA: Roles and Partners

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MN Medicare Part D Road Shows

May and June 2005 East Grand Forks

BemidjiBrainerdWillmar

Fergus FallsDuluth

MarshallMankato

RochesterFairmont

Mora St. Cloud

MinneapolisSt. Paul

ITV training for County Agencies

MMA: Roles and Partners

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Plan for…The Future

Round 2 of Medicare Part D Road Shows will begin in October, 2005

Focus on Part D plan options in MN

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What you can do…

• Make brochures available at your site• Promote awareness amongst

beneficiaries to take action!• Host educational events• Host sign-up events• Train your staff to help with

applications and Medicare drug plan enrollment assistance

MMA: Roles and Partners

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Where to turn for more information, answers and help

• Subscribe to the MN Medicare Part D listserv

• Senior LinkAge Line® • 1-800-333-2433

• www.Medicare.gov• 1-800-Medicare

• www.socialsecurity.gov• 1-800-772-1213

MMA: Roles and Partners

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Along the way, there may be some confusion about Part D…

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But by working together, we can help MN Medicare beneficiaries transition smoothly

into Part D

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Get Ready Get Set Go!!!!!

677,000 MN Medicare beneficiaries need to learn about Part D before 1/1/06

You are key to MN Medicare beneficiaries receiving accurate, consistent information about Part D

THANK YOU!