Download - 1 Medicare Drug Benefit: Part D in Minnesota Minnesota Road Shows May and June 2005 Posted 6-14-05
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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!