Medicare D Prescription Drug Benefit

1. Medicare D � Prescription Drug Benefit Michelle A. Fritsch, Pharm.D., CGP Clinical Pharmacy Specialist AlaMAP Director Alamance Regional Medical Center

3. Remember No need to be in a rush Sign up any time between November 15, 2005 and May 15, 2006

4. Resource Limits

5. Standard Benefit Summary Patient Medicare Catastrophic Coverage 5% 95% $5,100 ($3600 out-of-pocket) Patient Medicare �Doughnut Hole� 100% 0% $2,250 ($750 out-of-pocket) Patient Medicare Initial Coverage 25% 75% $250 Deductible

6. Low Income Benefit Summary

7. Plan Choice Variables Monthly Premium Yearly Deductible Participating pharmacies Cost per prescription Copay vs % coinsurance Medications on formulary Price discounts may be different (before you pay your percent)

8. Plan Choice Variables Covered counties Complete plan vs stand alone HMO vs PPO Participating physicians Compare the coverage you currently have with the Medicare options

9. Once You Choose Plan application goes from insurance company to Medicare with input from Social Security Plan takes effect 1st day of next month. Need letter or card with ID number for pharmacy to submit claim If not received, pay then submit for reimbursement

10. Medication Options Nonformulary medications will NOT count toward out-of-pocket maximum (unless approved through appeal) Will be important to choose the best plan for you and your specific regimen Work with your doctor(s) and clinical pharmacists

11. WHAT IF� Already have prescription insurance through former employer Should send next year�s rates/options so can compare to Medicare D Already enrolled in a Medicare Advantage plan Should send their prescription plan options Can change to a Medicare Advantage if not on one before Can leave a Medicare Advantage plan Cannot keep Medicare Advantage for medical and get stand-alone prescription plan

12. More Information www.medicare.gov 1-800-Medicare TTY use 1-877-486-2048 State Seniors Health Insurance Information Program (SHIIP) 1-800-443-9354 Social Security office 226-8444 www.cms.hhs.gov Plan Finder Tool at www.medicare.gov