Medicare Prescription Drug Coverage

1. Medicare PrescriptionDrug Coverage

2. 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

3. Target Audiences • General Population • Employer/Union Population • Limited Income and Resources (LI/R) Population • Long-term Care Population

4. General 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

5. Meet the General Population *All numbers are estimates

6. 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

7. 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)

8. 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

9. Key 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)

10. Meet the E/U 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

11. 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

12. Meet the E/U Population

13. The E/U Population Needs to Know • 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.

14. 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

15. If Coverage is NOT as Good … They Need to Know • You can enroll in Medicare Prescription Drug Coverage • Same messages as for General Population

16. Key Dates • Creditable Coverage “Notice” from Employer/Unions (Now - 11/15/05) • Fact sheets available on www.medicare.gov (April 2005)

17. Limited Income and Resources (LI/R) Population Full-benefit dual eligibles, MSP, SSI Income <150% FPL Goal: Engage, Encourage Application, Enroll

18. Two 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

19. Meet the LI/R Population *All numbers are estimates

20. Those Who Automatically Qualify Need to Know… • 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

21. 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

22. Key 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)

23. Key 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)

24. Key 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/

25. 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) *All numbers are estimates

26. 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

27. Key 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)

28. Message Discipline: Never deviate from tested, uniform message

29. 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.

30. Messaging Choice You can choose between at least two Medicare prescription drug plans and pick a plan that meets your needs.

31. 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

32. 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

33. Terminology Consistency: Please Help Us! Visit often for the most recent preferred terms www.cms.hhs.gov/partnerships/tools/materials/preferredterms.pdf

34. 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