Minnesota Rural Health Association presents “Pharmaceutical Options for Seniors”

1. Minnesota Rural Health Association presents“Pharmaceutical Options for Seniors” Robin Weis MN River Area Agency on Aging 2/9/07

2. Senior LinkAge Line® (SLL) • Statewide information and assistance phone line • 1-800-333-2433 • 7 Call Centers in MN- Slayton, Rochester, Metro, St. Cloud, Duluth, Fergus Falls, Warren • Monday-Friday, 8 a.m. to 4:30 p.m. • Resources online at www.minnesotahelp.info • Call specialists are certified health insurance counselors thru the MN Board on Aging and Certified Information and Referral Specialists thru the Alliance of Information and Referral Systems (at a minimum) • Senior Outreach Specialists and trained volunteers provide in-person assistance

3. SLL- Who we Serve • Seniors (60 and older) • Medicare Beneficiaries of all ages • Caregivers • Grandparents raising grandchildren • People of all ages needing prescription assistance • Professionals working with these populations

4. Options Based on Individual Circumstances • Medicare • Medicare Part D • Medical Assistance • Medicare Supplemental Polices • Health Plans and Advantage Plans • Employer/Retiree Plans • Veteran Benefits • RxConnect™ • Foundations

5. Medicare’s Rx Coverage • Medicare Part A and B continues to cover prescription drugs that were covered prior to Medicare Part D • Medicare approved hospital stay • Medicare approved nursing home stay • Medications that can’t be self- administered • Most prescriptions are NOT covered by Medicare Part A and B.

6. Medicare Part D’s Rx Coverage • Multiple options with varying premiums, deductibles, coverage gap and cost sharing. • Stand alone plans or Medicare Advantage/Health Plans • Formulary • Pharmacy Networks- Mail order an option with some companies • Enrollment periods • Creditable Coverage

7. Medical Assistance Rx Coverage • Drastically changed since Medicare Part D • Medicare Part D covered meds are no longer covered under Medical Assistance • Can change plans monthly if enrolled in a MN Health Care Program • MSHO/MnDHO- Medicare A, B and D • Wellpoint- Point of Sale Option

8. Medicare Supplemental Polices • Prescription coverage not available for purchase after 1/1/06 • 80% or 50% coverage still available on plans in place prior to 12/31/05 • Should compare current policy with Medicare Part D options • 50% coverage under supplemental plans is not creditable coverage

9. Health Plans and Advantage Plans • Medicare Cost Plans • Medicare Advantage Plans • Medicare Advantage HMO Plans • Medicare Advantage Private Fee-for-Services (PFFS) plans • Medicare Advantage Preferred Provider Organization (PPO) Plans • Medicare Advantage Special Needs Plans (SNP’s) • Medicare Medical Savings Account Plans

10. Medicare Cost Plans • Some provide drug coverage for their members only • Members may opt out of drug coverage and buy a stand alone Medicare Part D plan

11. Medicare Advantage (MA) Plans • Many Medicare Advantage Plans provide prescription drug coverage • If drug coverage is offered, enrollees must get drug coverage from their plan. • In most plans if they enroll in a stand-alone plan, they will be dis-enrolled from their health care coverage.

12. Medicare Medical Savings Account (MSA) Plans • Will begin to see options in MN in 2007 • MSA plans do not have drug coverage • Enrollees have the option of enrolling in a stand-alone Medicare Part D plan

13. Employer/Retiree Plans • Must refer to the coverage handbook to see how drugs are covered • Each plan varies • Consider premium costs paid by the senior

14. Veteran Benefits • Encourage to contact the county Veteran Service Officer if not currently receiving drug coverage thru VA • VA guidelines change frequently

15. RxConnect™- objective, neutral service that discusses all pharmaceutical options • Using web sites to compare various prices • Mail order • Review benefits available through a health plan,Medicare supplement plan or HMO • Enrolling in publicly funded programs • Negotiating with a local pharmacist • Getting help from the drug companies • Medicare Prescription Drug coverage • Prescription savings discount cards

16. Discount Card Example • TogetherRx Access • Can not have current drug coverage • Can not be a Medicare beneficiary • Uses local pharmacy • Free, little paperwork required • Discount available on over 300 brand names and some generics • Most receive 25-40% off of brand-name drugs

17. Help from Drug Companies • Most require no current drug coverage, however some helping in Medicare Part D coverage gap • Guidelines and applications often change • Income guidelines and sometimes asset guidelines • Physician participation • Renewals required frequently • www.needymeds.com or www.rxassist.org

18. Foundations • Vary by foundation • Examples • www.healthwellfoundation.org • www.patientaccessnetwork.org

19. Contact Information Robin Weis 507-836-8547, ext. 112 srlinkage@swrdc.org