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David Grant and Marie Jobling Presenters CARA 415-550-0828

Medicare Part D – Think “D” for Disaster The Advocate’s Guide for Organizing To Improve Medicare Drug Coverage. David Grant and Marie Jobling Presenters CARA 415-550-0828. This Workshop brought to you by….

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David Grant and Marie Jobling Presenters CARA 415-550-0828

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  1. Medicare Part D – Think “D” for Disaster The Advocate’s Guide for Organizing To Improve Medicare Drug Coverage David Grant and Marie Jobling Presenters CARA 415-550-0828

  2. This Workshop brought to you by… California Alliance for Retired Americans (CARA) 877-223-6107 in partnership with theMedicare Advocacy Collaborative:- Health Access California - OWL - California - Gray Panthers - California - Congress of California Seniors This workshop made possible in part by a grant from The California Wellness Foundation.

  3. Medicare Part D - Time to “Shout Out” an Alarm • Everywhere folks are talking about Part D • Mostly, individuals are trying to figure out if it will help or hurt them • We need to raise the “red warning flag” about dangers as they unfold. • We need to “Shout Out” that Medicare Part D has too many problems and must to be “Reconsidered and Replaced” by Congress

  4. Overview of Today’s Workshop • Medicare Part D – The Basics • Medicare Part D – An Advocate’s Perspective • Does Medicare Part D reduce cost & improve access? OR • Does it simply privatize a major part of Medicare by turning over drug coverage to an unregulated army of private drug providers (while sacrificing the standard benefits fundamental to Medicare?) • CARA’s Call to Action!

  5. Here is a CLUE… • In 2003, when Medicare Part D was enacted, the Drug Companies… • hired 952 lobbyists, • spent $141 million on • lobbying • contributed more than • $30 million to campaigns. • Drug profits rose $182 billion.

  6. Medicare Part D – Working for YOU? What has been your experience so far?

  7. Welcome to Medicare Part D “The Basics” • Coverage began January 1, 2006 for those enrolled • Available for all people with Medicare, but impacts particular groups differently • Drug Benefits provided through Private Plans: • Prescription Drug Plans (PDP’s) • Medicare Advantage Plans (HMO’s) • Some Employer and Union Retiree Plans receive government subsidies to help prevent them from dropping drug coverage.

  8. How it Works – The Basics • Monthly premium: minimum of $5.31 to $66.00 per month (in California) • Deductible - $250 per year • Co-payment - $500 maximum based on drug “costs” up to $2,250 • Donut Hole – No coverage for costs from $2,250 to $5,100 (but you must keep paying monthly premiums) • Catastrophic Coverage – After $5,100, it covers 95% of drug costs • Co-pays – generally $2 - $5 for each prescription

  9. Part D Plans – The Basics • Plan Choice – 47 “stand alone” plans in addition to current HMO plans • Co-payments, deductibles, pharmacy networks vary greatly • All mental health drugs, immunosuppressants, AIDS and cancer drugs are covered • In other categories, all drugs are not covered • Medi-Cal will continue to cover drugs not on Part D formulary for Medi-Cal recipients • Part D Plans can change formulary at any time • Customer service – up to each plan • Appeals - up to each plan

  10. Low Income Subsidy – The Basics • Three groups “deemed” eligible for full low-income subsidy were automatically enrolled January 1, 2006. • Dual eligible (Medicare/Medi-Cal) • People with SSI • People enrolled in Medicare Savings Programs (QMB, SLMB & QI-1) • Those with incomes OVER this level and UNDER 150% of poverty level are eligible but must apply through Social Security for this benefit. • Single – up to $1197 monthly • Couple – up to $1,604 monthly • Excess assets may prevent you from getting this benefit. First, you must apply for the subsidy, then you must enroll in a Part D Plan.

  11. Enrollment Issues – The Basics • Dual Eligibles (with both Medicare and Medi-Cal): • Were automatically enrolled in a Part D plan January 1, 2006 • Beneficiaries must determine if chosen plan covers their drugs and is accepted at a nearby pharmacy • Drugs on the Medi-Cal formulary, but not on the Part D formulary, will continue to be paid for by Medi-Cal • If you don’t like your plan, you can change as often as monthly • Medicare Only: • Can apply for Low-Income Subsidy • Are being encouraged to pick a Part D plan and enroll by May 15, 2006 • You can only change plans during the annual open enrollment period, November 15 through December 31. • Beneficiaries pay a 1% of premium penalty each month if you do not enroll by May 15, 2006

  12. Dual Eligibles • Dual eligibles in long term care facilities No premium, no deductible, no co-pays • Dual eligibles in the community and those in Medicare/Medi-Cal Medicare Savings Programs (QMB, SLMB, QI-1) or SSI/SSDI • No premium or deductible • Co-pays: $1 to $5 (per prescription) • No “donut hole” of non-coverage • No co-pay after $5,100 limit of total cost of drugs

  13. What did the Governor just do? • Authorized the State to pay for medications for those Medi-Medi’s who are unable to get their drugs paid for by Medicare. • This coverage was only for the period January 12 through January 17, 2006. • Sponsors of this workshop are part of efforts with the Legislature to get this safety net coverage continued.

  14. Low-income Medicare Beneficiaries Not on Medi-Cal • A two–step process • Apply for a “low-income subsidy” if income and assets are low • Single – up to $1,197 monthly • Couple – up to $1,604 monthly • Assets limits vary • Choose a prescription drug plan before May 15, 2006 and enroll – your subsidy should be automatically applied.

  15. Medicare Beneficiaries with Existing Drug Coverage • Watch out for a letter saying if your current coverage is at least as good as Medicare Part D – the term used is “creditable” – not all plans are “creditable”. • These letters could come from: • Existing Medi-gap policies • Medicare Advantage HMO’s • VA and TRICARE • Union and Corporate Retiree Benefit Programs • CALPERS • Covered individuals can still sign up for a Part D plan, but may lose their regular drug AND health coverage (More on this in the “red flag” section to follow). • If you have not yet received a letter, or are confused, call your health plan.

  16. Where You Can Go For Help • Health Insurance Counseling and Advocacy Program (HICAP): Call 1-800-434-0222 to reach your local HICAP or go to www.calmedicare.org. • Social Security: 1-800-772-1213 or go to www.ssa.gov. • Center for Medicare and Medicaid Services (CMS): Call 1-800-MEDICARE or go to www.medicare.gov. • Your CARA Part D Toolkit and at www.retiredamericans.org • Remember, most other sources of information are trying to sell you something

  17. Preparing Advocates to “Raise the Red Flag” • Presentations like what you just saw are happening all over the state. • We need to tell the other side of the story - that Medicare Part D = Disaster • We need to be “on guard” against the numerous dangerous features of Medicare Part D • Let’s count the ways that Part D is a Disaster…

  18. #1 Enrollment = Chaos and Confusion • Enrollment is being pushed too quickly • Enrollment decisions are too complex • Too few resources are available to help consumers • Too little information is available in multiple languages and in formats easy for consumers to understand.

  19. #2 Medi-Cal Enrollment Nightmare • On January 1, over 1 million Medi-Cal beneficiaries were automatically switched to Medicare Part D. Horror stories include: • Pharmacies can’t access computer system to process claims. When they do, data is not accurate. • Phone lines for Medicare and the private plans totally overwhelmed • High co-payments and totally different formularies mean beneficiaries leave without lifesaving drugs. • California and other states must step in to bail out the program.

  20. #3 - Late Enrollment Penalty It Lasts A Lifetime! • Beneficiaries not automatically enrolled have until May 15, 2006 to chose a plan. • After May 15, 2006, if you have not chosen a plan, you will pay 1% of the average area premium PER MONTH…FOR LIFE as your penalty! • Example – say the average monthly premium in your area is $50 a month. If you wait 12 months to sign up, your premium would be $50 + $6 (12% of $50) every month or an additional $72 per year forever! If the rate goes up, your penalty goes up proportionately. If you wait longer, the penalty just keeps growing.

  21. #4 -Retirees with Current Drug Coverage - Beware! • Retirees with current drug coverage through a retiree or employer health plan could lose ALL RETIREE HEALTH COVERAGE (not just drug coverage) by signing up for Medicare Part D. • Many letters to retirees regarding “creditable coverage” do not make this pitfall clear. • If you mistakenly join Part D, you and your family members covered by the retiree plan may not be able to get the coverage back.

  22. #5 The “Donut Hole” – Not Such A Sweet Deal • You get no coverage for costs between $2,250 and $5,100 • You keep paying premiums but get no benefit • It is unclear what drug costs will get counted toward the $2,250 (i.e. all out of pocket costs or only those that show up in the Medicare computer) • Many factors will make it difficult for individuals to reach the other side of the hole ($5,100) and to start getting benefits again.

  23. #6Choosing a Plan? Welcome to the Valley of Tiers • Already complex decisions related to cost and coverage are now more difficult because of choices within plans. • Many plans are organized into different “tiers” based on whether you are using generic, preferred, non-preferred, or specialty drugs – Higher tier = Higher cost. • Plans may force you to try cheaper drugs, perhaps with bad side effects, before you can get the “higher tier” drug they offer. • In addition, plans have different costs depending on whether you go to a preferred, non-preferred or off-plan pharmacy. • For example, you could have as 12 different combinations of premium and co-payment amounts and the possibility of even more confusion if all your drugs are not covered in one plan • End result – it is virtually impossible to make an informed choice!

  24. DANGER – With Part D, You Could Pay MORE! • Annual Premium $ 445 • Annual Deductible $ 250 • Co-payments (varies) $ 155 - $500 • Donut hole coverage gap $ 2,850 • Additional charges based on whether drug is covered, pharmacy is in network, etc. Unknown • How does this compare with what you pay now? • How does it compare if you simply bought your drugs from Canada or from places like Costco? • How would it compare if the government could negotiate lower drug prices, like those for the VA?

  25. #7-12More Dangers on the Road to Part D • Persons in special programs for HIV/AIDS, disabled children, other groups face even more confusion. • Many beneficiaries will find this new “benefit” actually reduces assistance from other programs like food stamps. • Beneficiaries in long term care facilities nursing home left to fend for themselves in terms of making choices. • Each plan has its own grievance and appeal process. Doctors and patients are forced to deal with multiple, differing appeal processes to get needed drugs. • Beneficiaries will be trapped in plans even if drug formularies changes • Drug plans have little or no oversight from government.

  26. #13 Unlucky California Will Lose Nearly $420 Million • The federal government will “clawback” $1.4 billion of the money formerly in Medi-Cal. • Experts estimate that over-all, California will lose more than $250 million in the first year alone. • Since the State is no longer buying drugs directly, it potentially loses all the discounts and rebates, an estimated loss of $170 million more.

  27. America Can Do Better After all that you’ve heard, what do YOU think… Will Medicare Part D reduce cost, improve access, and increase your ability to live a healthy life?

  28. Together We Can Get A Real Prescription Drug Benefit • CARA has a plan for how to “Reconsider and Reform” Medicare Part D, • Here are at least 4 Ways you can help. • CIRCULATE & ADVOCATE • EDUCATE • SHOUT OUT AND TELL OUR STORIES • ORGANIZE & MOBILIZE

  29. At the national level… CIRCULATE & ADVOCATE • Take the CARA Medicare Petition and get everyone you know to sign it. • Tell people about the problems with Part D and urge them to join the fight for a Real Drug Plan. • Join the CARA Action Team (CAT) and participate in meetings in your area. Call 877-223-6107(toll free) for the Team in your area. • Organize to hold your representative accountable for real relief from high drug costs • Support HR 3861, the Medicare Informed Choice Act (Stark, Schakowsky) to extend the deadline • Support HR 752 (Stark, Berry) the Medicare Prescription Drug Savings and Choice Act, to create a uniform drug benefit in Medicare and require that Medicare negotiate for the best possible prices. 

  30. CALL YOUR CONGRESSIONAL REPRESENTATIVES • Dial the House & Senate switchboard 1-202-224-3121 • Ask the operator for the first representative you want to reach • When connected: “Hello, I live in your district and I’m calling to ask you to: • Support HR 3861, the Medicare Informed Choice Act to extend the enrollment period and protect against bad choices. • Support HR 752, the Medicare Prescription Drug Savings and Choice Act, to create a uniform drug benefit in Medicare and require Medicare negotiate for the best prices • Reconsider & replace Medicare Part D with real reform that saves Medicare and provides relief from high drug prices.” • Repeat until you have called all 3 of your representatives! • Call today, call often, get your friends to call too!

  31. EDUCATE • Be part of a team to follow-up on today’s workshop. • Take what you’ve learned today back to other groups you’re involved with • Attend local Medicare Part D trainings and workshops to help “raise the red flag” about problems with Part D. • Write a “Letter to the Editor” about the pain and confusion Medicare Part D is causing (see information in your toolkit).

  32. “SHOUT OUT” AND TELL OUR STORIES • Share your experiences and those of people you know • “Tell Your Story” form is in the Toolkit to help make the issues real to the media and local policymakers. • Tell your story today! • Collect stories from others tomorrow • Host a local “Shout Out” to get the press to cover the “dangerous side” of Part D. • The Tool Kit can help guide you with these and other actions. • Your local CAT Team can help you organize a “shout-out and media” in your area.

  33. At the state level…ORGANIZE & MOBILIZE • Support State legislation being developed for the 3rd year of the statewide OuRx Coalition - Year 3? – Part D! • Establish a “wrap-around” benefit to protect “Medi-Medi’s” • Provide assistance with co-payments and deductibles • Increase funding for consumer counseling and support • Demand oversight and regulation of drug plans • Participate in state hearings on Medicare Part D • Coordinate “shout-outs” and legislative visits through the local CAT’s to participate in your area.

  34. REACH OUT TO POTENTIAL ALLIES • CARA member groups • Local senior and disability advocacy groups • Pharmacists and their organizations • Non-profit housing providers to seniors and persons with disabilities • Nursing Homes & Residential Care Facilities • Legal Services Programs • Paid and family care givers

  35. CALL TO ACTION • Now it’s time to move into action • Join us as we plan the next steps in your area • And to end on an up-beat note, join us in song as we prepare to march and sing our way into the history books.

  36. Stay Involved - Join the CARA Action Team (CAT) The Alameda County CAT meets every 2nd Monday, at 10:00 a.m. South Berkeley Senior Center Ellis at Ashby in Berkeley For more information, contact Jim Forsyth at 510-581-5169.

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