Center on Aging: Medicare Drug Information: Info for Consumers
Medicare Prescription Drug Information for Consumers
General Info -Extra Help with Medicare Prescription Drug Costs- Helpful Tools - People with Medicare - People with Disabilities - Caregivers - Consumer Protection, Scams & Fraud
General Information
NEW MAILING TO MEDICARE RECIPENTS RECEIVING EXTRA HELP
CMS is working toward a smooth transition to ensure continued
prescription drug coverage for all Medicare beneficiaries who received
extra help in paying their prescription drug costs in 2007.
Specifically, CMS is taking several actions in order to reach out to the
beneficiaries receiving the low-income subsidy (LIS) who are facing a
change in their Part D premiums in 2008, including providing more
information to beneficiaries about these changes via two letters.
This fall, CMS is sending both the blue reassignment letter which was
sent last year and a NEW tan letter to beneficiaries receiving the LIS
who selected a plan, but who will be responsible for paying a portion of
their plan premium beginning in January 2008 unless they join a new
plan.
During the week of October 29, 2007 CMS will begin mailing the
following:
Re-assignment Notices (Blue): Medicare will mail re-assignment notices
to people who qualify for the full extra help and will be reassigned to
a new plan in 2008.
Some people will be reassigned because their 2007 Medicare Prescription
Drug Plan's premiums are increasing for 2008 (Publication No. 11209).
This includes about 1.16 million people who will be moved to a new plan
outside their current organization. The reassignment notice they receive
will provide information about three options: moving to the new plan,
staying in the current plan, or selecting a different plan. Details
about their new zero premium plan (including co-payment amount, and
yearly deductible) are provided, along with the name of their new
organization and a phone number that can be used to get additional
information about prescriptions covered, drug coverage rules (like prior
authorization), and local pharmacies that can be used. The notice also
provides information about the person's current plan, and a list of all
the zero premium plans in the area. An additional 965,000 people will be
moved to a new plan within their current organization. These people will
receive the same reassignment notice described above; the only
difference is that the name of their organization may remain the same,
even though their plan is changing.
About 1,550 people will be reassigned because their 2007 Medicare
Prescription Drug Plans are terminating (Publication No. 11208). This
notice specifies that their current plan is leaving and also provides
information about their new plan, and alternative options.
All reassignment notices are printed on blue paper and inform
beneficiaries that that they will be reassigned to a new plan if they
don't tell their current plan they want to stay or join a new plan on
their own by December 31, 2007.
NEW "Chooser" Notices (Tan): Medicare will mail chooser notices
(Publication No. 11267) to a total of about 442,000 people who qualify
for the full premium subsidy and who chose to join a Medicare Drug Plan
that was "free" (no premium liability) when they first joined, but whose
premium will be above the regional low-income premium subsidy amount by
more than $1 in 2008. To respect individual choice, Medicare does not
reassign LIS beneficiaries who joined plans on their own or switched to
different Medicare Prescription Drug Plans than the plan Medicare
enrolled them in. These letters are printed on tan paper and inform
beneficiaries what their out-of pocket payment will be in 2008, lists
the zero premium plans available, and provides a list of important
things to think about when considering plan options such as pharmacy
networks, drugs covered, and satisfaction with current plan.
The following materials related to these two mailings have been posted
to the Limited Income and Resources web page
<http://www.cms.hhs.gov/limited
<http://www.cms.hhs.gov/limited
* Guide to LIS Mailings for CMS, Social Security and Plans *
Re-assignment Data of Beneficiary Notifications by state, county and zip
code * Re-assignment Notice Sent to Those with a Plan Not Available in
2008 (blue) * Re-assignment Notice Sent to Those with a Premium
Increase in 2008 (blue) * Re-assignment Partner Tip Sheet - Information
Partners Can Use on: Re-assignment * Chooser Data of Beneficiary
Notifications by state, county and zip code * Choosers Notice Sent to
Those with Drug Cost Changes in 2008 (tan) * Links to other helpful
information, including locating local resources in your area
If you have any questions regarding this information, please feel free
to contact Nancy Schmidt, Centers for Medicare & Medicaid Services,
Region VII - Kansas City, (816)426-6519, nancy.schmidt@cms.hhs.gov
<mailto:nancy.schmidt@cms.hhs.gov>
PAYING MEDICARE PART C/D PREMIUMS
People with Medicare have two options for how they pay their Medicare
Part C/D plan premiums. One option is to have their monthly plan premium
deducted from their monthly Social Security payments. The second option
includes getting billed directly from the plan for monthly premiums. In
2006, some people had incorrect amounts (including none at all) deducted
from their Social Security payments. Many of these errors were corrected
during 2006. To correct the remaining 2006 errors, Medicare performed a
comprehensive premium withholding payment reconciliation process for
people who had Medicare premiums withheld from their Social Security
payments for their Medicare Advantage Plan or Medicare Prescription Drug
Plan at any point during 2006. As a result of this process, Medicare
found that some people who had premiums withheld during 2006 still have
unresolved issues related to the withholding.
Medicare is taking steps to resolve the issues related to the
withholding for all of these people.
The first attachment is a tip sheet that describes the different people
affected by the 2006 premium withholding reconciliation. In addition, we
have attached a copy of the letter being sent to beneficiaries who owe
money to their plan(s).
Feel free to contact us at (816) 426-5783 with any questions you may
have regarding this important information.
Thank you,
Lisa Goschen
Acting Associate Regional Administrator
Division of Medicare Health Plans Operations Kansas City Regional Office
Centers for Medicare & Medicaid Services
Medicare Part D Prescription Drug Plan Complaints
The CMS Regional Office web site language has been changed to reflect the recommended method our partners, providers, and Medicare beneficiaries should use to address Medicare Part C (Managed Care) and Medicare Part D Prescription Drug Plan complaints. Medicare Part C (Managed Care) and Medicare Part D Prescription Drug Plan inquiries (e.g., complaints, grievances, etc.) should first be directed to the affected member's Medicare Advantage or prescription drug plan. If the Part C or D issue is not resolved after contacting the appropriate plan, beneficiaries or their representatives should then call 1-800-MEDICARE. The web link to the Regional Office site is: http://www.cms.hhs.gov/RegionalOffices/
If your filed complaint is not resolved by the plan or 1-800-MEDICARE in a timely manner, you may follow up with the Kansas City Regional Office using the Part D Complaints email box: CMS PartDComplaints_RO7@cms.hhs.gov <mailto:PartDComplaints_RO7@cms.hhs.gov> . Please provide specific information about what has been done to resolve the complaint, including providing date(s), name(s), and phone numbers when possible. HICN/Social Security numbers and other beneficiary Protected Health Information must not be transmitted via email. A CMS Kansas City regional office case worker will contact you should this information be needed to assist CMS in the resolution of your emailed complaint. For more information, contact Kathryn A. Coleman, Associate Regional Administrator, Division of Medicare Operations, Kansas City Regional Office, Centers for Medicare & Medicaid Services.
Medicare Mailings and Any Action That May Be Needed
This chart explains the mailings that Medicare beneficiaries will be receiving and any action, if any, that they need to take. Also included in the chart are the links to the documents.
CMS Medicare Q&A: "Tips for your first trip to the pharmacy after enrolling"
Key Questions
Should I Enroll in the New Prescription Drug Benefit?
A Guide for Iowa Beneficiaries and Caregivers
Questions to Ask Before You Choose
CMS: "Things to Think about when You Compare Plans"
Key factors to consider in comparing your drug plan options are: Coverage, cost, convenience and peace of mind now and in the future.
Choosing a Plan: Which Medicare Prescription Drug Benefit Plan Will Meet My Needs?
Out of Pocket Costs
Medicare Part D: Standard Beneficiary Cost-Sharing (2006
This chart shows the various costs related to Medicare’s standard prescription drug benefit, including the annual deductible, coinsurance costs, and coverage gap.
What Are “True Out-of-Pocket” Costs Under the Medicare Prescription Drug Benefit?
This fact sheet explains the relationship between True Out-of-Pocket costs and the Medicare drug plan deductible, coverage gap and start of catastrophic coverage for those with very high prescription drug costs.
How the Coverage Gap Works for People with Medicare Prescription Drug Plans
A tip sheet for partners who work with people with Medicare and contains several questions and answers related to the coverage gap.
Coordinating Coverage
CMS’s state-by-state lists of Prescription Drug Plans and Plan Sponsors contain specific information on monthly premiums and general information on annual deductibles and other costs.
Coordination of Medicare Prescription Drug Coverage With Other Prescription Drug Coverage
Medigap (Medicare Supplement Insurance) and Prescription Drug Coverage:
A tip sheet on ways people can avoid or delay entering the gap, and continue to save money on drug costs while in the gap.
Quick Facts for People with a Medigap Policy about Medicare's New Coverage for Prescription Drugs
Medigap Policies with Prescription Drug Coverage: What you Need to Know
Guide to the Medicare Part D Appeals Process
The Health Assistance Partnership's fact sheet on appealing a prescription drug plan's decision to deny coverage
Resources
Iowa’s Senior Health Insurance Information Program (SHIIP)
For objective, one-on-one, help in comparing Medicare drug plans, SHIIP can be contacted statewide at 1-800-351-4664. For a list of local counseling sites throughout Iowa, click here. For contact information for SHIP programs in other states, click here.
American Society of Consultant Pharmacists (ASCP) Medicare Part D Consumer Reference Page
Extra Help with Medicare Prescription Drug Costs
Updated income and resource standards for individuals who apply for the Low-Income Subsidy (LIS) for Medicare Part D.
The CMS is required by law to update the Medicare Part D income and resource limits each year. click here for more information.
Pharmaceutical Assistance Program-Help with the cost of medications:
Many of the major drug manufacturers offer assistance programs for people enrolled in Medicare Part D who have difficulty covering the cost of their medications. These programs vary by what they offer and what the eligibility criteria is for the program. You can find out whether a Patient Assistance Program is offered by the manufacturers of specific drugs by visiting our Pharmaceutical Assistance Program site at http://www.medicare.gov/pap/index.asp. Contact information and program details are included and the Web site is updated once a month.
Quick Facts about Medicare's New Coverage for Prescription Drugs for People with Limited Income and Resources
This CMS fact sheet provides basic information about Medicare’s program for “extra help” to help pay costs associated with the prescription drug program.
Extra Help with New Medicare Prescription Drug Benefit: Are You Eligible?
A Step-By-Step Flow Chart by the Health Assistance Partnership.
SSA: Help with Prescription Drug Costs
Online Application for Help with Medicare Prescription Drug Plan Costs
Q&A about the Extra Help Program
SSA Fact Sheet: Help Available to Pay Costs of New Prescription Drug Program - in English and Spanish
SSA Fact Sheet: What You Need to Complete the Application for Help with Medicare Prescription Drug Plan Costs
SSA Fact Sheets available in fifteen other languages
Extra Help for Low-Income Beneficiaries in Iowa: Charts
The Health Assistance Partnership produced these two charts to detail the different income and resource eligibility levels for Medicare’s “extra help” program for people with limited financial means.
Helpful Tools
Medicare Email Reminders for Preventive Services
Centers for Medicare and Medicaid Services recently added new
functionality to help beneficiaries track their preventive services
eligibility and utilization. CMS now will send beneficiaries who have
provided their email address an email reminder when they are eligible
for one of their preventive services. We are hopeful that the
notification will encourage more Medicare beneficiaries to utilize the
preventive services that are covered by Medicare. For more information
about signing up for mymedicare.gov see our latest brochure: Step by
Step Instructions for Using Mymedicare.gov (English)
http://www.medicare.gov/Publications/Pubs/pdf/11297.pdf
Step by Step Instructions for Using Mymedicare.gov (Spanish)
http://www.medicare.gov/Publications/Pubs/pdf/11297_S.pdf
KAISER FAMILY FOUNDATION: "Medicare Health and Drug Plan Tracker
Update."
"This updated resource also enables users to look up quick facts about the 1,429 stand-alone prescription drug plans offering Medicare benefits in 2006, including the number of participating plans, range of monthly premiums, share of plans with no deductible, and share of plans with a coverage gap. Users can see how premiums and deductibles for stand-alone drug plans vary by state and region, as well as the share of plans that have a gap in coverage, also known as a "doughnut hole," in which enrollees must pay the full cost of their drugs. It also reveals a difference in the number of plans that low- income beneficiaries who qualify for extra assistance can sign up for and have the government pay the full premium cost -- from a high of 16 such plans in South Carolina, Texas and Virginia to a low of six such plans in Arizona and Florida"
Medicare’s Prescription Drug Plan Finder and Formulary Finder Web-tools
The Plan Finder and Formulary Finder are Medicare’s main tools for finding information about Medicare drug plan benefits and coverage, pharmacy networks and details about plan formularies. Use these tools, along with information from drug plans themselves, to compare drug plan options and to make decisions.
Benefits Check Up Rx
This website will also offer a Medicare drug plan comparison tool, along with an eligibility screening tool for other federal and state programs. (The plan comparison tool is not yet in operation)
Medicare Prescription Drug Coverage Personal Information Worksheet
Use this worksheet to help gather the information you'll need to find a Medicare drug plan that meets your need.
People with Medicare
Medicare & You 2006, the Medicare program’s 104 page handbook for people with Medicare coverage.
Go to Section 8 for enrollment and other general information about Medicare’s prescription drug benefit.
Note: The printed versions of Medicare & You 2006 which were mailed in early October contain a mistake involving the prescription drug plans for which a person with limited income would pay no premium. CMS issued a Notice of Errata on October 5, 2006 to explain this.
Medicare’s Fact Sheet for retirees who have prescription drug coverage through a former employer or union plan
People with Disabilities
Understanding Changes in Prescription Drug Coverage for People with Disabilities on Medicare
This guide provides information for people with disabilities, benefits counselors, disability organizations and others on transitioning to the Medicare Part D Prescription Drug Benefit.
Caregivers
New Medicare Prescription Drug Coverage: A message for People whoCare for Someone with Medicare
New Medicare Prescription Drug Coverage: Who Can Help Me Apply and Enroll?
Medicare Beneficiaries Warned To Be Aware of Telephone Scams Surrounding New Medicare Drug Benefit
Quick Facts about Medicare Prescription Drug Coverage and Protecting Your Personal Information
Medicare Beneficiaries Urged to be on the Look-out for Fraud & Phone Scams
