medicare prescription drug coverage patrick hamilton rural health coordinator centers for medicare...

Medicare Prescription Medicare Prescription Drug CoverageDrug CoveragePatrick HamiltonPatrick Hamilton

Rural Health CoordinatorRural Health CoordinatorCenters for Medicare & Medicaid Centers for Medicare & Medicaid

ServicesServicesPhiladelphia Regional OfficePhiladelphia Regional Office

2005 Maryland Rural Summit2005 Maryland Rural SummitOctober 28, 2005October 28, 2005

10/28/05 2Medicare Prescription Drug Coverage

Session TopicsSession Topics

OverviewOverview Eligibility and enrollmentEligibility and enrollment Extra helpExtra help Out-of-pocket thresholdOut-of-pocket threshold Medicare prescription drug coverageMedicare prescription drug coverage Medicare prescription drug plan Medicare prescription drug plan

finder web toolfinder web tool Partnering with CMSPartnering with CMS


Impact: BeneficiariesImpact: Beneficiaries 42 million Medicare beneficiaries 42 million Medicare beneficiaries

nationwide (about 675,000 in Maryland)nationwide (about 675,000 in Maryland) ALL 42 million are eligible for Medicare ALL 42 million are eligible for Medicare

Prescription Drug CoveragePrescription Drug Coverage 23% do not currently have drug coverage23% do not currently have drug coverage Beneficiary population will double in 30 Beneficiary population will double in 30

yearsyears 14 million Medicare beneficiaries14 million Medicare beneficiaries

Eligible for extra help with drug costsEligible for extra help with drug costs 96% of drug costs will be covered96% of drug costs will be covered

Overview


Important DatesImportant Dates

January 1, 2006:January 1, 2006: Drug coverage Drug coverage beginsbegins

November 15, 2005:November 15, 2005: Enrollment Enrollment begins, continues through May 15, 2006begins, continues through May 15, 2006

October 2005:October 2005: Plan marketing begins Plan marketing begins September 2005:September 2005: Plans announced Plans announced Summer 2005:Summer 2005: Formulary and bid Formulary and bid

reviews, reviews, extra help applicationsextra help applications Winter/Spring 2005:Winter/Spring 2005: Final regulation Final regulation

was released; bids were submittedwas released; bids were submitted

Overview


Medicare Prescription Drug Medicare Prescription Drug CoverageCoverage

Coverage begins January 1, 2006Coverage begins January 1, 2006 Available for all people with Available for all people with

Medicare Medicare Provided throughProvided through

Prescription drug plans (PDPs)Prescription drug plans (PDPs) Medicare Advantage Plans (MA-PDs)Medicare Advantage Plans (MA-PDs) Some employers and unions to retireesSome employers and unions to retirees

Overview


PDP and MA-PD RegionsPDP and MA-PD Regions

34 PDP regions (DE, DC & MD= Region 5)34 PDP regions (DE, DC & MD= Region 5) In MD, 19 PDP organizations offering 47 plansIn MD, 19 PDP organizations offering 47 plans

26 MA-PD regions (DE, DC & MD= Region 5)26 MA-PD regions (DE, DC & MD= Region 5) In MD, 17 of 26 counties have access to MA In MD, 17 of 26 counties have access to MA

plansplans Key factors in establishing regionsKey factors in establishing regions

Eligibility population and capacityEligibility population and capacity Beneficiary considerationBeneficiary consideration Limited variation in prescription drug spendingLimited variation in prescription drug spending

Overview


Overview


Medicare Prescription Medicare Prescription Drug PlansDrug Plans

Must offer basic drug benefitMust offer basic drug benefit Standard benefitStandard benefit

May offer supplemental benefitsMay offer supplemental benefits Enhanced benefitEnhanced benefit

Can be flexible in benefit designCan be flexible in benefit design Must follow marketing guidelinesMust follow marketing guidelines

Overview


Example of Standard Example of Standard Prescription Drug Prescription Drug

CoverageCoverage $32 average monthly premium $32 average monthly premium $250 deductible$250 deductible Up to $2,250: Beneficiary pays 25% drug Up to $2,250: Beneficiary pays 25% drug

costs and Medicare pays 75% drug costscosts and Medicare pays 75% drug costs Between $2,250 and $5,100: Beneficiary Between $2,250 and $5,100: Beneficiary

pays 100% drug costs (coverage gap)pays 100% drug costs (coverage gap) After $3,600 in out-of-pocket spending: After $3,600 in out-of-pocket spending:

Medicare pays approximately 95% and Medicare pays approximately 95% and beneficiary pays greater of $2/$5 copay or beneficiary pays greater of $2/$5 copay or 5% coinsurance5% coinsurance

Overview


Standard Benefit 2006Standard Benefit 2006

$250 $2250 $5100

$ +

Beneficiary Liability

Deductible

Coverage Gap

Total Spending

≈ 95%

80% Reinsurance

15% Plan Pays

Catastrophic

Coverage

5% Coinsurance

Medicare Pays Reinsurance

75% Plan Pays

25% Coinsurance

Out-of-pocket

Threshold

Direct Subsidy/Beneficiary Premium

$750 $3600 TrOOP

Total Beneficiary

Out-Of-Pocket$250


Eligibility and Eligibility and EnrollmentEnrollment

Entitled to Part A and/or enrolled in Entitled to Part A and/or enrolled in Part BPart B

Reside in plan’s service areaReside in plan’s service area Must enroll in a Medicare Must enroll in a Medicare

prescription drug plan to get prescription drug plan to get Medicare prescription drug Medicare prescription drug coveragecoverage

Eligibility and Enrollment


Enrolling in a PlanEnrolling in a Plan People with Medicare can enrollPeople with Medicare can enroll

Directly with the plan sponsorDirectly with the plan sponsor Through a personal representativeThrough a personal representative

““Stands in the shoes” of a person with Medicare Stands in the shoes” of a person with Medicare and has authority to act on his or her behalfand has authority to act on his or her behalf

This authority comes from state law (e.g., Power This authority comes from state law (e.g., Power of Attorney, guardian) or other applicable law of Attorney, guardian) or other applicable law (e.g., tribal or military law)(e.g., tribal or military law)

By enlisting the assistance of othersBy enlisting the assistance of others Spouse, relative, friend, caregiver, or advocacy Spouse, relative, friend, caregiver, or advocacy

group volunteergroup volunteer



Enrollment OptionsEnrollment Options People eligible for Medicare prescription drug People eligible for Medicare prescription drug

coverage may enroll in acoverage may enroll in a Prescription Drug Plan (PDP) or Prescription Drug Plan (PDP) or Medicare Advantage Prescription Drug plan (MA-Medicare Advantage Prescription Drug plan (MA-

PD plan)PD plan) People enrolled in an MA plan must receive Medicare People enrolled in an MA plan must receive Medicare

prescription drug coverage from the MA-PD plan prescription drug coverage from the MA-PD plan except ifexcept if Enrolled in a PFFS plan without drug coverage; or Enrolled in a PFFS plan without drug coverage; or Enrolled in an MSA planEnrolled in an MSA plan

People enrolled in a cost plan can elect to receive People enrolled in a cost plan can elect to receive Medicare prescription drug coverage from the cost Medicare prescription drug coverage from the cost plan or enroll in a PDPplan or enroll in a PDP

People must obtain Medicare prescription drug People must obtain Medicare prescription drug coverage from their PACE organization if it is offeredcoverage from their PACE organization if it is offered



Enrollment PeriodsEnrollment Periods In general, the enrollment periods for PDPs In general, the enrollment periods for PDPs

and MA-PDs are similarand MA-PDs are similar There are three enrollment periods for PDPsThere are three enrollment periods for PDPs

Initial Enrollment Period (IEP)Initial Enrollment Period (IEP) November 15, 2005 – May 15, 2006 for beneficiaries November 15, 2005 – May 15, 2006 for beneficiaries

eligible for Medicare by January 2006eligible for Medicare by January 2006 For newly eligible, coordinates with Part B enrollmentFor newly eligible, coordinates with Part B enrollment

Annual Coordinated Election Period (AEP)Annual Coordinated Election Period (AEP) For the first year: November 15, 2005 – May 15, 2006For the first year: November 15, 2005 – May 15, 2006 2006 and beyond: November 15 – December 312006 and beyond: November 15 – December 31

Special Enrollment Period (SEP)Special Enrollment Period (SEP)



Postponing EnrollmentPostponing Enrollment Higher premiums for people who wait Higher premiums for people who wait

to enrollto enroll Exception for those with prescription drug Exception for those with prescription drug

coverage at least as good as a Medicare coverage at least as good as a Medicare prescription drug planprescription drug plan

Assessed 1% of base premium for every Assessed 1% of base premium for every monthmonth Eligible to enroll in a Medicare prescription drug Eligible to enroll in a Medicare prescription drug

plan but not enrolledplan but not enrolled No drug coverage as good as a Medicare No drug coverage as good as a Medicare

prescription drug coverage for 63 consecutive prescription drug coverage for 63 consecutive days or longerdays or longer



Possible Examples of Coverage Possible Examples of Coverage at Least as Good as Medicare’sat Least as Good as Medicare’s

Coverage under a PDP or MA-PDCoverage under a PDP or MA-PD Some Group Health Plans (GHP)Some Group Health Plans (GHP) State Pharmacy Assistance Program (SPAP)State Pharmacy Assistance Program (SPAP) VA coverageVA coverage Military coverage including TRICAREMilitary coverage including TRICARE* Note: The source of the current drug coverage will Note: The source of the current drug coverage will

send a notice telling the person if it is at least as send a notice telling the person if it is at least as good as Medicare prescription drug coveragegood as Medicare prescription drug coverage



Enrolling in a PlanEnrolling in a Plan Look at Look at Medicare & You 2006Medicare & You 2006 handbook handbook Read about the prescription drug plans Read about the prescription drug plans

available in the areaavailable in the area Contact the plan to enrollContact the plan to enroll Need help choosing and enrolling in a plan?Need help choosing and enrolling in a plan?

Medicare Prescription Drug Plan Finder ToolMedicare Prescription Drug Plan Finder Tool www.medicare.govwww.medicare.gov 1-800-MEDICARE (TTY 1-800-MEDICARE (TTY 1-877-486-2048)1-877-486-2048)

Local SHIPLocal SHIP Maryland 1-800-243-3425Maryland 1-800-243-3425

CMS and partner-sponsored enrollment fairsCMS and partner-sponsored enrollment fairs



Auto-EnrollmentAuto-Enrollment Medicaid prescription drug coverage for full-benefit Medicaid prescription drug coverage for full-benefit

dual eligibles ends 12/31/05dual eligibles ends 12/31/05 Full-benefit dual eligibles who Full-benefit dual eligibles who do notdo not enroll in a plan by enroll in a plan by

12/31/0512/31/05 CMS will enroll them in a prescription drug plan with a CMS will enroll them in a prescription drug plan with a

premium covered by the low-income premium assistancepremium covered by the low-income premium assistance Their Medicare prescription drug coverage will begin Their Medicare prescription drug coverage will begin

1/1/061/1/06 Will receive letter in October with auto-assignment Will receive letter in October with auto-assignment

informationinformation Full-benefit dual eligibles have a SEPFull-benefit dual eligibles have a SEP

Can change plans any timeCan change plans any time



Facilitated EnrollmentFacilitated Enrollment CMS is facilitating the enrollmentCMS is facilitating the enrollment

MSP, SSI-only, and people who apply and MSP, SSI-only, and people who apply and qualify for extra help (but do not choose a qualify for extra help (but do not choose a plan)plan)

Enrollment facilitated if they do not Enrollment facilitated if they do not choose a plan by May 15, 2006choose a plan by May 15, 2006

Coverage effective June 1, 2006Coverage effective June 1, 2006 SEP – may change plansSEP – may change plans

MSP/SSI: Continuous SEPMSP/SSI: Continuous SEP LIS: SEP through 12/31/06LIS: SEP through 12/31/06



Extra HelpExtra Help

Assistance with premium and cost Assistance with premium and cost sharingsharing

Eligibility determined by SSA or stateEligibility determined by SSA or state Income and resource tests Income and resource tests Some groups are “deemed” eligibleSome groups are “deemed” eligible Apply with paper form or at ssa.govApply with paper form or at ssa.gov Applications accepted on a rolling Applications accepted on a rolling

basisbasis

Extra Help


Deemed EligibleDeemed Eligible

Full-benefit dual eligiblesFull-benefit dual eligibles SSI recipientsSSI recipients Medicare Savings Program groups, Medicare Savings Program groups,

e.g., QMBs, SLMBs, QIse.g., QMBs, SLMBs, QIs Received letters this summerReceived letters this summer All others must file an applicationAll others must file an application

Extra Help


Applying for Extra HelpApplying for Extra Help

People with Medicare can applyPeople with Medicare can apply Personal representatives can applyPersonal representatives can apply

Who has authority to act on behalf of a person Who has authority to act on behalf of a person with Medicare under state law (e.g., Power of with Medicare under state law (e.g., Power of Attorney, guardian) or other applicable law Attorney, guardian) or other applicable law (e.g., tribal or military)(e.g., tribal or military)

Representative payee appointed by SSARepresentative payee appointed by SSA People with Medicare and personal People with Medicare and personal

representatives may enlist others to applyrepresentatives may enlist others to apply Spouse, child, caregiver, advocacy group Spouse, child, caregiver, advocacy group

volunteervolunteer

Extra Help


Extra HelpExtra Help Group 1 (about 76,000 in MD)Group 1 (about 76,000 in MD)

Full-benefit dual eligibles with incomes at or Full-benefit dual eligibles with incomes at or below 100% Federal poverty level (FPL)below 100% Federal poverty level (FPL)

Group 2 (about 200,000 in MD)Group 2 (about 200,000 in MD) Full-benefit dual eligibles above 100% of FPL; Full-benefit dual eligibles above 100% of FPL;

QMB, SLMB, QI, SSI-only, or non-dual eligible QMB, SLMB, QI, SSI-only, or non-dual eligible beneficiaries with incomes below 135% FPL beneficiaries with incomes below 135% FPL and limited resources ($6,000 per individual and limited resources ($6,000 per individual and $9,000 married couple)and $9,000 married couple)

Group 3 (about 40,000 in MD)Group 3 (about 40,000 in MD) Beneficiaries with incomes below 150% FPL Beneficiaries with incomes below 150% FPL

and limited resources ($10,000 individual and and limited resources ($10,000 individual and $20,000 married couple)$20,000 married couple)

Extra Help


Federal Poverty Level – Federal Poverty Level – 2005*2005*

2005 FPL2005 FPL One PersonOne Person CoupleCouple 100%100% $9,570$9,570 $12,830$12,830

$797.50/mo$797.50/mo $1,069.17/mo$1,069.17/mo

135%135% $12,919$12,919 $17,320$17,320 $1,076.58/mo$1,076.58/mo

$1,443.37/mo$1,443.37/mo

150%150% $14,355$14,355 $19,245$19,245 $1,196.25/mo$1,196.25/mo

$1,603.75/mo$1,603.75/mo

*Levels revised annually in February*Levels revised annually in February

Extra Help


Extra HelpExtra Help

Group 1Group 1 Group 2Group 2 Group 3Group 3Premium Premium $32/month$32/month

$0$0 $0$0 Sliding scale Sliding scale based on based on incomeincome

Deductible Deductible $250/year$250/year

$0$0 $0$0 $50$50

Coinsurance Coinsurance up to $3,600 up to $3,600 out of pocketout of pocket

$1/$3 $1/$3 copaycopay

$2/$5 copay$2/$5 copay 15% 15% coinsurancecoinsurance

Catastrophic Catastrophic 5% or $2/$5 5% or $2/$5 copaycopay

$0$0 $0$0 $2/$5 copay$2/$5 copay

Extra Help


Out-of-Pocket ThresholdOut-of-Pocket Threshold

The amount of money to reach The amount of money to reach catastrophic coveragecatastrophic coverage

Consists ofConsists of Deductible - Deductible - $250$250 in 2006 in 2006 25% coinsurance - 25% coinsurance - $500$500 in 2006 in 2006 100% between $2,250 and $5,100 - 100% between $2,250 and $5,100 - $2,850$2,850

in 2006in 2006 Medicare prescription drug plan Medicare prescription drug plan

premium is not part of out-of-pocket premium is not part of out-of-pocket thresholdthreshold

Out-of-Pocket Threshold


Sources Applied to Out-Sources Applied to Out-of-Pocket Thresholdof-Pocket Threshold

Payment fromPayment from People with Medicare themselvesPeople with Medicare themselves Another individual such as family memberAnother individual such as family member Medicare’s cost-sharing assistanceMedicare’s cost-sharing assistance Qualified State Pharmacy Assistance Qualified State Pharmacy Assistance

ProgramProgram



Sources Sources NotNot Applied to Out- Applied to Out-of-Pocket Thresholdof-Pocket Threshold

Employer/retiree group health plansEmployer/retiree group health plans TRICARETRICARE Black LungBlack Lung VAVA Worker’s CompensationWorker’s Compensation Automobile/no-fault/liability insuranceAutomobile/no-fault/liability insurance Supplemental benefit portions of PDP Supplemental benefit portions of PDP

or MA-PDor MA-PD



Sources Sources NotNot Applied to Out- Applied to Out-of-Pocket Thresholdof-Pocket Threshold

Most third party payment Most third party payment arrangementsarrangements

Drugs purchased outside the USDrugs purchased outside the US Over-the-counter drugsOver-the-counter drugs Drugs not on the Plan’s formularyDrugs not on the Plan’s formulary Drugs not covered by lawDrugs not covered by law



How Out-of-Pocket How Out-of-Pocket Threshold WorksThreshold Works

Drug plans will calculate out-of-pocket Drug plans will calculate out-of-pocket thresholdthreshold

Drug plan will ask person with Drug plan will ask person with Medicare what third party coverage Medicare what third party coverage he/she hashe/she has

Total out-of-pocket threshold for 2006 Total out-of-pocket threshold for 2006 is $3,600is $3,600

Wrap-around drug coverage doesn’t Wrap-around drug coverage doesn’t count but is beneficialcount but is beneficial



How Out-of-Pocket How Out-of-Pocket Threshold WorksThreshold Works

Example under standard benefitExample under standard benefit Met $250 deductibleMet $250 deductible Gets a prescription for $100Gets a prescription for $100 Drug plan pays $75Drug plan pays $75 Person with Medicare pays $25Person with Medicare pays $25 $250 deductible and $25 co-insurance $250 deductible and $25 co-insurance

are counted toward out-of-pocket are counted toward out-of-pocket thresholdthreshold




OverviewOverview Eligibility and enrollmentEligibility and enrollment Extra helpExtra help Out-of-pocket thresholdOut-of-pocket threshold Medicare prescription drug Medicare prescription drug

coveragecoverage Medicare prescription drug plan finder Medicare prescription drug plan finder

web toolweb tool Partnering with CMSPartnering with CMS


Medicare Prescription Drug Medicare Prescription Drug CoverageCoverage

Available only by prescriptionAvailable only by prescription Prescription drugs, biologicals, insulinPrescription drugs, biologicals, insulin Medical supplies associated with Medical supplies associated with

injection of insulininjection of insulin A PDP or MA-PD may not cover all A PDP or MA-PD may not cover all

drugsdrugs Brand name and generic drugs will be Brand name and generic drugs will be

in each formularyin each formulary

Covered Drugs


Definition of Medicare Definition of Medicare Prescription DrugPrescription Drug

IncludesIncludes Drug dispensed by Drug dispensed by

RxRx Insulin & associated Insulin & associated

suppliessupplies Compounded drugsCompounded drugs Parenteral nutritionParenteral nutrition Vaccines (those not Vaccines (those not

currently covered by currently covered by Part B)Part B)

Does NOT IncludeDoes NOT Include Drugs covered Drugs covered

under Medicare under Medicare Parts A or BParts A or B

Those excluded by Those excluded by statute, including statute, including benzodiazepines, benzodiazepines, barbiturates, and barbiturates, and OTCs [1927(d)(2)]OTCs [1927(d)(2)]

Covered Drugs


Excluded DrugsExcluded Drugs Drugs forDrugs for

Anorexia, weight loss, or weight gainAnorexia, weight loss, or weight gain FertilityFertility Cosmetic purposes or hair growthCosmetic purposes or hair growth Symptomatic relief of cough and coldsSymptomatic relief of cough and colds

Prescription vitamins and mineral productsPrescription vitamins and mineral products Except prenatal vitamins and fluoride preparationsExcept prenatal vitamins and fluoride preparations

Non-prescription drugsNon-prescription drugs BarbituratesBarbiturates BenzodiazepinesBenzodiazepines

Covered Drugs


FormularyFormulary

Drug plans may have a formularyDrug plans may have a formulary CMS will ensure formularies do not CMS will ensure formularies do not

discourage enrollment among certain discourage enrollment among certain groups of peoplegroups of people

Formulary review requirements are Formulary review requirements are posted on the cms.hhs.gov/pdps websiteposted on the cms.hhs.gov/pdps website

CMS approved formularies in advance CMS approved formularies in advance for plans to complete their bid for plans to complete their bid

Covered Drugs


Pharmacy Access Pharmacy Access StandardsStandards

Retail pharmacy TRICARE access Retail pharmacy TRICARE access standardsstandards Urban areas: network pharmacy within 2 Urban areas: network pharmacy within 2

miles of 90% of beneficiariesmiles of 90% of beneficiaries Suburban areas: network pharmacy within Suburban areas: network pharmacy within

5 miles of 90% of beneficiaries5 miles of 90% of beneficiaries Rural areas: network pharmacy within 15 Rural areas: network pharmacy within 15

miles of 70% of beneficiariesmiles of 70% of beneficiaries

Covered Drugs


Count toward TRICARE standards:Count toward TRICARE standards: Community pharmaciesCommunity pharmacies Indian Tribe/Tribal Organization/Urban Indian Tribe/Tribal Organization/Urban

Indian Organization (I/T/U) pharmaciesIndian Organization (I/T/U) pharmacies Federally Qualified Health Center Federally Qualified Health Center

pharmaciespharmacies Rural Health CenterRural Health Center

Community Pharmacy Access Community Pharmacy Access StandardsStandards

Does not countDoes not count Mail-service pharmaciesMail-service pharmacies

Covered Drugs


Medicare Prescription Drug Medicare Prescription Drug Plan Finder Web ToolPlan Finder Web Tool

Makes it easy to find & compare Medicare Makes it easy to find & compare Medicare drug plansdrug plans

www.medicare.govwww.medicare.gov To use, a person needs:To use, a person needs:

Medicare cardMedicare card List of prescription drugsList of prescription drugs

Key factors to consider:Key factors to consider: CostCost CoverageCoverage ConvenienceConvenience




finder web toolfinder web tool• Partnering with CMSPartnering with CMS


Partnering with CMSPartnering with CMS

Education is keyEducation is key We need your help to reach beneficiariesWe need your help to reach beneficiaries CMS Partner Center CMS Partner Center

http://www.cms.hhs.gov/partnerships/http://www.cms.hhs.gov/partnerships/ Key messagesKey messages Outreach toolkitOutreach toolkit Fact sheets and timelinesFact sheets and timelines Presentations, handouts, scripts, and morePresentations, handouts, scripts, and more

SocialSecurity.gov for information about SocialSecurity.gov for information about extra helpextra help

Partnering with CMS


CMS Marketing Guidance: CMS Marketing Guidance: Providers CAN…Providers CAN…

• Provide names of plans Provide names of plans with which they with which they participateparticipate

• Provide objective Provide objective information on specific information on specific plansplans

• Distribute PDP marketing Distribute PDP marketing materials, including materials, including enrollment applications*enrollment applications*

• Distribute MA and/or MA-Distribute MA and/or MA-PD marketing materials, PD marketing materials, excluding enrollment excluding enrollment applicationsapplications

• Provide information and Provide information and assistance in applying for assistance in applying for the low-income subsidythe low-income subsidy

• Refer patients to other Refer patients to other sources of informationsources of information

• Print out and share Print out and share information with patients information with patients from CMS web sitefrom CMS web site

• Use comparative Use comparative marketing materials marketing materials created by a non-created by a non-benefit/service providing benefit/service providing third-partythird-party

Partnering with CMS


CMS Marketing Guidelines:CMS Marketing Guidelines:Providers CANNOT…Providers CANNOT…

Direct, urge, or attempt Direct, urge, or attempt to persuade any to persuade any prospective enrollee or prospective enrollee or to insure with a to insure with a particular company particular company based on financial or based on financial or any other interest of the any other interest of the provider (or provider (or subcontractor)subcontractor)

Collect enrollment Collect enrollment applicationsapplications

Offer inducements to Offer inducements to persuade beneficiaries persuade beneficiaries to enroll in a particular to enroll in a particular plan or organizationplan or organization

• Health screen when Health screen when distributing information distributing information to patientsto patients

• Offer anything of value Offer anything of value to induce Plan enrollees to induce Plan enrollees to select them as a to select them as a providerprovider

• Expect compensation Expect compensation for enrollment of a for enrollment of a beneficiarybeneficiary

• Expect compensation Expect compensation directly or indirectly directly or indirectly from the Plan for from the Plan for beneficiary enrollment beneficiary enrollment activitiesactivities

Partnering with CMS


CMS Marketing Guidelines:CMS Marketing Guidelines:

“Common Areas”“Common Areas”Common Areas:Common Areas: Hospital or nursing Hospital or nursing

home cafeteriashome cafeterias Community or Community or

recreational roomsrecreational rooms Conference roomsConference rooms AWAYAWAY from the from the

pharmacy counter, pharmacy counter, where patients wait for where patients wait for services or interact services or interact with pharmacy with pharmacy providers and obtain providers and obtain medicationsmedications

NOT Common Areas:NOT Common Areas: Areas where patients Areas where patients

primarily intend to primarily intend to receive health care receive health care servicesservices

Waiting roomsWaiting rooms Exam roomsExam rooms Hospital patient roomsHospital patient rooms Pharmacy counter Pharmacy counter

areas where patients areas where patients wait for services or wait for services or interact with pharmacy interact with pharmacy providers and obtain providers and obtain medicationmedication

Partnering with CMS


For More InformationFor More Information

Visit www.medicare.govVisit www.medicare.gov Visit www.cms.hhs.govVisit www.cms.hhs.gov Publications such as:Publications such as:

Medicare & YouMedicare & You 20062006 handbookhandbook

Facts About Medicare Facts About Medicare Prescription Drug PlansPrescription Drug Plans

1-800-MEDICARE1-800-MEDICARE


Patrick Hamilton, Rural Health Coordinator:

[email protected]

215-861-4097

medicare prescription drug coverage patrick hamilton rural health coordinator centers for medicare...

Documents

drug costs coverage

drug costs eligible

medicare available

beneficiary pays

retirees overview slide

coinsurance overview

cms slide

enrollment eligibility