Retiree Health Benefits Retiree Health Benefits ProgramProgram

Medicare Part D Medicare Part D

and Your State Benefitsand Your State Benefits

Your Benefits ChoicesYour Benefits Choices

We Will Look At…We Will Look At…

The good news!The good news! Basic Medicare Part D Basic Medicare Part D Your choices under the Your choices under the

Retiree Health Benefits Retiree Health Benefits ProgramProgram

Actions you need to take Actions you need to take and whenand when

The Good News

State program’s new State program’s new prescription drug option applies prescription drug option applies the value of Medicare Part Dthe value of Medicare Part D

Lower premiums and more Lower premiums and more flexibilityflexibility

Basic Medicare Part DBasic Medicare Part D

Passed Congress in 2003 and takes Passed Congress in 2003 and takes effect on Jan. 1, 2006effect on Jan. 1, 2006

Provided by Medicare-approved Provided by Medicare-approved Prescription Drug Plans (PDPs)Prescription Drug Plans (PDPs)

Enrollment period is November 15, Enrollment period is November 15, 2005 – May 15, 2006 2005 – May 15, 2006

You enroll in a PDP, can switch each You enroll in a PDP, can switch each yearyear

Basic Medicare Part DBasic Medicare Part D

Coverage includes a formulary, or list Coverage includes a formulary, or list of drugs covered by the plan of drugs covered by the plan

Some drug categories are not covered, Some drug categories are not covered, for examplefor example Drugs for symptomatic relief of Drugs for symptomatic relief of

cough and coldscough and colds Drugs used for cosmetic purposesDrugs used for cosmetic purposes Drugs for weight loss or weight gainDrugs for weight loss or weight gain BarbituratesBarbiturates

Basic Medicare Part D Basic Medicare Part D

Drug ExpenseDrug Expense You Pay (Covered You Pay (Covered Drugs)Drugs) Potential OOP Potential OOP

$0 - 250$0 - 250 DeductibleDeductible $250$250

$250 - 2,250$250 - 2,250 25% Coinsurance25% Coinsurance $500$500

$2,250 - 5,100$2,250 - 5,100 100% Coinsurance100% Coinsurance $2,850$2,850

$5,100+$5,100+ 5% Coinsurance/$2/$55% Coinsurance/$2/$5 5% of Unknown5% of Unknown

National Average Estimated Monthly Premium = $32.20 National Average Estimated Monthly Premium = $32.20

Adjusted Each Year for InflationAdjusted Each Year for Inflation

The State Program The State Program and Youand You

This Means….This Means…. Lower premiums and more flexibility!Lower premiums and more flexibility!

Retiree Health Benefits Program

State Enhanced Medicare State Enhanced Medicare Part D BenefitPart D Benefit

Incorporates Part D value into state Incorporates Part D value into state programprogram

Enhances Part D benefit Enhances Part D benefit

Retiree Health Benefits Program

State Enhanced Medicare State Enhanced Medicare Part D BenefitPart D Benefit

Broad formulary includes generic, preferred Broad formulary includes generic, preferred brand and non-preferred brand drugsbrand and non-preferred brand drugs

Low copayments for generic and preferred Low copayments for generic and preferred brand drugsbrand drugs

Protection through the“donut hole” ($2,250 Protection through the“donut hole” ($2,250 - $5,100) in Basic Part D - $5,100) in Basic Part D

Retiree Health Benefits Retiree Health Benefits ProgramProgram

State Enhanced Medicare Part State Enhanced Medicare Part D BenefitD Benefit

Administered by Medco Health Administered by Medco Health Solutions, Inc.Solutions, Inc.

Medco national prescription drug Medco national prescription drug networknetwork

No deductible for generic drugsNo deductible for generic drugsDrug tiers based on type and costDrug tiers based on type and cost

Retiree Health Benefits Retiree Health Benefits ProgramProgram

State Enhanced Medicare State Enhanced Medicare Part D BenefitPart D Benefit

Per Day SupplyPer Day Supply Generic Generic Drugs Drugs

Tier 1Tier 1

Preferred Preferred BrandBrand

Tier 2Tier 2

Non-Preferred Non-Preferred BrandBrand

Tier 3Tier 3

Specialty Specialty DrugsDrugs

Tier 5Tier 5

No No deductible deductible

**$250 deductible applies****$250 deductible applies**

30 days 30 days retailretail

You pay You pay

$4 $4

You payYou pay

$17 $17

You payYou pay

75% 75%

You pay You pay

25% 25%

90 days 90 days mail ordermail order

You payYou pay

$4 $4

You payYou pay

$34 $34

You payYou pay

75%75%

You payYou pay

25%25%

Retiree Health Benefits Program

State Plans with Enhanced Medicare Part D BenefitState Plans with Enhanced Medicare Part D Benefit Starting January 1Starting January 1

Advantage 65 Advantage 65 Advantage 65 + Dental/VisionAdvantage 65 + Dental/Vision Option IOption I Option II Option II Option II + Dental/VisionOption II + Dental/Vision

Same medical coverage as todaySame medical coverage as todayNew enhanced Part D coverageNew enhanced Part D coverage

Retiree Health Benefits Program

New Medical-Only Plans Starting New Medical-Only Plans Starting January 1January 1

Advantage 65 Medical-Only Advantage 65 Medical-Only Advantage 65 Medical-Only Plus Advantage 65 Medical-Only Plus

Dental/VisionDental/Vision Include same medical (and Include same medical (and

dental/vision) benefits as todaydental/vision) benefits as todayNo prescription drug coverageNo prescription drug coverage

Retiree Retiree Health Benefits ProgramHealth Benefits Program

PlanPlan 2005 2005 PremiumPremium

2006 2006 Premium Premium

Increase/Increase/DecreaseDecrease

Advantage 65 (includes drug)Advantage 65 (includes drug) $293$293 $220$220 ($73)($73)

Advantage 65 + Dental/Vision Advantage 65 + Dental/Vision (includes drug)(includes drug) $320$320 $249$249 ($71)($71)

Option I (includes drug)*Option I (includes drug)* $259$259 $183$183 ($76)($76)

Option II (includes drug)*Option II (includes drug)* $317$317 $259$259 ($58)($58)

Option II + Dental/Vision Option II + Dental/Vision (includes drug)*(includes drug)* $344$344 $288$288 ($56)($56)

Advantage 65 – Medical OnlyAdvantage 65 – Medical Only N/AN/A $117$117 ($176)($176)

Advantage 65 – Medical-Only + Advantage 65 – Medical-Only + Dental/VisionDental/Vision N/AN/A $146$146 ($174)($174)

Total Premiums

*No new enrollees*No new enrollees

Retiree Health Benefits Program

State Enhanced Medicare Part D Benefit Vs. State Enhanced Medicare Part D Benefit Vs. Other Drug Plan ChoicesOther Drug Plan ChoicesGather informationGather informationCompare costs Compare costs Check formulariesCheck formularies ConvenienceConveniencePeace of MindPeace of MindChoose the plan that is best for you!Choose the plan that is best for you!

Retiree Health Benefits Retiree Health Benefits ProgramProgram

What Do I Need to Do?What Do I Need to Do?Review the notification materials carefully, Review the notification materials carefully, then choose one:then choose one:

Do nothingDo nothing and remain in your current plan with and remain in your current plan with the Enhanced Part D Drug Benefit the Enhanced Part D Drug Benefit

Select a state medical-only planSelect a state medical-only plan and and re-enroll in a re-enroll in a separate Part D plan separate Part D plan (no return to state drug (no return to state drug coverage in the future)coverage in the future)

Cancel state program coverage Cancel state program coverage If you cancel state program coverage, you If you cancel state program coverage, you cannot cannot

returnreturn

Retiree Health Benefits Retiree Health Benefits ProgramProgram

What Do I Need to Do?What Do I Need to Do?Use the special enrollment form in your notification Use the special enrollment form in your notification

package to make a choice:package to make a choice: Enroll in a Medical-Only PlanEnroll in a Medical-Only Plan Cancel state program coverageCancel state program coverage Switch from Option I, Option II to Advantage 65 plansSwitch from Option I, Option II to Advantage 65 plans Take other permitted enrollment actionsTake other permitted enrollment actions

Retiree Health Benefits Retiree Health Benefits ProgramProgram

What Do I Need to Do?What Do I Need to Do?Return form by Return form by November 30, 2005November 30, 2005Provide Medicare Claim Number (if appropriate – Provide Medicare Claim Number (if appropriate –

see form)see form) If your form is If your form is not receivednot received by November 30, by November 30, you you

defaultdefault to your current plan with state Enhanced to your current plan with state Enhanced Medicare Part DMedicare Part D

Retiree Health Benefits Retiree Health Benefits ProgramProgram

Getting AssistanceGetting AssistanceState Medicare-coordinating prescription drug State Medicare-coordinating prescription drug

coverage coverage Medco:Medco:

1-800-572-40981-800-572-4098Medco Medicare Part D Plan quick link:Medco Medicare Part D Plan quick link:

www.dhrm.virginia.gov/hbenefits/retirees/medicareretireewww.dhrm.virginia.gov/hbenefits/retirees/medicareretiree.html.html

Retiree Health Benefits Retiree Health Benefits ProgramProgram

Getting AssistanceGetting AssistanceMedicare Part D plans (not associated with Medicare Part D plans (not associated with

the state program) the state program) Medicare:Medicare:

1-800-Medicare1-800-Medicarewww.medicare.govwww.medicare.gov

Medicare Part D Medicare Part D and Your Benefitsand Your Benefits

Thanks for Thanks for listening!listening!

Now’s the time Now’s the time to ask to ask questions questions

Make the right choice for you!Make the right choice for you!