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Medicare & Medicaid Drug coverage 5U~~E ~Yk.~ MEMORANDUM May 12, 2005 i....--....) TO: The Honorable Mayor and City Council Members -~ , , ,'"J i )'-, i FROM: Michael C. Van Milligen, City Manager SUBJECT: Centers for Medicare and Medicaid Services ,";.., I have spoken with the U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services Health Insurance Specialist Nancy Schmidt about the April 25, 2005 letter to the City from Regional Administrator Thomas Lenz. I have offered the services of Public Information Officer Randy Gehl, Public Health Specialist Mary Rose Corrigan and Housing and Community Development Department Director David Harris to assist with publicizing the availability of prescription drug coverage for Medicare recipients, /11\ C/ I1J, IL / L (..\-~ I ' ' Michael C. Van Milligen MCVM/jh Attachment cc: Barry Lindahl, Corporation Counsel Cindy Steinhauser, Assistant City Manager Mary Rose Corrigan, RN, Pubic Health Specialist David Harris, Housing and Community Development Department Director Randy Gehl, Public Information Officer DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 601 East 12'h Street, Suite 235 Kansas City, Missouri 64106 CAlS ",',_~'ii"'~~'""",k-"Ji\il.'..:t'~",~.;it4~;;:i:&,_"<'i':<;~;'0<.t,;'i,-,,*k,,,~k\\.;.ifi,~"#;:M~c;l'~4;':""'" 0,.'Aii';ii CENTERS for MEDICARE & MEDICAID SERVICES Office of the Regional Administrator April 25, 2005 City Manager Michael Van Milligen City Hall 50 W 13th St. Dubuque, IA 52001 Dear City Manager Van Milligen, For the first time in its history, Medicare will soon offer prescription drug coverage to all people with Medicare. Over two-million people with Medicare in our area will be able to get help paying for the prescriptions they need. There are approximately 14,616 people with Medicare currently residing in Dubuque County, which is 16.4 percent of the population of people with Medicare in the county. The Medicare Modernization Act (MMA) contains a number of substantive changes that affect people with Medicare in your city. The most significant change is the creation of a new prescription drug benefit, along with coverage for preventive services, improvements to Medicare managed care (known as Medicare Advantage) and a retiree options program which allows employer health plans to preserve existing retiree drug coverage. The Centers for Medicare & Medicaid Services (CMS) knows that the key to successful implementation of the drug coverage is education. The CMS Kansas City Regional Office (KCRO) staff is actively working to build new relationships with a wide variety of organizations and to educate these partners on the upcoming drug coverage so they can, in turn, assist us in educating all people with Medicare, as well as health care providers, family caregivers, and other key information sources. We hope that you will help us by facilitating information dissemination, mobilizing constituencies, encouraging enrollment and generating ideas for increasing awareness in your city. To brief you and your staff on the changes brought about by the MMA, and the implications for your citizens, enclosed please find three MMA Fact Sheets, a timeline for MMA implementation and a calendar of key dates in 2005. More detailed information about the MMA can be found on CMS' website at www.cms.hhs.gov/medlcarereform. Also, the CMS KCRO is available to provide you with further information in the form of speakers at meetings and monthly Question and Answer articles for publication in newsletters. We look forward to working with you and your staff as we continue to implement the MMA provisions. To ensure that you have the information needed and to answer any questions, Nancy Schmidt of my staff will call your office in the near future. If you need information and/or assistance before hand, please feel free to contact her at 816-426-6519 or Nancy .Schmidt@cms.hhs.gov. Sincerely, ~al~ Thomas W. Lenz Regional Administrator Centers for Medicare & Medicaid Services Enclosures Facts about Medicare Prescription Drug Plans Facts about Medicare's New Preventive Benefits Facts about Medicare Advantage The Road to Improving Medicare Benefits Key Medicare Dates for 2005 " The Facts About Medicare Prescription Drug Plans Coming in 2006 MEDICARE MODERNIZATION ACT What are Medicare prescription drug plans? Beginning January 1, 2006, new Medicare prescription drug plans will be available to people with Medicare. Insurance companies and other private companies will work with Medicare to offer these drug plans. They will negotiate discounts on drug prices. These plans are different from the Medicare-approved drug discount cards, which phase out by May 15, 2006, or when your enrollment in a Medicare prescription drug plan takes effect, if earlier. Medicare prescription drug plans provide insurance coverage for prescription drugs. Like other insurance, if you join you will pay a monthly premium (generally around $35 in 2006) and pay a share of the cost of your prescriptions. Costs will vary depending on the drug plan you choose. Drug plans may vary in what prescription drugs are covered, how much you have to pay, and which pharmacies you can use. All drug plans will have to provide at least a standard level of coverage, which Medicare will set. However, some plans might offer more coverage and additional drugs for a higher monthly premium. When you join a drug plan, it is important for you to choose one that meets your prescription drug needs. When can I join a Medicare prescription drug plan? If you currently have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance), you can join a Medicare prescription drug plan berween November 15, 2005, and May 15, 2006. If you join by December 31, 2005, your Medicare prescription drug plan coverage will begin on January 1, 2006. If you join after that, your coverage will be effective the first day of the month after the month you join. In general, you can join or change plans once each year berween November 15 and December 31. Even if you don't use a lot of prescription drugs now, you still should consider joining a plan. If you don't join a plan by May 15, 2006, and you don't have a drug plan that covers as much or more than a Medicare prescription drug plan, you will have to pay more each month to join later. What if I can't pay for a Medicare prescription drug plan? Some people with an income at or below a set amount and with limited assets (including your savings and stocks, but not counting your home) will qualifY for extra help. The exact income amounts will be set in early 2005. People who qualifY will get help paying for their drug plan's monthly premium, and/or for some of the cost they would normally have to pay for their prescriptions. The type of extra help will be based on your income and assets. Look for details in the mail from Medicare and the Social Security Administration (SSA). If you think you qualifY for extra help, you can sign up with SSA or your local Medicaid office as early as the summer of2005. Do Medicare prescription drug plans work with all types of Medicare health plans? Yes. There will be Medicare prescription drug plans that add coverage to the Original Medicare Plan. These plans will be offered by insurance companies and other private companies. There will also be other drug plans that are a part of Medicare Advantage Plans (like HMOs), in some areas. What if I already have prescription drug coverage from a Medigap (Supplemental Insurance) Policy? If you have a Medigap policy with drug coverage, you will get a detailed notice from your insurance company telling you whether or not your policy covers as much or more than a Medicare prescription drug plan. This notice will explain your rights and choices. What if I have prescription drug coverage from an employer or union? If you have prescription drug coverage from an employer or union, you will get a notice from your employer or union that tells you if your plan covers as much or more than a Medicare prescription drug plan. If your employer or union plan covers as much as or more than a Medicare prescription drug plan you can. . . . keep your current drug plan. If you join a Medicare prescription drug plan later your monthly premium won't be higher, or drop your current drug plan and join a Medicare prescription drug plan, but you may not be able to get your employer or union drug plan back. . If your employer or union plan covers less than a Medicare prescription drug plan you can. . . · keep your current drug plan and join a Medicare prescription drug plan to give you more complete prescription drug coverage, or · just keep your current drug plan. But, if you join a Medicare prescription drug plan later, you will have to pay more for the monthly premium, or · drop your current drug plan and join a Medicare prescription drug plan, but you may not be able to get your employer or union drug plan back. When will I get more information? Throughout 2005, Medicare will provide you more information about Medicare prescription drug plans, including how to choose and join a drug plan that best meets your needs. In the fall of 2005, the "Medicare & You 2006" handbook will list the Medicare prescription drug plans available in your area. In mid-2005, SSA will send people with certain incomes information about how to apply for extra help paying their prescription drug cOSts. How can I get help choosing a Medicare prescription drug plan? In the fall of 2005, you will be able to get personalized information at www.medicare.gov on the web, or by calling I-800-MEDICARE (1-800-633-4227) to help you make your best choice. TTY users should call 1-877-486-2048. Your State Health Insurance Assistance Program (SHIP), and other local and community-based organizations, will also provide you with free health insurance counseling. t. The Facts about Medicare's New Preventive Benefits MEDICARE MODERNIZATION ACT It makes sense to prevent diseases, not just treat them. Eat well, stay active, stop smoking, and get the preventive services you need. Medicare covers many different preventive benefits such as screening tests for many cancers, flu vaccine and other shots, and a variety of other tests. What new preventive benefits does Medicare cover? Starting January 1, 2005, Medicare will cover these three new preventive benefits: · One-time "Welcome to Medicare" physical exam for people new to Medicare · Cardiovascular screening · Diabetes screening Note: These new preventive services are covered no matter what kind of Medicare health plan you have. However, the amount you pay for these services varies depending on the type of health plan. This fact sheet explains the way these preventive services are covered if you have Part B under the Original Medicare Plan (sometimes called fee-for-service). If you have another type of Medicare health plan, call the plan for specific information. What is the new ..Welcome to Medicare.. physical exam? If your Medicare Part B coverage begins on or after January 1, 2005, Medicare will cover a one-time preventive physical exam within the first six months that you have Part B. The exam will include a review of your health; education and counseling about the preventive services you need, like certain screenings and shots; and referrals for other care. The "Welcome to Medicare" physical exam is a great way to get up-to-date on important screenings and shots, and to talk with your doctor about your family history and how to stay healthy. What should I expect during my exam? During the exam, your doctor will record your medical history and check your blood pressure, weight and height. Your doctor will also give you or order an Electrocardiogram (EKG) and a vision test. Your doctor will check to make sure that you are up-to-date with your shots. Depending on your general health and medical history, further tests may be ordered, if necessary. Your doctor will also give you advice to help you prevent disease, improve your health and stay well. You will also get a written plan (such as a checklist) when you leave letting you know which screenings and other preventive services you should get. / fa. e C(\ (\t\C . 5\;t f e It\ ;11 What should I bring with me to the exam? When you go to your "Welcome to Medicare" physical exam, bring your · medical records, including immunization records (if you are seeing a new doctor). Call your old doctor to get copies of your medical records. · family health history-try to learn as much as you can about your family's health history before your appointment. Any information you can give your doctor can help determine if you are at risk for certain diseases. · list of prescription and over-the-counter drugs that you currently take, how often you take them, and why. How much does the exam cost? You pay 20% of the Medicare-approved amount after you meet the yearly Part B deductible ($110 for 2005). Since this may be your first Medicare-covered service, you may meet your entire Part B deductible at this visit. q Remember! Medicare will only cover your "Welcome to Medicare" physical exam if you get it within the first six months you have Part B. Note: If your doctor thinks this six-month period has passed, he or she should give you a notice that says Medicare probably won't pay for this service. If you still want to get the service, you will be asked to sign an agreement that you will pay for the service yourself if Medicare doesn't pay for it. This is called an Advance Beneficiary Notice. What is the new Cardiovascular Screening? Medicare covers cardiovascular screenings that check your cholesterol and other blood fat (lipid) levels. High levels of cholesterol can increase your risk for heart disease and stroke. These screenings will tell you if you have high cholesterol. You might be able to make lifestyle changes (like changing your diet and exercising more often) to lower your cholesterol and stay healthy. Medicare will cover these tests every five years and you pay nothing. What is the new Diabetes Screening? Diabetes is a medical condition in which your body doesn't make enough insulin or has a reduced response to insulin. Diabetes causes your blood sugar to be too high because insulin is needed to use sugar properly. For people with Medicare at risk for getting diabetes, Medicare covers a screening blood sugar test to check for diabetes. You are considered at risk if you have any of the following: high blood pressure, dyslipidemia (history of abnormal cholesterol and triglyceride levels), obesity, or a history of high blood sugar. Other risk factors may also qualifY you for this test. Based on the test results, you may be eligible for up to two screenings each year. You pay nothing for these tests. Medicare also covers certain supplies and self-management training to control and treat diabetes. For more information about these and other Medicare preventive services, get a free copy of the Guide to Medicare's Preventive Services (CMS Pub. No. 10110) at www.medicare.gov on the web. Or, call1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877 -486- 2048. 'U.S. Government Printing Office: 2005-751-624 ,~ +'~!:1@' The Facts About Medicare Advantage - - MEDICARE MODERNIZATION ACT What is Medicare Advantage? Medicare Advantage is the new name for Medicare + Choice Plans-but it's more than just a new name. Medicare Advantage gives you more health care coverage choices and better health care benefits. This fact sheet has basic information about how Medicare Advantage affects your health care choices, and has contact information for where to get your questions answered. Medicare Advantage Plans are offered in many areas of the country by private companies that sign a contract with Medicare. Medicare pays a set amount of money to these private health plans for your health care. You must have Medicare Part A and Part B to join a Medicare Advantage Plan. Medicare Advantage Plans provide Medicare-covered benefits to Medicare members through the plan, and may offer extra benefits that Medicare doesn't cover, such as vision or dental services. You may have to pay an additional monthly premium for the extra benefits. The plan may have special rules that you need to follow. What are Medicare Advantage Plan Choices? Medicare Advantage Plans are a way that you can get your Medicare health care. You can choose to get your health care from the Original Medicare Plan, or from a Medicare Advantage Plan in your area. Most Medicare Advantage Plans charge an extra monthly premium and may charge copayments. But, they usually provide you with more benefits than the Original Medicare Plan. Medicare Advantage Plans include: · Medicare Managed Care Plans (like HMOs)-You see doctors in the plan's network. A primary doctor coordinates your health care. Referrals are usually required to see specialists. These plans have been part of Medicare longer than any other Medicare Advantage Plan. · Medicare Preferred Provider Organization Plans (PPOs)- You can see any doctor, but it costs less to see doctors in the plan's network. Some plans don't require a referral to see a specialist. PPOs are among the most common and popular plans right now for Americans with private insurance. · Private Fee-for-Service Plans-You can see any doctor that accepts the plan's payment terms. The private company, not Medicare, negotiates with providers to decide how much it will pay and what you pay for the services you get. No referrals are necessary. · Medicare Specialty Plans will be available in some areas. They provide all Medicare health care for certain people with Medicare with special needs, such as people in institutions. ~~~c~ ~ . ~ ..,. "c\. e(\ ee . ,\,(\11 ',15\1 (\1'e \ What if I have a Medigap policy? If you get your Medicare health care from the Original Medicare Plan, you may have a Medigap (Medicare supplement insurance) policy to pay the gaps in Original Medicare Plan coverage. Medigap policies only work with the Original Medicare Plan. You don't need to buy a Medigap policy if you are in a Medicare Advantage Plan. Will a Medicare Advantage Plan pay for my presoiption drugs? Some Medicare Advantage Plans include coverage for prescription drugs. Some plans may also offer new Medicare-approved drug discount cards to help you save on your outpatient prescription drugs. Extra help paying for prescription drugs may be available if you have a low income and limited assets. Are there more changes coming? C' In 2006, the law will provide for a new option-regional PPOs. Regional PPOs can give more people with Medicare multiple choices for Medicare health care coverage. Regional PPO members will have an added protection-a limit for their out-of-pocket copayment costs. Also, Medicare prescription drug plans will be available to people with Medicare in 2006. It will be important for you to compare the drug plans in your area to pick the one that is best for you. Do I have to change how I get my health care? No. If you are happy with your health care coverage now, you don't have to change. If you are in a Medicare + Choice Plan now, you don't have to do anything. Your plan will automatically become a Medicare Advantage Plan. The traditional fee-for-service Medicare (Original Medicare Plan) that you know and trust is still here for you. If you want to stay in traditional Medicare, you don't have to do anything. No matter what you decide, you are still in the Medicare program. Who can answer my Medicare questions? For the latest information about Medicare, visit www.medicare.gov on the web, or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. To find out which Medicare health plans are available in your area, look at www.medicare.gov on the web. Select "Medicare Personal Plan Finder." This tool helps you narrow down your Medicare health plan choices and choose the plan that's best for you. Or, calII-800-MEDICARE (1-800-633-4227) and ask about health plans in your area. TTY users should call 1-877-486-2048. To get a copy of this information in Spanish, calII-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Para una copia en espafiol, llame gratis alI-800-MEDICARE (1-800-633-4227). Los usuarios de TTY deben llamar alI-877-486-2048. " '. " ..., "".. I . 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