October 2005 Newsletter
Volume 5, Number 2
~ SPECIAL ISSUE ~
This edition of the Working Healthy Newsletter focuses on the issue of new Medicare
prescription drug coverage created by Title I of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (MMA), also known as Medicare Part
D. More than 90% of people enrolled in Working Healthy are dually eligible for
both Medicare and Medicaid coverage. On January 1, 2006, these individuals will
no longer be able to obtain prescription drugs through Medicaid. Instead, they
will be required to participate in a Part D plan. The transition to Medicare
coverage carries with it a new set of rules and regulations for people to navigate.
Working Healthy staff stand ready to help with the change.
NOTICE: Important Error in "Medicare and You 2006"
Handbook
(taken from the “Disability Benefits
101 Website, http://www.disabilitybenefits101.org/ca/news/news_1671.htm)
According to the Associated Press, CMS has already mailed 35 million copies
of its annual handbook, “Medicare & You” to Medicare beneficiaries
this year.
“ Medicare & You 2006” explains the new Medicare Prescription Drug Benefit. A section starting on page 97-A has tables comparing Drug Plans within specific regions of the country. The last column on these tables contains incorrect information about the Low Income Subsidy, which CMS calls Extra Help.
The column has the heading, “If I Qualify for Extra Help, will My Full
Premium be Covered?” It lists “Yes” for all of the Plans.
It SHOULD list “Yes” for Plans that have premiums at or below the
regional benchmark and “No” for the Plans that have premiums above
the benchmark. This information is important for people who are receiving Extra
Help and who want to switch plans.
You can find corrected versions of the Handbook for your region on the CMS
website at http://www.cms.hhs.gov/partnerships/tools/materials/publications/state/handbook2006/default.asp
Medicare Prescription Drug Plan - Part D Outreach
By Nancy Scott, Benefits Specialist Team Leader
Working Healthy received grant funding to provide outreach to Working Healthy beneficiaries and others who are dually-eligible (Medicare and Medicaid). To date we have provided more than 85 presentations statewide to more than 1,000 community service providers and beneficiaries at sites in many Kansas communities.
At presentations we stressed that we’re not promoting Medicare Part D,
but sharing as much information as we have available at this time and that
Medicare is still developing the program policy and details may change. Many
people were anxious about the different drug plans, but we didn’t have
any specific information to share until the drug formulary plans are announced
mid-October. Many participants stressed the need for another round of presentations
after the plans are announced. Consequently, we are in process of developing
more presentation dates and updated materials. Dates and locations for future
presentations will be posted on the Working Healthy website, www.workinghealthy.org.
Several of the same questions tended to come up at our outreach presentations.
These frequently asked questions and our responses to them were documented
in order to remain consistent throughout all presentations. We also believe
that being aware of these questions will help us develop our next round of
presentations. Two of the most frequently asked questions (with answers provided)
were:
1. Question: How often can I change plans?
Answer: Dual eligibles may change plans monthly. All others may change plans
at Annual Enrollment. Every year, you will be able to choose another Medicare
prescription drug plan or Medicare Advantage plan during an annual enrollment
period that lasts from November 15 through December 31. Coverage under the
new plan will begin January 1 of the following year.
2. Question: What if I already have prescription drug coverage?
Answer: Check with your current plan to see if the coverage is as good as,
or better than, Medicare Part D.
If it is, you may keep your current coverage. If at some point you need
to enroll in Part D, you will need to show
Medicare that the insurance you had was comparable to Part D in order to
avoid a premium penalty. It is important to keep the information from your
insurance
carrier in order to prove you had this coverage when you wish to enroll
in Medicare Part D in the future without a penalty.
Many people voiced their concerns about finding a plan that covered their prescription drugs. Beneficiaries who are dually-eligible will be automatically enrolled in the program and placed in a plan. This plan may or may not be the best one for them. In presentations we stressed the importance of reviewing the plan you are placed in and making changes if necessary.
The companies that will be providing Part D coverage and their prescription
plans have been announced and the formularies (listing of covered medications)
will
be announced in mid-October. Medicare has several online tools that will
be helpful to people in determining what plan options are best for them.
The Medicare
prescription
drug plan cost estimator will show beneficiaries how much they may save
with Medicare Part D coverage. The Drug Plan Finder Tool can illustrate
the best
plan options. These tools can be found on the Medicare website at: http://www.medicare.gov/medicarereform/drugbenefit.asp.
Working Healthy Benefits Specialists will be available at presentations
and conferences to assist people with these tools and any other questions
they
may have regarding
Medicare Part D. Service providers and beneficiaries are also welcome
to contact their Working Healthy Benefits Specialists directly or by
calling
the Working
Healthy toll free number, 1-800-449-1439.
Benefits Specialist Corner
This issue features Working Healthy Benefits Specialist
Sherri Sherman from the Hays Area SRS Office. Sherri has worked for SRS for over
twelve years and has been a part of the Working Healthy team for almost
two years. She enjoys spending time with her family and friends, cooking, working
in the
garden, listening to music and going to art openings and museums. An ideal weekend
for Sherri would be spent with her two college-aged children. With both kids
in college coordinating schedules is difficult, so bringing everyone together
is a rare and treasured family treat. Sherri covers a large portion of western
Kansas
for the Working Healthy program and can be contacted by phone at (785)
628-1066
ext. 268 or by E-mail at HASAS@srskansas.org.
“Working Healthy Benefits Specialists have completed the first round
of Medicare Part D outreach. This outreach was completed either alone, with
the help of another Benefits Specialist or with the input of Senior Health
Insurance Counseling of Kansas (SHICK), the Social Security Administration
(SSA) and Community Collaboration staff at SRS. It was not always easy, as
some beneficiaries and community agencies were upset about the change before
having any information about it. Many others were grateful that we were able
to share information with them. It is human nature not to like change and to
have a fear of the unknown; we hope that through our outreach we have shed
light on some of the unknowns regarding Medicare Part D. We are all hoping
for a smooth transition for our dually eligible (Medicare and Medicaid) beneficiaries.
To make this happen, we will need to be proactive and pay attention to specific
dates.
Important dates to remember are:
October 2005 - Beneficiaries will receive the “Medicare
and You” handbook.
This handbook will be mailed to all Medicare beneficiaries and will contain
drug plan information.
Mid-October 2005 - Center for Medicare and Medicaid Services
(CMS) will assign dually eligible beneficiaries, those with both Medicare and
Medicaid, to prescription
drug plans and notify them of their assignment.
November 1, 2005 - CMS will begin routine monthly auto-enrollment
of new full dual beneficiaries.
November 15, 2005 - All Medicare beneficiaries can start to
choose a plan. Dually eligible beneficiaries will be able to change plans.
A decision to change should
be based upon whether the plan assigned to you covers the prescriptions that
you take. Plan changes must be completed by December 31, 2005.
January 1, 2006 - Medicare Part D begins.
Please make the choice to become involved in making sure that you have the
plan that is best for you. Fill out our worksheet with the prescriptions you
take ahead of time, so that you will be ready to check the plan you are assigned.
Then if needed, you can change your plan. You can get a worksheet from your
Working Healthy Benefits Specialist if you do not have one. If you were not
able to attend one of our previous outreach sessions, plan to come to one in
the second round. Together we can work for the smooth transition from Medicaid
to Medicare Part D for prescription drug coverage.”
-Sherri Sherman, Working Healthy Benefits Specialist
New Staff Member in Wichita
The Working Healthy team has welcomed a new Benefits Specialist to
the fold! Stefania Haessig is now the Benefits Specialst for the Wichita area.
Before joining
the
Working Healthy team in July, Stefania worked in SRS as a Human Services
Specialist working mostly on cases assisting children and families. She also
worked with
Early Headstart and her masters thesis focused on her work with Headstart. Stefania’s
region covers the counties of Harper, Kingman, Reno, Sedgwick and Sumner. She
can be reached by phone at (316) 337-6427 and by email at WSZH@srskansas.org.
This newsletter and other Working Healthy information can be found online
at: http://www.workinghealthy.org
Working Healthy is published quarterly by the University of Kansas CRL, Division
of Adult Studies and in cooperation with the Kansas Department of Social and
Rehabilitation Services.Additional copies and copies in alternate formats are
available upon request by writing the University of Kansas Division of Adult
Studies, Attn: Noelle, 1122 West Campus Rd.. JRP Hall Rm. 517, Lawrence, KS 66045,
by phone (785) 864-7085, by email: pixie@ku.edu.
KU Research Team:
Jean Hall, Principal Investigator
Noelle Kurth, Project Coordinator and Editor
Kansas Division of Health Policy & Finance:
Mary Ellen O'Brien Wright, Program Director
Nancy Scott, Benefits Specialist Team Leader