Medicare in Minnesota  

Medicare Topics	Date
Minnesota Medicare Approved Drug Discount Cards (PDF)	June 16, 2004
Medicare Rate Change	2004
Medicare.gov	2004
Medicare Part D
Archives:
New Medicare Legislation Alert	December 15, 2003
Medicare Bill passes Senate 54-44	December 08, 2003

For Medicare Part A, which pays for inpatient hospital, skilled nursing facility, some home health care, hospice care and blood, the deductible paid by the beneficiary will be $876 in 2004, an increase of $36 from this year’s $840 deductible. The monthly premium paid by beneficiaries enrolled in Medicare Part B, which covers physician services, outpatient hospital services, certain home health services, durable medical equipment and other items, will be $66.60, an increase of 13.5 percent or $7.90 over the $58.70 premium for 2003.

The deductibles and premiums are updated annually in accordance with formulas set by law. The Part B premium is required to be the amount needed to cover 25 percent of estimated program costs for enrollees aged 65 and older. General revenue tax dollars cover the other 75 percent of the costs. The same statute prescribes the method for computing the Part A inpatient hospital deductible.

The Part A deductible is the beneficiary’s only cost for up to 60 days of Medicare-covered inpatient hospital care. However, for extended Medicare-covered hospital stays, beneficiaries must pay an additional $219 per day for days 61 through 90 in 2004, and $438 per day for hospital stays beyond the 90^th day in a benefit period. There is no coverage beyond 150 days. For 2003, payment for days 61 through 90 was $210, and $420 for beyond 90 days. Skilled nursing facility coinsurance is $109.50 per day for days 21 through 100 each benefit period.

A benefit period begins on the first day a Medicare beneficiary is admitted to a hospital or skilled nursing facility. The benefit period ends when a Medicare beneficiary has not received any hospital or skilled nursing facility care for 60 consecutive days. If you go into a hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period($876 in 2004). There is no limit to the number of benefit periods you can have.

There is a $100 deductible per year. Medicare beneficiaries pay 20 percent of the Medicare-approved amount for services after you meet the $100 deductible.

Minnesota has programs that will pay for some or all of the beneficiaries’ premiums and coinsurance for those with low incomes. To find out if you qualify contact the Senior LinkAge LineÒ at 1 800 333 2433.

Nearly 90 percent of Medicare beneficiaries also have some form of supplemental coverage such as Medigap, Medical Assistance or Medicare+Choice to help reduce medical costs. The Senior LinkAge LineÒ at 1 800 333 2433 staff will also be able to help you review your options in determining the best options for your needs.

The Part A premium for individuals who have 30 – 39 quarters of Medicare-covered employment will be $189. The premium is $343 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.

Call the Senior LinkAge LineÒ at 1-800-333-2433. Certified health insurance counselors are available to help Medicare beneficiaries understand Medicare and the array of options available in Minnesota. Senior LinkAge LineÒ does not sell, endorse or market any insurance products.

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NEW MEDICARE PRESCRIPTION DRUG DISCOUNT CARD ON HORIZON

When will I be able to get the Medicare-approved discount card?

A new Medicare-approved discount card for prescription drugs will be available in April of 2004. This benefit will provide transitional assistance until the full drug benefit goes into effect in January, 2006.

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How will this new card work?

Minnesota Medicare beneficiaries will have a minimum of two choices for a discount card, offered by different sponsors which meet specific requirements determined by Medicare. Beneficiaries can enroll in just one program at a time. The card will be valid at your local pharmacy. The cards will be available through a variety of sources, including pharmaceutical benefit managers, insurers, retail pharmacies, and Medicare+Choice plans. To qualify, the sponsor must have an extensive retail pharmacy network. No mail-order only programs will be allowed. The cards are primarily intended for individuals without outpatient prescription drug insurance. The card is not intended to be a prescription drug benefit.

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Who is eligible for the discount card?

Medicare beneficiaries are eligible for the drug discount card program if they are enrolled under Part A or B, so long as the beneficiary is not receiving outpatient drug benefits through Medicaid.

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What steps do I need to take to enroll?

• Beneficiaries will need to select the discount card program that best meets their needs. The beneficiary will then submit basic information on an enrollment form to the selected, approved discount card program about his or her Medicare and Medicaid status.

• The Centers for Medicare and Medicaid (CMS) will verify this information and notify the approved discount card program of the beneficiary’s eligibility and enrollment outcome.

• Once enrolled the beneficiary may start utilizing the discount card as early as the first day of the following month.

• Individuals found to be ineligible for the discount card may request a reconsideration if they continue to believe they qualify.

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Where can I find information on the programs available in Minnesota?

Information will not be available until next Spring. As soon as details become available, they will be posted on www.mnaging.org. This information will also include a price comparison that will help to compare negotiated prices, fees, and other card program features from card to card. The negotiated prices displayed will be a drug’s maximum price for an approved sponsor’s service area. Actual prices may vary, but will not be more than the posted prices.

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How much will I save on my prescription drugs?

The discount card is expected to save Minnesota Medicare beneficiaries from 10 to 25% on their prescription drugs. Card sponsors would have to pass on to card enrollees negotiated prices on covered drugs. Discount card drug prices would not apply to Medicaid "best price" requirements. The typical older Minnesotan spends $1,285 annually on medications. The card could save those who lack drug coverage as much as $300 annually. Any company interested in selling a Medicare "endorsed" discount card must offer price reductions on at least one medication per category in more than 200 categories of drugs, as well as insulin supplies such as syringes.

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How much will it cost?

The cards could cost up to $30 annually. One of the factors that will need to be considered when choosing among the available discount drug cards, will be how much the different card sponsors charge for their prescriptions. There is no guarantee that the price for a prescription will remain the same from one enrollment period to the next.

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What if I have low income and low assets?

There will be an added benefit for discount card program enrollees with incomes less than 135% of the federal poverty guidelines, $12,123 for a single individual or $16,362 for married coupes in 2003, (these income levels will vary slightly for subsequent years,) who do not have Medicaid or drug coverage. The government would pay the enrollment fee and deposit $600 to enrollee card accounts to be used for drug expenses. These subsidized enrollees would still be required to pay 10% coinsurance on each prescription, or 5% in cases of those who are less than 100% of the federal poverty guidelines.

To encourage Medicare beneficiaries to enroll in the program earlier rather than later, but to provide sufficient time for beneficiaries to learn about the drug card program and their options to join, in 2004 eligible beneficiaries will receive the full $600. In 2005, however, the $600 will be prorated depending on when a beneficiary first applies for the funds. The $600 will be reduced for late enrollees every quarter by $150 starting in April 2005. In most cases funds made available but not spent in one calendar year may carry over into the following year and will remain available through early 2006.

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Are there any restrictions?

Nearly all prescription drugs that can be purchased at retail pharmacies are eligible for discounts and use of the $600. Syringes and medical supplies associated with the injection of insulin, needles, alcohol, and gauze, are also included. It is anticipated that many approved programs will use formularies to obtain deeper discounts on prescription drugs. A formulary is a specific list of drugs for which discounts are offered. However, even if a drug is not on the sponsor’s formulary, the $600 can still be used to purchase the prescription drug. Some drugs may not be eligible for the discount. These drugs would be those that are excluded under Medicare such as weight loss or gain, fertility, cosmetic, hair growth, cough or cold relief, vitamins and minerals, non-prescription drugs, barbituates, and benzodiazepines, except for smoking cessation agents.

Approved discount card programs, if they choose, may offer discounts on over-the-counter drugs. However, the $600 cannot be used to purchase these drugs.

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What if I want to switch to another discount card before the enrollment period?

If a discount card sponsor decides to reduce the discounts it offers in the middle of an enrollment period, or if a doctor changes a beneficiary’s prescription to a drug that is not on the discount card formulary, the beneficiary might qualify under special circumstances, to switch to another provider. These have not been determined at this time.

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When does the new Medicare prescription drug benefit begin?

January 1, 2006.

The discount card is not the Medicare prescription drug benefit.

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Where can Minnesota Medicare beneficiaries go for more assistance and information?

• Call the Senior LinkAge LineÒ at 1-800-333-2433
• Regularly visit the www.mnaging.org web site for updated Medicare information specifically for Minnesotan Medicare beneficiaries
• Use www.MinnesotaHelp.infoÔ to find resources and providers in your area
• Visit the www.medicare.gov web site for additional Medicare information

On Monday, December 8, 2003 President George W. Bush is scheduled to sign historic Medicare legislation that will impact all Medicare beneficiaries by significantly changing and expanding health care options, including the addition of prescription drug coverage.

The new drug benefit does not take effect until January 2006, but there is some relief for older persons on the horizon:

• Beginning in April of 2004 and ending by January 2006, Minnesota Medicare beneficiaries will be able to purchase prescription drug discount cards from selected companies for $30.00 per year.
• Beneficiaries with incomes below 135 percent of the federal poverty guideline ($12,124 in annual income for single person or $16,362 for a couple, which will change in February 2004) will be able to get this discount card for free.
• Low- income beneficiaries will also receive a credit worth $600.00 embedded in the card (like a prepaid gift card) to be used for the purchase of drugs.
• There will also be a copay of 5 to 10 percent on each purchase.

The average savings will be between 10 and 25% off the cost of most medicines. The card will be valid at your local pharmacy.

Beginning in January, 2006, Medicare beneficiaries will pay an estimated average premium of $35.00 per person, per month and an annual deductible of $250.00 per person for prescription drug coverage. This coverage is optional and not mandatory.

No.

• First, Medicare will develop a prescription drug formulary, which is a list of drugs that will be eligible for coverage under the new Medicare benefit. Prescription drugs not on this list, will most likely not be eligible for coverage under the new benefit, and the $250 annual deductible will not apply.

• Second, after you pay the $250 annual deductible for your prescription drug expenses, Medicare will cover 75% of your prescription drug costs. You will be responsible for paying the remaining 25% of your expenses until your prescription drug costs reach $2,250. There is no coverage for annual prescription drug expenses from $2,251 through $5,100. If your annual prescription drug expenses reach $5,101, then Medicare will cover 95% of the costs with the requirement that you pay either a $2.00 copay for generic drugs or $5.00 copay for brand name drugs or 5%.

Medicare beneficiaries with annual incomes that do not exceed $12,000 and modest assets would not pay a premium or deductible for prescription drug coverage. There will however, be small co-payments for each prescription drug.

• Medicare will offer several ways for older persons to voluntarily receive prescription drug coverage. If you are in the original Medicare Plan, you may enroll in a Prescription Drug Plan. Prescription Drug Plans are private plans that will contract with Medicare to provide drug coverage to people with Medicare who live in a certain area.

• People with Medicare will be able to enroll in a private health plan, known as a Medicare Advantage Plan. These plans may be a local Health Maintenance Organization or a regional Preferred Provider Organization. Medicare Advantage Plans will offer drug coverage in addition to other medical benefits.

• Some people with Medicare may receive prescription drug coverage through a former employer, just as they do now, and Medicare will help that employer pay for the coverage.

• In 2007 Medicare will begin to link premiums under Part B, which covers outpatient services, to the incomes of beneficiaries. Medicare beneficiaries with higher incomes will pay higher premiums.

• In 2010, a pilot program will begin in which traditional, fee-for-service Medicare will compete with private health plans in six metropolitan areas. Beneficiaries would have to pay more to remain in fee-for-service Medicare, provided that fee-for-service would cost more, but Medicare would cap premium increases at 5% per year with safeguards to exempt the oldest and lowest-income beneficiaries. It is uncertain at this time if Minnesota will be a pilot location.

Employers that currently provide prescription drug coverage to retirees would receive tax-free subsidies valued at as much as $70 billion to continue to provide such coverage after the Medicare prescription drug benefit takes effect.

Where can I go for more information?

Call or email the Senior LinkAge Line at 1-800-333-2433. Also check back frequently for updates on the www.mnaging.org web site.

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The Medicare Endorsed Drug Discount Card:
It’s NOT the Medicare Prescription Drug Benefit, but it provides some relief!

Soon all Minnesota Medicare beneficiaries will receive information in the mail from the Social Security Administration about the Medicare Endorsed Drug Discount Card. If you have questions please call the Senior LinkAge LineÒ at 1-800-333-2433 or email us at [email protected]

No one knows yet how many Medicare Endorsed Drug Discount Cards will be available in Minnesota, but as soon as the information is made public, it will be posted on this site. There were 106 companies that applied to offer the card in various parts of the United States.

The Medicare Endorsed Drug Discount Cards will be available to practically all Minnesota Medicare beneficiaries. The Cards will offer discounts, not coverage, for prescription drugs. Discounts may range from 10 – 25% depending on the prescription drug. Enrollment in one of the Medicare Endorsed Drug Discount Cards may cost up to $30 per year. Enrollment in a Medicare Endorsed Drug Discount Card is optional.

The Medicare Endorsed Drug Discount Cards are scheduled to be in place from June 2004 through December 31, 2005. The new Medicare Prescription Drug Benefit (known as Medicare Part D) is scheduled to begin on January 1, 2006. Check this site frequently for updates!

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Medicare Endorsed Drug Discount Card Transitional Assistance

For individuals with Medicare and a monthly income of $1,031 or less
AND
For couples with Medicare and a monthly income of $1,384 or less

You may be eligible for a $600 per year prescription drug credit! This is known as the Medicare Endorsed Drug Discount Card Transitional Assistance.

The Medicare Endorsed Drug Discount Card and the Transitional Assistance are not the Medicare prescription drug benefit, but it can provide you with some relief until the Medicare prescription drug benefit (Medicare Part D) takes effect on January 1, 2006.

What is Transitional Assistance?
• $600 credit per year in 2004 and 2005 available to help you pay for your prescription drugs purchased with your Medicare Endorsed Drug Discount Card, if you are eligible.
• You also don’t have to pay the annual card fee of up to $30 per year.
• You will have to pay either 5% or 10% of your prescription costs while using the $600 credit. This means that 90 to 95 percent of your prescription drug costs up to $600 per year will be paid for!

How do I find out what Medicare Endorsed Drug Discount Cards are available in Minnesota?
• The list of companies offering the Medicare Endorsed Drug Discount Card to Minnesota Medicare beneficiaries will be available on this web site as soon as it is made public.
• Visit www.Medicare.gov for information.
• Call the Senior LinkAge LineÒ at 1-800-333-2433 for individual, comprehensive, objective assistance about your Medicare Endorsed Drug Discount Card options available in Minnesota.

How do I apply?

• Step 1: Choose a Medicare Endorsed Drug Discount Card to enroll in. All of the Medicare Endorsed Drug Discount Card companies must offer the Transitional Assistance. You can however, only choose one Card to apply for.
   

• Step 2: This step may vary by company and Card application, but generally you may need to complete 2 separate application forms:
  • Complete the Standard application for the company’s Medicare Endorsed Drug Discount Card
  • Complete the Application for the Low-income benefits (also known as Transitional Assistance). You will need to complete the form and state your income information, but you do not need to send any additional income documentation with your application. The Centers for Medicare & Medicaid (CMS) may verify your income by reviewing any available data, such as tax returns and Social Security records.
   

• Step 3: Mail your completed application
   

• Step 4: You should be notified about your Transitional Assistance eligibility by the Medicare Endorsed Drug Discount Card company within one week of applying.
   

• Step 5: If approved, begin using your $600 annual Transitional Assistance. You do this by visiting your local pharmacy and getting your needed medications.

You do not need to reapply for the $600 credit in 2005, unless you decide to change to a different Medicare Endorsed Drug Discount Card company. You can change cards once per year.

If denied, you can appeal the decision to Medicare

Call the Senior LinkAge Line at 1-800-333-2433 if you need assistance or have questions.

Does it matter when I apply for the Transitional Assistance?
YES!
It is in your best interest to apply as soon as the Medicare Endorsed Drug Discount Cards are made available in Spring 2004.

• If you apply at any time in 2004 and are approved, you will get the full $600 credit amount for 2004 and 2005.
• If you wait and don’t apply until 2005, your credit amount is reduced by the following:
• Apply between January 1, 2005 – March 31, 2005 = $600 credit
• Apply April 1, 2005 – June 30, 2005 = $450 credit
• Apply July 1, 2005 – September 30, 2005 = $300 credit
• Apply October 1, 2005 – end of year = $150 credit

This is all so complex and confusing. Is there assistance available?

YES! The Senior LinkAge LineÒ can provide you with free help. Call 1-800-333-2433 statewide, or send an email to [email protected]

The Senior LinkAge Line is designated by the Centers for Medicare & Medicaid Services (CMS) to be the State Health Insurance Assistance Program for Minnesota (SHIP). Statewide, free individualized objective information and assistance about all of your Medicare options, including your Medicare Endorsed Drug Discount Card options are available to all Medicare beneficiaries in Minnesota. Staff and an outstanding group of highly trained volunteers can assist you in all 87 counties of Minnesota!

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