 |
Home | Contact Us | Press Room | Site Overview | Help | Login | Register |
 |
 |
| About NCSL | State & Federal Issues | Legislatures | Legislative Staff | Meetings | Bookstore | Legislators & Staff Only |
| NCSL Home > State & Federal Issues: Issue Areas >Health > | Add to MyNCSL |
|
| General Information |
- MMA Guide for State Legislators (5 page PDF document)
This site contains a schedule for implementation and Checklist for State Legislators. - Medicare Drug Coverage 101: Everything You Need to Know About the New Medicare Prescription Drug Benefit, publication by The Medicare Rights Center
-
Medicare Prescription Drug Coverage Basics (2 page PDF document)
A person in a Medicare prescription drug plan that covers the minimum standard would expect to pay a $250 deductible and then 25 percent of their drug costs up to an out-of-pocket limit of $2,250. Medicare drug coverage includes coverage which begins when a person with Medicare drug coverage spends $3,600 for covered drugs in a year. Once this level is reached, the person pays only 5 percent of their drug costs. Again, some plans will offer additional coverage, this is a description of the minimum that must be offered. -
Long-Term Care Guidance (6 page PDF document)
This document is provided as guidance to assist Medicare Part D plans in formulating policies for the implementation of CMS requirements regarding pharmacies providing products and services to Long Term Care (LTC) facilities. - CMS MMA Education Campaign Regional Contacts
-
Kaiser Family Foundation Medicare Prescription Drug Benefit Fact Sheet This fact sheet, describing the new Medicare Prescription Drug, Improvement, and Modernization Act of 2003, explores the new drug benefit, as well as additional changes to the Medicare program (March 2005).
- Full Text of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (415 page PDF document)
- NCSL Summary of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 ( 88 page PDF document)
- Medicare Prescription Drug Benefit: Final Rule
- MEDICARE FACT SHEET: Final Rules Implementing the New Medicare Law
Medicare Dual Eligibles and the Low-Income Subsidy
A Strategy for Transitioning Dual Eligibles for Medicaid to Medicare Prescription Drug Coverage (44 page PDF document published May 2, 2005)
Dual Eligible Income Limits for 2005
Medicare Payment Advisory Commission (MEDpac) Databook (12 page PDF document) Contains demographic, health acuity and expenditure data on the Medicare dual eligible population.
"Clawback" or the Phased-Down State Contribution (PDSC) - The PDSC payment refers to the states' monthly payment made to the Federal government beginning in 2006 to defray a portion of the Medicare drug expenditures for full-benefit dual eligible individuals whose Medicaid drug coverage is assumed by Medicare Part D. Provides a table of annual phased-down percentages of state contributions to Medicare Part D drug benefit costs.
Excluded Drug Coverage By State Medicaid Program
Effective January 1, 2006, Medicaid beneficiaries who are entitled to receive Medicare benefits under Part A or Part B will no longer receive their pharmacy benefits under their State Medicaid agency, except for excluded drugs. Each State has the option to cover these drugs for their Medicaid beneficiaries who also have Medicare coverage.
Part D Drugs/Part D Excluded Drugs (Updated April 19th 2006)
Enrollment
- Overview of the Many Steps that CMS has taken to Make Sure All Dual Eligibles have Medicare Prescription Drug Coverage January 1, 2006 (November 14, 2005) On January 1, 2006, responsibility for payment for the prescription drugs of over 6 million individuals who are dually eligible for the both Medicare and Medicaid will shift from the States to the Federal government. CMS working with the States has taken several proactive steps to ensure that all current and future full benefit dual eligibles will have Medicare Prescription Drug Coverage.
- Auto-Enrollment Notice (PDF 83KB document posted September 12, 2005) - The purpose of this auto-enrollment notice is to inform people with Medicare and full Medicaid coverage about the change in their drug coverage from Medicaid to Medicare. The notice explains that these individuals will be enrolled in a Medicare Prescription Drug Plan if they don’t join a plan by the end of the year, what plan Medicare will enroll them in, and their costs in the plan. It will also notify them that their Medicaid isn’t creditable prescription drug coverage. The notice includes a one-page letter, and two pages of questions and answers about Medicare prescription drug coverage.
The Low-Income Subsidy
- Social Security Administration Program Operations Manual for Low-Income Subsidy
Designed for Social Security Administration staff, this manual offers detailed information about various issues related to the extra help available through the new Medicare Prescription Drug Coverage. - CMS Memorandum: SPAP Assistance for Low Income Subsidy Eligible Individuals under the Medicare Prescription Drug Benefit (4 page PDF document) This memorandum describes some of the opportunities for state savings and outlines savings approaches that are contrary to Medicare policy goals and questionable under the law.
| Coverage Under the Medicare Prescription Drug Benefit |
-
Part D Drugs/Part D Excluded Drugs (Updated April 19th 2006)
-
Medicare Prescription Drug Benefit Model Guidelines: Drug Categories and Classes in Part D (13 page PDF document)
USP’s Model Guidelines consist of a listing of therapeutic categories (first column of the Model Guidelines) and associated pharmacologic classes (second column of the Model Guidelines) that create a framework that PDPs and their pharmacy and therapeutics (P&T) committees, if needed, may follow as they create a drug plan formulary. -
Comprehensive Drug Listing of Drugs in the USP Model Guidelines for Drugs Approved through October 2004 (34 page PDF document)
-
Medicare Part B Versus Medicare Part D Coverage Issues (42 page PDF document)
|
Employer Subsidy Program |
- Overview of Retiree Drug Subsidy Option (2 page PDF document)
- CMS Retiree Drug Subsidy (RDS) Program
CMS website to act as a resource for employers sponsoring retiree prescription drug coverage that qualifies for federal subsidy payments.
- Explaining Medicare Prescription Drug Coverage to People With Coverage Through an Employer or Union (2 page PDF document)
This information is intended to help benefits managers, plan administrators, and other employer/union partners and stakeholders explain how Medicare prescription drug coverage will work for their employees and retirees with Medicare.
-
GAO Report (2/14/05) - Options for Employer-Based Prescription Drug Benefits Under the MMA (68 page PDF document)
-
Milliman and Robertson Case Study (7/13/05) - Medicare Part D Strategies for Plan Sponsors (5 page PDF document)
Key Messages for People with Medicare
Medicare is an important health insurance program for people age 65 or over, people under age 65 with certain disabilities, and people of all ages with End-Stage Renal Disease. The following are some key messages that people with Medicare need to know and understand about the new Medicare prescription drug coverage:
- Starting in 2006, Medicare will offer drug coverage that helps people with Medicare pay for the prescriptions they need.
- Medicare prescription drug coverage is available to all people with Medicare.
- There is extra help for those who need it most.
- Medicare prescription drug coverage pays for brand name and generic drugs.
- You can choose between at least two Medicare prescription drug plans and pick a plan that is right for you.
CMS On-Line Tools Understanding Changes in Prescription Drug Coverage for People with Disabilities on Medicare The Georgetown Hospital Health Policy Institute has developed a guide for individuals with disabilities who are also Medicare beneficiaries to help navigate the changes associated with Medicare Part D. The guide contains an overview of the program, a consumer plan selection worksheet, and suggested questions for physicians which will enable them to make the best choice of plans. Find a Medicare Prescription Drug Plan (as of 10/19/05) Formulary Finder for Prescription Drug Plans (as of 10/19/05) Landscape of Local Plans State-by-State The Landscape of Local Plans lists all plans available in your area, providing important information on:
BenefitsCheckUpRX is a free, and confidential service provided by the Access to Benefits Coalition to help individuals find public and private programs to save money on prescription drugs. Medicare Rights Center - The Medicare Rights Center (MRC) is the largest independent source of health care information and assistance in the United States for people with Medicare. Founded in 1989, MRC helps older adults and people with disabilities get good, affordable health care. Fact Sheets Consumer Assistance Consumers may be able to get extra help to pay for the annual deductible, premiums and co-payments related to the new Medicare Prescription Drug program—an average of $2,100 in extra help. In order to qualify consumers must submit the attached application to the Social Security Administration.
Important Links for Constituents
This tool will allow you to find plans in your state that match your required drug list.
Note: NCSL provides links to other Web sites for information purposes only. Providing these links does not indicate NCSL's support or endorsement of the site.
© 2008 National Conference of State Legislatures, All Rights Reserved
Denver Office: Tel: 303-364-7700 | Fax: 303-364-7800 | 7700 East First Place | Denver, CO 80230 | Map
Washington Office: Tel: 202-624-5400 | Fax: 202-737-1069 | 444 North Capitol Street, N.W., Suite 515 | Washington, D.C. 20001
