Did You Know?
Did You Know?
|98% of Americans over 65 are covered by Medicare.|
|You do not have to be 65 or older to be on Medicare. If you are blind or |
|disabled and qualify for Social Security Disability Income (SSDI), you qualify |
for Medicare 24 months after SSDI benefits begin.
|Of the 41.8 million individuals that qualify for Medicare, 17% are also on |
|Medicaid (approximately 7.1 million individuals).|
|Dual eligible (Medicare and Medicaid) recipients spend $20,840 annually in |
|health care expenses compared to $10,050 for Medicare beneficiaries with |
|61% of dual eligible individuals have no high school diploma compared to |
|28% of in non-dual segment.|
|27% of individuals with lower income responded to applications sent to |
|them by Social Security to apply for Lower Income Subsidy (extra help) to |
help pay for Part D prescription drug premium and co-pays.
|30% of individuals who are eligible for a Medicare Savings Program (helps |
|pay Medicare premium and/or co-insurances and deductibles) have applied.|
| Individuals who qualify for Low Income Subsidy (extra help paying for |
|prescription drugs) must re-certify every year in order to retain their subsidy.|
|20% of lower income individuals responded to a letter about re-certifying for |
|a lower income subsidy.|
|Under the new Medicare Part D prescription drug program, any individual |
|that qualifies for a subsidy to help with his/her prescription drug cost does |
not have a coverage gap (donut hole).
|All dual eligible individuals, or those who qualify for Low Income Subsidy, |
|do not have enrollment seasons like everyone else. They are in a Special |
Election period (SEP) and can change plans any time of the year and as
often as they choose.
|Medicare Part D will not cover barbituates, benzodiazepines , and some |
|other prescription medications.|
|Medicaid will pay for many Part D excluded drugs.|
|Some Medicare Part D enhanced plans will pay for some Part D excluded |
|Of the 8.2 million Low Income Status individuals, less than 300,000 picked |
|a part D plan. The rest were automatically enrolled by the state.|
|When automatically enrolled for Medicare Part D from Medicaid, no |
|matching of individual's prescriptions and formulary of the Part D they were |
enrolled in was taken into consideration. It was done from a lottery system.
|When lower income individuals reach the catastrophic level of $3850 in |
|2007 True Out Of Pocket Cost (TROOP) for Medicare Part D prescription |
coverage, they no longer have a co-pay.
|Many doctors and clinics will not accept out-of-state Medicaid. |
|Consequently, when traveling Dual Eligible recipient may be relying on |
Medicare only benefits.
|If individuals has a Medicaid spend down, they are not required to pay their |
|spend down every month, only on the months that health care is needed |
(dental, optical, hospital, tests, therapy, etc…).
|There are Medicare Part C plans specially designed for dual eligible |
|individuals (called Special Needs Plans) that have 0 or low co-pays and |
save the spend-down recipients from having to pay their spend-down.
|Over 5 million Medicare beneficiaries are enrolled in a Medicare Advantage |
|Plan (Approximately 12% of Medicare beneficiaries).|
|Out-Of-Pocket cost for Medicare Advantage enrollees are 34% lower than |
|beneficiaries that have traditional Medicare coverage.|
|Medicare Advantage Plans (aka Medicare Part C) are commonly referred to |
|as Medicare HMO. Why? Because all Medicare Advantage Plans were |
Managed Care in one form or the other (HMO or PPO) until 2003. Now,
many Medicare Advantage Plans are Private Fee For Service (PFFS) that
have no network restrictions.
|Nearly 60% of Veterans are eligible for Medicare.|
|Many veterans that receive care at VA facilities are eligible for a Medicare |
|Advantage Plan that includes Part D prescription coverage. Most plans have |
no additional out-of-pocket cost besides Part B premium they, Medicaid or a
third party is already paying.
|70% of veterans that have a heart attack receive treatment at a Medicare |
|The VA's formulary of medications includes about 1400 drugs, most part D |
|formularies include about 4300 medications.|
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