Toledo Area Ministries - Managed Care Advocacy Program

Assist seniors in understanding Managed Care Health System (Medicare, Medicaid, HMO and Medigap policies) in terms of paying correct costs, access to and receiving available benefits, coordinating insurance benefits, settling debt problems, disseminating new information and education as to how polices will affect their present healthcare benefits.

In 2006, 413 seniors received benefits counseling and over 625 seniors benefited from group presentations.

Managed Care Advocacy Program’s goal is to empower seniors through education and information to make the best decisions possible to meet individual health care needs; thus enabling seniors to maintain a sense of enrichment, remain in their homes and communities - as long as possible - with comfort and dignity.

WHAT WE DO:

Assist seniors in determining correct amounts on medical balances, obtain available benefits, coordinate insurance benefits and settle debt problems related to health care costs.

Provide educational presentations for seniors and interested groups regarding access to senior health care systems that best meet their individual need.

Advocate reforms and work against injustices that affect access to - and delivery of health care needs.

Provide current and objective information regarding health care options in senior health care systems.

Act as an intermediary between seniors, health care insurance providers and collection agencies.

Traditional Medicare
Medicare Advantage Plan
Medicare Supplements
Retirement Benefit Health Plans

Medicaid Assistance
Medicare Prescription Drug Plans
Medical Bill Reconciliation

Managed Care Advocacy Program

FACT SHEET
MEDICARE DRUG BENEFIT FOR 2007

Part D Medicare Prescription Drug, Improvement & Modernization Act of 2003.

Premiums can start as low as $14 depending on plan deductible which range from $0 to $265. This does not include the co-pay to the pharmacy.

Part D enrollment begins November 15, and continues through December 31, 2006. Co-pays may start at $2 for generic and $5 for brand name drugs if you qualify for Extra Help.

Prescription drug coverage for your selected plan begins January 1, 2007.

Some Facts to Remember If You Are Eligible for Enrollment in Part D

If you have a Medigap insurance and/or employment retiree plan that has a prescription benefit, you should receive information from the provider regarding your status of Rx coverage. If your benefit is going to continue, it must be equal to or better than the Medicare plan. (Be sure to keep your letter.)
Be sure whatever provider you select, your prescription drugs are listed on the formulary and the company will cover additional medications if prescribed by your doctor.
Discuss adding medications that could possibly be prescribed for you in the future. What is their Policy?
What is the company’s policy about changing plans if additional medications are not on their formulary - or they will not make an exception and/or work with you. (The reason this could be important is that dollars COULD be involved.) You need to know this information.
Medicare Advantage Plans (Medicare HMO's) are also being offered during the same time period. There are many components to prescription drug plan coverage; i.e., disenrollment, penalties, and what companies (other than national providers) will provide this service in northwest Ohio.
If you call to enroll in a prescription drug plan, be sure to verify amount of plan, monthly premium, the name of the insurance company and the names of ALL individuals you speak with.
Advise how you want to be billed for this plan. Review payment options with your selected prescription drug company. The options are:
     (1) deduct from your monthly Social Security
     (2) deduct from a checking or savings account
     (3) bill monthly
Advise how you wish to pay

QUESTIONS YOU MAY WANT TO ASK AND GET ANSWERS TO WHEN TALKING TO THE COMPANY YOU HAVE SELECTED TO BE YOUR MEDICARE PERSCRIPTION DRUG CARRIER (PART D).

FIRST: Verify the monthly premium, the name of the insurance company and the names of ALL individuals that you speak with.

SECOND: Discuss adding medications that could possibly be prescribed for you in the future. What is their policy?

THIRD: What is the company's policy about changing plans if additional medications are not on their formulary - or they will not make an exception and/or work with you? (The reason that this could be important is that dollars COULD be involved.) You need to know this information.

FOURTH: Review payment options with your selected prescription drug company. The options are deduct from: (1) your monthly Social Security, (2) from a checking or savings account or (3) bill monthly. Advise how you wish to pay.