Medicare Part D Outline

Lesson 1: Introduction to Medicare Part D—Background

1. Social and Legislative History of Medicare Part D
2. Goals of Medicare Part D
3. Structure of Medicare Part D
4. Timeline for Medicare Part D
5. Medicare Modernization Act
6. Eligibility for Medicare Part D
7. Enrollment in Medicare Part D
8. Reasons to Enroll in Medicare Part D

Lesson 2: Introduction to Medicare Part D—The Benefits

1. Levels of Coverage:
   1. Formularies
   2. Prior Authorization
2. The "Donut Hole" and TrOOP
3. Costs:
   1. Premium
   2. Deductible
   3. Copayment/Coinsurance
4. Prescription Drug Plan Options: Stand-Alone
5. Prescription Drug Plan Options:Medicare Advantage
6. Prescription Drug Plan Options: Other
7. Medicare Parts B and D: How They Interact
8. Beneficiaries With Limited Incomes and Resources
9. Coordination of Benefits With Medicare and Other Coverage

Lesson 3: Options for Plan Sponsors

1. The Basic Menu of Options
   1. Retiree Drug Subsidy
   2. Wraparound Plans
   3. Enhanced Coverage
   4. Medicare Advantage Plans
   5. Other Plans
   6. Part D Plan Premium Assistance
   7. Account-Based Arrangements
2. Issues in Choosing a Sponsor Option
3. Options vs. Plans: The Choice Is Not Done
4. Sponsor Response to Medicare Part D

Lesson 4: Retiree Drug Subsidy—Qualification

1. Overview and Eligibility for the Subsidy
2. Actuarial Equivalency
   1. Gross Value Test
   2. Net Value Test
3. Creditable Coverage
4. Account-Based Arrangements
5. Qualifying Covered Retirees
6. COBRA Issues
7. Application Details
8. Personnel Required
   1. Authorized Representative
   2. Account Manager
   3. Designee
   4. Benefit Options Administrator
   5. Qualified Actuary
9. The Retiree List
10. HIPPA Implications

Lesson 5: Retiree Drug Subsidy—Coordinating with CMS

1. Subsidy Payments
2. Plan Design Requirements
3. Coordination of Benefits
4. Enrollment and Enrollment Data
5. Covered Drugs
6. Other Plan Design Issues

Lesson 6: Retiree Drug Subsidy—Administration of the Plan

1. Notice of Creditable Coverage to CMS
2. The Retiree Drug Subsidy and Disclosure Notices
3. General Notice of Creditable Coverage to Beneficiaries
4. Notice Requirements for Plan Sponsors Without Retiree Plans
5. Medigap Creditable Coverage Notice to Beneficiaries

Lesson 7: Medicare Advantage Prescription Drug Plans

1. Medicare Advantage: Background and History
2. Medicare Advantage Prescription Drug Plans
3. Plan Design for MAPD Plans
4. Vendors
5. Individual and Group Eligibility
6. Choosing an MAPD Plan
7. Pros and Cons of MAPD Plans

Lesson 8: Stand-Alone Prescription Drug Plans

1. Introduction to Stand-Alone Prescription Drug Plans
2. Plan Design
3. Vendors
4. Individual and Group Eligibility
5. Choosing a Stand-Alone PDP
6. Pros and Cons of Stand-Alone Plans

Lesson 9: Wraparound Plans

1. Introduction to Wraparound Plans
2. Wraparound Plan Design
3. Wraparound Plan Challenges
4. Coordination of Benefits
5. Eligibility
6. Pros and Cons of Wraparound Plans

Lesson 10: Cost/Savings Implications

1. Taxpaying Organizations
2. Nontaxpaying Organizations
3. Nontaxpaying Organizations: PDP vs. RDS Subsidies
4. Both Taxpaying and Nontaxpaying Organizations
5. Part D Effect on National Prescription Drug Expenditures