Capella University Multicultural Education Theory Presentation

1. Aligns the components of a multicultural theory or model to instructional practices and identifies strengths and weaknesses of the alignment. 2. Explains how to implement instruction using practices from multicultural theory or model selected and identifies potential challenges in implementation. 3. Implements multicultural practices in teaching and evaluates implementation. 4. References the multicultural theories and research that informed strategies implemented and identifies gaps in the theories or research. MEDICARE PRESCRIPTION PLAN AN OVERVIEW OF MEDICARE PART D MEDICARE PART D Medicare Part D, also called the Medicare prescription drug benefit, is a United States federal-government program to subsidize the costs of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries. • A benefit of Medicare that members are not automatically enrolled in • A separate cost associated withenrollment into Part D Plan • Monthly premiums associated with plan, premium price based on type of plan enrolled into • Some plans are employer sponsored, called “Wrap Plans” • Only part of Medicare that is enrollee exclusive • Runs on calendar year, January 1-December 31 TYPES OF PART D PLANS PDP’s (Prescription Drug Plans): MA-PDs (Medicare Advantage Prescription Drug Plans): • They are stand-alone companies that sell prescription drug coverage only. • They do not offer hospital or medical coverage, patients must utilize Part A and B for additional services outside of prescriptions. • In addition to prescription coverage, they offer hospital and medical coverage under one policy • Can also be known as Medicare Part C • Similar to commercial policies and benefits, as they have HMO and PPO plans available DRUG COVERAGE A medication may be able to be covered under Medicare Part D if certain criteria is met 1. Must be approved for sale in the U.S by the FDA 2. Available by prescription 3. It is medically necessary and prescribed for a medically accepted diagnosis for that medication. Part D plans are not obligated to cover all Part D medications • Each plan develops their own prescription drug formulary • Mainly limited to drugs listed on formulary, but can request exceptions through appeal or coverage determination process • Prior authorizations are common for most specialty and some brand name medications STAGES OF COVERAGE Plan sponsors must offer a “standard benefit” package mandated by federal law. Standard benefit plans have 3 phases of coverage, including a deductible • Initial Phase • Coverage Gap or commonly known as “The Donut Hole” • Catastrophic Coverage Deductible: You pay all drug costs until you meet you plan’s deductible, typically $405 Initial Coverage: You pay a fixed copay or coinsurance until you/payer reach the $3750 total drug cost limit Coverage Gap: You pay 44% for Generics, 35% for Brand names until you reach the $5,000 outof-pocket limit Catastrophic Coverage: You pay the greater of Generics: $3.35 or 5%; All other drugs: $8.35 or 5% DEDUCTIBLE AND INITIAL PHASE Initial coverage includes the time period between when the patient pays deductible and when the patient reaches the coverage gap. • Deductible amount of up to $405 • Standard plan coinsurance of 25%, can range up to 33% depending on tier level of medication • In this phase until member/payer reaches $3,750 in total drug spent. COVERAGE GAP/DONUT HOLE • In the coverage gap, a patient pays 35% of the cost associated with brand name prescriptions, and 44% with generic prescriptions • Patient pays a portion, and a discount is paid by the drug company that counts as out-of-pocket spending • Once the out of pocket cost of $5,000 is reached, patient will transition into the catastrophic coverage phase for the remainder of the year. CATASTROPHIC PHASE Patient’s are responsible for $3.35 or $8.35 copay, or5% of medication cost Remain inthis phase forthe remainder of calendar year Questions? Most affordable phase ofPart D Plan References Q1medicare.com Medicare.gov CMS.gov
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