7/7/151

Sponsored by the:

SHIBAStatewide Health Insurance Benefits Advisors

Medicare Open Enrollment PeriodDo your yearly checkup!

2

What is SHIBA?

Statewide Health Insurance Benefits Advisors A free program of the Office of the

Insurance Commissioner We provide unbiased and confidential

information about Medicare and other health insurance

We are an educational service We don’t sell anything!

Today’s overview

3

Quick overview of Medicare

What is Medicare Open Enrollment?

Stand-alone Part D prescription drug

plans

Medicare Advantage (Part C) plans

Do you need help paying for your plan?

How to choose a plan

4

Protect yourself!

As you research your options:

Keep a notebook Write down the names of people you talk

to, the date and their contact information Note what was said in the conversation Keep copies of any paperwork Beware of fraud!

5

What is Medicare?

Health insurance for people: Age 65 and older Under age 65 with certain

disabilities Any age with End-Stage Renal

Disease (ESRD)

6

The four parts of Medicare

7/7/15

Today, we’ll talk about plans/programs available to most people on Medicare• Medigaps; Medicare Advantage Plans (Part C) and

Medicare Drug Plans (Part D)

There may be different considerations or timelines for people with:• Employer or retiree coverage• Veterans or Indian Health Services• Medicaid or other assistance for low-income people

Talk to SHIBA if you have questions7

People have many options that work with Medicare

8

Decide how you want to get your Medicare coverage

What is a Medigap policy?

Also called: Medicare Supplement insurance policies• Sold by private companies

Fill the payment gaps in Original Medicare • Deductibles, coinsurance, copayments

Your doctors and providers bill Medicare, your Medigap pays after Medicare A or B pays

Standardized plans - all plans with same letter • Have same coverage

• Only the costs are different

9

Don’t cover outpatient Rx (Part D)• Most people will want to sign up for a stand-alone

Part D plan to go with their Medigap

Don’t have the same Open Enrollment rules You can buy one anytime a carrier will sell to

you• Not everyone can get one - may be health

screenings - check with SHIBA

Cannot have a Medicare Advantage plan at the same time

10

Medigaps

What is Medicare’s Open Enrollment Period to join a drug

plan or Medicare Advantage Plan?

Every year from Oct. 15 – Dec. 7 People with Medicare can join, switch or

drop a Medicare Part D or Medicare Advantage (Part C) plan

Changes take effect Jan. 1 of the next year• Medicare also calls this the “Annual

Enrollment Period”- it means the same thing!11

12

Why do a yearly Open Enrollment checkup?

Plans change!

Coverage changes!

Costs change!

Your needs change!

Sometimes plans can stop offering coverage

Usually, if you do nothing during Open Enrollment, you will remain in the same Part D or Medicare Advantage (Part C) plan

BUT if your plan is changing or no longer going to offer coverage, it will notify you

Read your mail from your plan! Ask questions if you don’t understand your

options

13

It’s optional • You can choose a plan and enroll

Plans have formularies • Lists of covered drugs

• Must include range of drugs in each category You pay the plan a monthly premium You pay deductibles and copayments There is Extra Help to pay Part D costs

• If you have limited income and resources 15

How Medicare Part D works

You must have either Part A or Part B or both You must live in the plan’s service area You can’t live outside the U.S. You must actively enroll to join You can only have one plan at a time

• To join a new plan or change plans, you must submit an application to enroll

15

Who can join Part D?

Consider:• Do you have already have “creditable” drug

coverage?o Coverage as good as Medicare’s o Example: Employer plan through you or your spouse

• Will that coverage end when you retire?

• How much do your current drugs cost?

• What if you get sick and need drugs later? Without creditable coverage

• Late enrollment may mean you pay a penalty

16

Should I join a Part D plan?

17

What do Part D plans cost?

For coverage in 2016, you will generally pay:• Monthly premium* varies by plan

• Possible deductible, no more than $360*

• Copayments or coinsurance*

• If costs paid by both you and your drug plan reach $7,063*, you will only pay a 5% copay for the rest of the year (Catastrophic coverage)

*These amounts can change each year.

Join when you are first eligible for Medicare• Initial Enrollment Period - usually 7 months

surrounding your 65th birthday

Join, switch or drop:• During the Open Enrollment Period

• Oct. 15 – Dec. 7 - Coverage starts Jan. 1

• During Special Enrollment Periodso Examples: Moving, losing/changing other coverage,

enrolling in a 5-Star plan, getting Extra Help

18

For BOTH Medicare Advantage & Part D Plans

19

What about the coverage gap (Donut Hole)?

The Affordable Care Act is phasing out the Donut Hole by 2020

In 2016, the Donut Hole will start when the cost for your prescription drugs paid by you and your drug plan reach $3,310

In the Donut Hole in 2016, you’ll pay:• 45% of the retail costs for brand name drugs

• 58% of the retail costs for generic drugs

• You will get credit for the full retail cost

20

ACA closes the Medicare “Donut hole”

21

What about pharmacies?

Medicare drug plans work with certain pharmacies

• You generally must use plan pharmacies

• You may save by using

“preferred pharmacies” Some plans also offer mail mail

mail order Check with the plan - are its pharmacies

convenient for you?

Plans are Medicare-contracted plans with all the rights and protections of Original Medicare

Your doctors and providers bill the plan, not Medicare

You still get the services provided under Medicare Parts A and B

Plan may include prescription drug coverage (Part D)• If so, all the rules about drug costs, enrollment, etc. are the same as in a

stand-alone Part D plan

Plan may include extra benefits –benefits are limited• Examples: vision, hearing or dental benefits

Benefits and cost-sharing may be different• Make sure to go over these costs before you join!

22

How Medicare Advantage (Part C) works

Who can join Medicare Advantage?

You must have Medicare Parts A and B You must live in the plan’s service area You must live inside the U.S. You cannot have End Stage Renal Disease

• Permanent kidney failure requiring dialysis or a transplant

You must actively enroll to join

23

Consider:• Most offer comprehensive coverage

o Including Part D drug coverage

• Do your doctors accept it? o May require you to use network doctors or get referralso Make sure that your doctors accept the plan!

• Nearly everyone must pay the Part B premium

• Some plans may also charge a monthly premium, or may have a $0 premium

• Can only join/leave plan during certain periods

• Plan does not work with Medigap policies24

Should I join a Medicare Advantage plan?

When you are first eligible for Medicare• Initial Enrollment Period- usually 7 months surrounding

your 65th birthday You may join, drop or change plans during the Open

Enrollment Period• Oct. 15 – Dec. 7 each year

May be able to join/drop/change at other times• Special Enrollment Periods

Generally, can only leave the plan at the end of a calendar year

Contact the plan or Medicare to join

25

When can I enroll in an MA plan?

Do you need help paying for your plan?

Programs are available for people with lower income and assets

SHIBA can help you apply!

OR For Extra Help for Part D:

www.ssa.gov/medicare/prescriptionhelp/ For Medicare Savings Program:

www.washingtonconnection.org

26

Get help paying for Part D

27

Individual Monthly Income

Limit

Married Couple Monthly Income

Limit

Helps Pay Your

Extra Help

$1,471 $1,991 Part D Premium, Deductibles and Co-pays Extra Help works with Stand-alone plans or Medicare Advantage Plans!

Asset Limits: Individual $13,640 Couple $27,250

28

What other help is there?

If you qualify for Extra Help: (MSP) You might also qualify for help to pay

Part B premiums and other Medicare costs This is called the Medicare Savings

Program • There are several levels of MSP:

o QMB o SLMBo QI - 1

Who can qualify for MSP?

29

Individual Monthly Income

Limit

Married Couple Monthly Income

Limit

Helps Pay Your

Medicare Savings Program

$1,324 $1,792 Part B premiums, and sometimes Part A premiums, Medicare A & B deductibles and co-insurance

Asset Limits: Individual $ 7,280 Couple $10,930

30

How do I choose a plan?

Step 1: Collect your information • Medicare card, any insurance cards

• Current coverage, drugs and dosages

• Extra Help info (income/asset information) Step 2: See if you qualify for Extra Help Step 3: Compare plans for upcoming year

• It’s easy using the Medicare Plan Finder on www.Medicare.gov

• SHIBA can help with the Plan Finder

31

How do I join a plan?

After choosing the plan you are interested in:

Step 1: Call plan with any questions• Confirm any rules, coverage and exceptions

Step 2: Enroll in plan• www.medicare.gov

• Call: 1-800-MEDICARE

• Call plan directly At any time: Call SHIBA for help at

1-800-562-6900

32

Tips to help when you change to a new plan

Plan ahead at the end of this year- fill all of your Rx before 12/31• Ask your doctor about a 60 or 90 day supply

If your new plan denies your drugs:• Ask about a “transitional supply”• If you have to pay out of pocket, save

receipts and ask your plan to reimburse you• Ask your pharmacist, doctor or SHIBA for

help

Need help with other insurance questions?

The Office of the Insurance Commissioner can also help you with questions, information, and complaints about all types of insurance, such as:

Call our Insurance Consumer Hotline

1-800-562-6900

33

• Homeowner• Auto• Life

• Annuities• Health• And more!