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Medicare Open Enrollment

Medicare Open Enrollment . October 15 to December 7, 2012 . 1-800-MEDICARE www.medicare.gov. Objectives. Following this session you should be able to Provide an overview and relate key dates Know how to compare Medicare plans Describe how to join a new plan Explain LIS reassignment

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Medicare Open Enrollment

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  1. Medicare Open Enrollment October 15 to December 7, 2012 1-800-MEDICARE www.medicare.gov

  2. Objectives • Following this session you should be able to • Provide an overview and relate key dates • Know how to compare Medicare plans • Describe how to join a new plan • Explain LIS reassignment • Be aware of notices to beneficiaries • Refer to helpful resources Medicare Open Enrollment 2012

  3. 2013 Overview • Medicare Advantage premiums are projected to remain stable • Average weighted premium will increase by $1.47 (4.7%) • However, if beneficiaries switch to lower cost plans at the same rate in 2013 as they did in 2012, we expect the average premium to increase by only $.57 (1.8%) • 99.6 percent of beneficiaries have access to an MA plan • The number of plan choices will increase by 7% Medicare Open Enrollment 2012

  4. 2013 Overview • Part D estimated average basic premium and estimated total premium will slightly increase • Average premium projected to be $30 in 2013 • People who reach the “donut hole” • 52.5% discount on covered brand name drugs • 21% discount on covered generic drugs Medicare Open Enrollment 2012

  5. Open Enrollment for People with Medicare • From October 15 to December 7 you can • Join or switch a Medicare prescription drug plan • Join or switch a Medicare Advantage Plan • Take time to review health and drug plan choices • Choose the plan that fits your needs • Coverage begins on January 1, 2013 • You’ll have membership card/materials in hand

  6. *Dual eligible Special Needs Plans have the option to send a combined ANOC/EOC by 9/30 or send the ANOC and Summary of Benefits by 9/30 and the EOC by 12/31.

  7. Comparing Plans • Each year • Medicare Plans can change costs and coverage • Plans mail Evidence of Coverage/Annual Notice of Change • Gives details about plan coverage, costs, etc. • For the next year • Some plans may choose to leave Medicare • Plans mail notice of non-renewal • Members have a Special Enrollment Period Medicare Open Enrollment 2012

  8. Things to Consider • Coverage • Are the services or drugs you need covered? • Do you have or are you eligible for other health and drug coverage? • Costs • Premiums, coinsurance (copays), deductibles • What is the out-of-pocket limit for medical care? • Are your doctors/hospitals part of the plan? • Are your prescription drugs covered? • What are the plan’s quality ratings? • Are the offices/pharmacies/hospitals convenient? • Do you travel for long periods during the year?

  9. Where to Get Plan Information • Medicare Plan Finder on www.medicare.gov • The plan’s website • Medicare & You handbook • 1-800-MEDICARE (1-800-633-4227) • State Health Insurance Assistance Program (SHIP) Medicare Open Enrollment 2012

  10. 1. Medicare Plan Finder • More detailed comparison using Medicare Plan Finder • www.medicare.gov, select “Find Health and Drug Plans” • Check the plan’s quality summary rating • 5-Star and low-performing plan icons • See which drugs are on the plan’s formulary • Compare the cost ranges for plans in your area Medicare Open Enrollment 2012

  11. 5-Star Special Enrollment Period • Enroll one time any time during the year in a • 5-Star Medicare Advantage Plan • 5-Star Medicare Advantage with Prescription Drug Plan • 5-Star Prescription Drug Plan • Even if already in a 5-Star Plan • New plan starts first of month after enrolled • Star ratings on Plan Finder October 11 • Updated yearly

  12. Low-Performing Medicare Plans • Plans that receive a summary rating of less than 3-Stars for at least 3 years in a row • Ratings are on Medicare Plan Finder • Medicare & You doesn’t have full, updated ratings • Changes for low-performing plans in 2013 • No online enrollment for low-performing plans • No enrollment through 1-800-Medicare • Must contact plan directly to enroll • Enrolled beneficiaries can call 1-800-Medicare and ask to move to a higher quality plan

  13. 2. Contact the Plan • Plan sites have the most comprehensive information • Unlike Medicare Plan Finder, you can’t compare other plans • Call plan or check their website • On Medicare Plan Finder • Contact information in Medicare & You handbook • Phone number • Web address Medicare Open Enrollment 2012

  14. 3. Medicare & You Handbook • Has basic plan information • Mailed each fall to beneficiary households • Good for quick comparison • Plan information not comprehensive • Only one quality rating • Mailed September 16 - 30 • CMS Publication No. 10050 Note: The star rating in the handbook is the percent of people who rated their plan as the best. Medicare Open Enrollment 2012

  15. 4. 1-800-MEDICARE • 1-800-MEDICARE (1-800-633-4227) • Say “Medicare Number” if available • Say “Agent” if it is not • Available 24 hours a day, 7 days a week • Support is offered in multiple languages • Tell customer service representative preferred language • TTY users should call 1-877-486-2048 Medicare Open Enrollment 2012

  16. 5. State Health Insurance Assistance Programs (SHIPs) • Program for people with Medicare • And their families • Free personalized counseling and assistance • Funded through Federal grants to states • Find your local SHIP contact • Look at the back of your Medicare & You handbook • Check the web at www.medicare.gov/contacts • Call 1-800-MEDICARE Medicare Open Enrollment 2012

  17. How to Join a New Plan • May be able to enroll in Medicare Health Plan or Medicare Prescription Drug Plan by • Paper Application • Calling the Plan • Enrolling on the plan’s website or on www.medicare.gov • Call 1-800-MEDICARE (1-800-633-4227) • TTY users call 1-877-486-2048 • Enrolling in a new plan will disenroll you from your previous plan Medicare Open Enrollment 2012

  18. If You Have Other Coverage IMPORTANT • If you have other coverage, like from an employer or union • Check with your plan’s benefits administrator before making any changes to your coverage • Otherwise, you could lose coverage for you and your dependents

  19. Your Medicare Choices • Original Medicare • Medigap (Medicare supplement insurance) policies • Medicare Prescription Drug Coverage • Medicare Advantage Plans • With or without Medicare Prescription Drug Coverage • Other Medicare Health Plans • Like Cost Plans and Programs of All-Inclusive Care for the Elderly (PACE) Plans Medicare Open Enrollment 2012

  20. Original Medicare • Run by the Federal government • Provides hospital (Part A) and doctor (Part B) coverage • See any doctor or hospital that accepts Medicare • You pay • Part B premium (Part A free for most people) • Deductibles, coinsurance or copayments • Can buy a Medigap policy to help pay some of these costs • Get Medicare Summary Notice (MSN) • Can join a Medicare Rx Plan to add drug coverage

  21. Medigap Policies (Medicare Supplement Insurance) Pay the “gaps” in Original Medicare coverage Private health insurance for individuals Sold by private insurance companies Follow Federal/state laws that protect you Must state “Medicare Supplement Insurance” Don’t work with Medicare Advantage Plans

  22. Medigap and Open Enrollment • If you drop a Medicare Advantage (MA) Plan and join Original Medicare during the Open Enrollment Period • There is no guarantee that an insurance company will sell you a Medigap policy • You may have to meet medical underwriting requirements • Unless you have a guaranteed issue right • Example: If your MA Plan leaves Medicare • Contact Medigap insurers in your area to see what might be available to you

  23. Medigap and Open Enrollment • If your Medicare Advantage Plan does not renew and you join Original Medicare and you are age 65 or older • You have a special right to buy a Medigap policy • Called a guaranteed issue right • From 60 days before to 63 days after your coverage ends • If you’re under age 65, you may not be able to buy a Medigap policy until you turn age 65. • Check with your State Health Insurance Assistance Program or State Insurance Department

  24. Medicare Advantage Plans • Health plan options approved by Medicare • Run by private companies • Part of the Medicare program • Sometimes called “Part C” • Available in most areas of the country • Medicare pays a set amount to plan for your care • Most MA plan include prescription drug coverage Medicare Open Enrollment 2012

  25. Who Can Join a Medicare Advantage Plan? • Eligibility requirements • Live in plan service area • Entitled to Medicare Part A (Hospital Insurance) • Enrolled in Medicare Part B (Medical Insurance) • No End-Stage Renal Disease (ESRD) at enrollment • Some exceptions • To remain enrolled a person must also • Pay the plan’s premium on time • Provide necessary information to the plan • Follow the plan rules • You can only belong to one MA plan at a time

  26. How Medicare Advantage Plans Work • Receive services through the plan • All Part A and Part B covered services • Some plans may provide additional benefits • Receive a separate plan membership card • Medicare pays plan monthly for your care • You may have to visit network doctors/hospitals • May be different than Original Medicare • Benefits • Cost-sharing

  27. Medicare Advantage Plan Costs • Must still pay Part B premium • Some plans may pay all or part for you • May pay additional monthly premium • You pay deductibles, coinsurance and copayments • Different from Original Medicare • Varies from plan to plan • Costs may be higher if out-of-network

  28. Medicare Advantage Plans and Open Enrollment • If you are in a Medicare Advantage (MA) Plan • You can switch to another MA Plan by joining a new MA plan • You will be automatically disenrolled from your old plan • You can switch back to Original Medicare by joining a stand-alone Medicare drug plan • If you do you should consider/see if you can get a Medigap policy REMEMBER: If you have other health or drug coverage, like from an employer or union, check with your benefits administrator before you make any changes to your coverage.

  29. Leaving a Medicare Advantage Plan • Between January 1–February 14 • You can leave an MA plan and switch to Original Medicare • If you make this change, you may also join a Medicare Prescription Drug Plan to add drug coverage • Coverage begins the first of the month after the plan gets enrollment form • Check whether you could get a Medigap policy

  30. Medicare Prescription Drug Coverage • Also called Medicare Part D • Available for all people with Medicare • Provided through • Medicare Prescription Drug Plans (PDPs) • Most Medicare Advantage Plans • Some other Medicare plans • Must include range of drugs in each category Medicare Open Enrollment 2012

  31. Who Can Join a Part D Plan? • You must have Medicare Part A and/or Part B • You must live in the plan’s service area • You must proactively choose and enroll in a Part D plan • You can’t live outside the U.S. or be incarcerated

  32. Prescription Drug Plans and Open Enrollment • If you change your PDP, enroll in a new PDP or join an MA Plan with drug coverage (MAPD) • You are automatically disenrolled from old plan • If you drop a Medicare Advantage Plan and join Original Medicare • You can enroll in a PDP • If you didn’t get Medicare drug coverage when you were first eligible, and did not have coverage “as good as” Medicare Part D, you may have to pay a penalty when you enroll • People with Extra Help don’t pay a penalty

  33. Need a Rx Before You Get Your Membership Materials • Take as much information to the pharmacy/provider as possible, including • Your red, white, and blue Medicare card • A photo ID • An acknowledgement or confirmation letter, or an enrollment confirmation number from the plan • If your enrollment can’t be confirmed, you can pay out-of-pocket and work with the plan to be reimbursed • Your Medicaid card or letter showing eligibility for Extra Help

  34. Reassignment Process • Each Fall, CMS reassigns Low Income Subsidy (LIS) (Extra Help) beneficiaries with 100% premium subsidy to a new Medicare plan if • Plan is terminating • Plan premium increases • Over regional LIS premium subsidy amount or • Converting to enhanced benefit • Reassignment is random • Basic plans only • People who chose their current plan won’t be reassigned Medicare Open Enrollment 2012

  35. Non-Renewing Medicare Plans • Sometimes plans don’t renew all of their plans • Usually based on the plans’ business decisions • Or on CMS sanctions or contract terminations • You may join another Medicare Advantage or Medicare Prescription Drug Plan • Plans must notify members affected • No later than the beginning of October (90 days before the end of the year) • Those affected get Special Enrollment Period • October 15, 2012 – February 28, 2013 Medicare Open Enrollment 2012

  36. Beneficiary Notices • Terminating Medicare Prescription Drug Plans • Medicare Advantage Plan Termination • Prescription Drug Plan Premium Increase • “Choosers” • Reassignment Formulary Notice • See Appendix A for complete list Medicare Open Enrollment 2012

  37. Prescription Drug Plan Premium Increase • CMS sends letter in late October on • BLUE PAPER version 2 • Current plan’s premiums increasing over LIS benchmark, or converting to enhanced plan • Reassigned to new plan effective January 1, 2013 • Unless they join a new plan by December 31, 2012 • Action • Keep the notice • Compare new 2013 plan with others • Can choose to change plans

  38. Medicare Advantage Plan Termination • CMS sends letter in late October/early November • BLUE PAPER version 3 • Current plan is leaving Medicare Program • Health coverage will revert back to Original Medicare • If LIS, Reassigned to a PDP plan effective January 1, 2013 • Unless they join a new plan by December 31, 2012 • Action • Keep the notice • Compare new 2013 plan with others • Can choose to change plans

  39. Terminating Medicare Prescription Drug Plans • CMS sends letter in late October • BLUE PAPER version 1 • Current plan is leaving Medicare Program • Reassigned to new plan effective January 1, 2013 • Unless they join a new plan by December 31, 2012 • Action • Keep the notice • Compare new 2013 plan with others • Can choose to change plans

  40. “Choosers” • People who have Low Income Subsidy (LIS) with 100% premium subsidy • Chose current plan AND • Have premium liability in 2013 >$0 • Does not include • Choosers in benchmark plans that remain below benchmark • LIS people with partial subsidies (75%, 50%, or 25%) • CMS conducts outreach instead of reassignment • Will receive tan letter

  41. “Choosers” Outreach Notices • In the Spring (April) • New this year, but will be sent out from now on • Reminder that there are $0 premium plans available • Printed on TAN paper • In the Fall (October) • Informs of the premium liability • Responsible for paying a portion unless they join a new plan • Printed on TAN paper • Action • May want to look for a new plan • Compare current plan with others • Can choose to change plans

  42. Reassignment Formulary Notice • CMS sends letter in December • BLUE PAPER version 4 • Sent to people affected by reassignment • Summarizes which Part D-covered drugs they took in 2012 will or will not be covered by their new Medicare drug plan for 2013 • Unless they join a new plan by December 31, 2012 • Action • Keep the notice • Compare new 2013 plan with others • Can choose to change plans

  43. Resources • Landscape of plans http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/ • Plan Finder https://www.medicare.gov/find-a-plan/questions/home.aspx • Medicare & You handbook https://www.medicare.gov/Publications/Pubs/pdf/10050.pdf • State Health Insurance Assistance Program www.medicare.gov/contacts • 1-800-MEDICARE (1-800-633-4227) Medicare Open Enrollment 2012

  44. Resources • Open Enrollment Center on cms.gov at http://www.cms.gov/Center/Special-Topic/Open-Enrollment-Center.html • Download poster, sticker, conference card • Product ordering website at http://productordering.cms.hhs.gov/ • Drop-in articles • Live-read PSAs • Publications

  45. Additional Medicare Publications Available on www.Medicare.gov

  46. Appendix A

  47. Appendix A

  48. Appendix A

  49. Appendix A

  50. Appendix A

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