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Benefits update. StateWide Senior Action Council annual convention East Greenbush, NY October 12, 2011 Presenter: Cathy Roberts, Senior Paralegal Empire Justice Center, Albany, NY. Today’s presentation. A review of changes affecting: Medicare Medicaid Food stamps HEAP

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benefits update

Benefits update

StateWide Senior Action Council annual convention

East Greenbush, NY October 12, 2011

Presenter: Cathy Roberts, Senior Paralegal

Empire Justice Center, Albany, NY

today s presentation
Today’s presentation

A review of changes affecting:

Medicare

Medicaid

Food stamps

HEAP

(Home Energy Assistance Program)

medicare part d
Medicare Part D
  • New open enrollment period: Oct 15 - Dec 7
  • Special enrollment period for 5 star plans
  • Higher Part D premiums for higher income beneficiaries
  • Gradual closing of coverage gap
    • 14% discount for generics
    • 50% discount for brand name drugs
  • $0 drug co-pays for HCBS Medicaid waiver participants
medicare advantage
Medicare Advantage
  • Same change to open enrollment period:
  • Oct 15 - Dec 7
  • Preventive services must be free
  • Other limitations on cost sharing:
    • Chemotherapy
    • Dialysis
    • Skilled nursing facility
original medicare
Original Medicare
  • Mental health co-pays reduced to 40%
    • Were 45% in 2011
  • Coming soon:
    • Info regarding Part A and B premiums, deductibles, etc.
no more medicaid wrap for dual eligibles
No more Medicaid “wrap” for dual eligibles
  • Medicaid no longer pays for any Part D covered drugs (as of 10/1/2011)
  • Medicaid continues to cover:
    • Part B drugs (co-insurance)
    • Benzodiazepines
    • Barbiturates
    • Prescription vitamins
    • Certain OTC drugs
new limitations in medicaid services
New limitations in Medicaid services
  • Affects access to:
    • Compression stockings
    • Prescription footwear
    • Enteral nutritional formula
    • Level 1 personal care services
    • Physical, occupational and speech therapy
dramatic expansion of mandatory managed care
Dramatic expansion of mandatory managed care
  • Does not affect most Medicare beneficiaries (yet), except for:
    • New requirements governing managed long term care (MLTC).
      • Beginning in NYC in May 2012:
        • Anyone needing personal care for more than 120 days will be required to enroll in an MLTC plan
reduction in reimbursement rates to providers
Reduction in reimbursement rates to providers
  • Decreased reimbursement rates may affect access to care, especially:
      • Home care services
      • Adult dental care
slide13

Food Stamps

(aka SNAP:

Supplemental Nutrition Assistance Program)

many eligible seniors are not participating
Many eligible seniors are not participating
  • Estimated “take-up” rate for seniors: 34%
  • Recent changes have improved access
    • No asset test for most seniors
    • No in-person interview required
    • Can apply by mail or internet
  • Most seniors getting Part D Extra Help or EPIC premium assistance can qualify
  • For more info, go to https://www.mybenefits.ny.gov/
slide15

HEAP:

Home Energy Assistance Program

cuts on the federal level will drastically affect new york this winter
Cuts on the federal level will drastically affect New Yorkthis winter
  • Shorter HEAP season:
    • Regular HEAP opens Nov 16, 2011
    • Emergency HEAP not expected to open until January 3, 2012
  • Significant reduction in benefit levels:
    • Most households will get 30-40% less than
    • what they got last year
  • More info is available at http://otda.ny.gov/programs/heap/
where to go for help
Where to go for help
  • Health Insurance Information Counseling and Assistance Program (HIICAP)
    • NYS toll-free helpline: 1-800-701-0501
  • 1-800-MEDICARE or www.medicare.gov
  • Social Security Administration
  • (to enroll in Medicare): 1-800-772-1213 or www.socialsecurity.gov
  • Food stamps and HEAP:
    • https://www.mybenefits.ny.gov/
questions
Questions?
  • www.nyhealthaccess.org
  • My contact information:
    • Cathy Roberts, Senior Paralegal
    • Empire Justice Center
    • 119 Washington Avenue
    • Albany, NY 12210
    • 1-800-635-0355 x 112
    • croberts@empirejustice.org
    • www.empirejustice.org