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Medicare Open Enrollment

Medicare Open Enrollment

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Medicare Open Enrollment

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  1. Medicare Open Enrollment October 15 to December 7, 2013 1-800-MEDICARE www.medicare.gov

  2. Objectives • Following this session you should be able to • Provide an overview of key dates • Know how to compare Medicare plans • Describe how to join a new plan • Refer to helpful resources Medicare Open Enrollment 2013

  3. 2014 Overview • Medicare Advantage (MA) premiums are projected to remain stable • Average weighted premium will increase by $1.64 • The average MA premium is projected to be $32.60 • MA premiums are down 9.8 percent • Since passage of Affordable Care Act (ACA) • 99.1 percent people with Medicare have access to an MA plan • Over one-third MA plans have four or more stars Medicare Open Enrollment 2013

  4. 2014 Overview • Part D estimated average basic premium and estimated total premium will slightly increase • Average premium projected to be $32.42 in 2014 • People who reach the “donut hole” • 52.5 percent discount on covered brand name drugs • 28 percent discount on covered generic drugs Medicare Open Enrollment 2013

  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, 2014 • 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 2013

  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, and 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 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 2013

  10. 1. Medicare Plan Finder • More detailed comparison using Medicare Plan Finder • 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 2013

  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 8 • 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 • Low-performing plans • 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 2013

  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 • CMS Product No. 10050 Note: The star rating in the handbook is the percent of people who rated their plan as the best. Medicare Open Enrollment 2013

  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 150 languages • Tell customer service representative preferred language • TTY users should call 1-877-486-2048 Medicare Open Enrollment 2013

  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 Medicare.gov/contacts • Call 1-800-MEDICARE Medicare Open Enrollment 2013

  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 Medicare.gov • Calling 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 2013

  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 • May add Medigap (Medicare supplement insurance) • May add Medicare prescription drug coverage • Medicare Advantage Plans • With or without Medicare Prescription Drug Coverage • Other Medicare Health Plans • Like Cost Plans, Medicare Medical Savings Accounts and Programs of All-Inclusive Care for the Elderly (PACE) Plans Medicare Open Enrollment 2013

  20. 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

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

  22. 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.

  23. 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

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

  25. 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 2013

  26. 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, 2013 – February 28, 2014 Medicare Open Enrollment 2013

  27. 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 2013

  28. 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, 2014 • Unless they join a new plan by December 31, 2013 • Action • Keep the notice • Compare new 2014 plan with others • Can choose to change plans

  29. 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, 2014 • Unless they join a new plan by December 31, 2013 • Action • Keep the notice • Compare new 2014 plan with others • Can choose to change plans

  30. 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, 2014 • Unless they join a new plan by December 31, 2013 • Action • Keep the notice • Compare new 2014 plan with others • Can choose to change plans

  31. “Choosers” • People who have Low Income Subsidy (LIS) with 100% premium subsidy • Chose current plan AND • Have premium liability in 2014 >$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

  32. “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

  33. 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 2013 will or will not be covered by their new Medicare drug plan for 2014 • Unless they join a new plan by December 31, 2013 • Action • Keep the notice • Compare new 2014 plan with others • Can choose to change plans

  34. Medicare and the Health Insurance Marketplace • Messages in the media are increasing about the new Health Insurance Marketplace • People with Medicare may become confused and think they need to enroll in a Marketplace plan • People with Medicare are covered and the Marketplace will not require them to do anything different with their Medicare

  35. Medicare and Marketplace Key Messages • Your Medicare benefits aren’t changing • Marketplace does not affect your Medicare coverage • Medicare is not part of the Marketplace • Medicare Open Enrollment is the time to review your health/drug plans • Protect your personal information • See Appendix B for Medicare/Marketplace frequently asked questions (FAQs)

  36. Resources • Landscape of plans CMS.HHS.gov/PrescriptionDrugCovGenIn/ • Plan Finder Medicare.gov/find-a-plan/questions/home.aspx • Medicare & You handbook Medicare.gov/Publications/Pubs/pdf/10050.pdf • State Health Insurance Assistance Program Medicare.gov/contacts • 1-800-MEDICARE (1-800-633-4227) Medicare Open Enrollment 2013

  37. Resources (Continued) • Open Enrollment Center on cms.gov at CMS.gov/Center/Special-Topic/Open-Enrollment-Center.html • Download poster, drop-in articles, publications • View public service announcement scripts • Product ordering website at Productordering.cms.hhs.gov/ • Poster, sticker, conference card

  38. Additional Medicare Publications Available on Medicare.gov

  39. Appendix A As of July 19, 2013. Electronic version available at www.cms.hhs.gov/LimitedIncomeandResources/Downloads/2013Mailings.pdf

  40. Appendix A As of July 19, 2013. Electronic version available at www.cms.hhs.gov/LimitedIncomeandResources/Downloads/2013Mailings.pdf

  41. Appendix A As of July 19, 2013. Electronic version available at www.cms.hhs.gov/LimitedIncomeandResources/Downloads/2013Mailings.pdf

  42. Appendix A As of July 19, 2013. Electronic version available at www.cms.hhs.gov/LimitedIncomeandResources/Downloads/2013Mailings.pdf

  43. Appendix A As of July 19, 2013. Electronic version available at www.cms.hhs.gov/LimitedIncomeandResources/Downloads/2013Mailings.pdf

  44. Appendix B People with Medicare and the Health Insurance Marketplace Frequently Asked Questions

  45. Appendix B People with Medicare and the Health Insurance Marketplace Frequently Asked Questions

  46. Appendix B People with Medicare and the Health Insurance Marketplace Frequently Asked Questions