medicare annual enrollment important medicare updates for 2015
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Medicare Annual Enrollment Important Medicare Updates for 2015

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Medicare Annual Enrollment Important Medicare Updates for 2015. SHINE Overview. SHINE stands for S erving the H ealth I nsurance N eeds of E veryone Provides free and unbiased insurance information and counseling to Medicare beneficiaries

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shine overview
SHINE Overview

SHINE stands forServingthe Health Insurance Needs of Everyone

Provides free and unbiased insurance information and counseling to Medicare beneficiaries

Over 600 SHINE counselors available throughout Massachusetts to help

SHINE Counselors are available at many Senior Centers, Councils on Aging (COA), Community hospitals and many other community-based sites

2014 2015 important dates
2014–2015 Important Dates
  • October 15th 2014: Open Enrollment begins
    • Medicare beneficiaries can change health and prescription coverage
  • December 7th 2014: Open Enrollment ends
    • Enrollment requests must be received by the 7th
  • January 1st 2015: Coverage begins
Your Medicare Coverage Choices

Step 1: Decide how you want to get your coverage











Combines Part A, Part B

and usually Part D


Step 2: Decide if you need a Prescription Drug Plan


Included in Part C


Stand Alone PDP

Step 3: Decide if you need to add supplemental medical coverage


If you join a Medicare Advantage Plan with drug coverage (MAPD), you cannot join another drug plan and you don’t need and cannot be sold a Medigap policy


Supplement Core or

Supplement 1 plan

part b preventive benefits
Part B Preventive Benefits
  • ACA provides access to many free preventive benefits
    • Mammograms
    • Some pap smear and pelvic exams
    • Colorectal Screenings
    • Diabetes Self-Management Training/Tests
    • Bone Mass Measurements
    • Prostate Cancer Screening
    • Obesity screening/counseling
    • Depression screening/counseling
    • Annual Wellness Visit
      • Update individual’s medical & family history
      • Record height, weight, body mass index, blood pressure and other routine measurements
      • Provide personal health advice and coordinate appropriate referrals

and health education

open enrollment options
Open Enrollment Options
  • If in a Medicare Advantage (MA) plan:
    • Can change to a different MA plan
    • Can change to Original Medicare and enroll in a Part D (along with a Medigap, if desired)
      • Members of MA plans must have Medicare Parts A & B and must continue to pay the Part B premium
  • If in Original Medicare:
    • Can enroll in an MA plan
  • If in a Part D plan:
    • Can drop or switch Part D plans
medicare supplement plans 2015
Medicare Supplement Plans 2015
  • Supplement Plans (Medigaps)
    • Sold by private insurance companies
    • Coverage varies for deductibles and co-insurance
    • No network restrictions
    • Drug coverage is NOT included
  • 2015 updates
    • Continuous open enrollment
    • If changing plans, cancel enrollment in old plan
medicare advantage plans 2015
Medicare Advantage Plans 2015
  • MA plans (HMO’s, PPO’s)
    • Coverage provided through private plans within networks
    • Prescription drug coverage usually included
  • 2015 Updates
    • Plan changes will be announced to members on September 30th
medicare prescription drug coverage
Medicare Prescription Drug Coverage
  • Also called Part D
  • Provides outpatient prescription drugs
  • All Medicare beneficiaries are eligible
    • Can have Part A and/or Part B
  • Coverage for Part D is provided by:
    • Prescription Drug plans (PDP’s), also known as stand alone plans
    • Medicare Advantage Prescription Drug Plans (MAPD’s)
anatomy of a drug plan
Anatomy of a Drug Plan
  • Cost components
    • Premiums: Monthly cost
    • Deductibles: Annual cost
    • Co-pays and co-insurance: Paid at pharmacy
    • Formularies: List of medications covered
    • Drug tiers: Pricing ladder
    • Restrictions: Quantity limits, prior authorization, or step therapy
  • Amounts change periodically, therefore it is important to review coverage during Open Enrollment
part d coverage 2014 vs 2015
Part D Coverage2014 vs. 2015

* In 2015, after $2,960 in retail costs, the beneficiary pays 45% of brand name drug costs and 65% of generic drug costs until total out-of-pocket costs equal $4,700

part d changes for 2015
Part D Changes for 2015

Plan changes announced September 30th

Important to compare plans every year

assistance programs may help
Assistance Programs May Help
  • There are several assistance programs to help pay Medicare cost-sharing including:
    • Extra Help (Low Income Subsidy/LIS)
    • Prescription Advantage
    • Patient Access Programs
    • See handout “Concerned about Medicare Costs?”
  • These programs are based on income and/or assets
  • A SHINE Counselor can help you determine which programs you may qualify for and assist you in applying

SHINE: 1-800-AGE-INFO (1-800-243-4636), press 3

Medicare: 1-800-MEDICARE (1-800-633-4227)

MCPHS Pharmacy Outreach Program: 1-800-633-1617

Prescription Advantage: 1-800-AGE-INFO, press 2

Medicare Advocacy Project (MAP): 1-866-778-0939

Senior Medicare Patrol: 1-800-892-0890

  • This is the time of year to make changes to your Medicare Advantage or Prescription Drug Plan
  • Ask yourself:
    • Will my plan cover the drugs I take?
    • How much will my plan cost?
    • Will my doctor/hospital take my Medicare Advantage Plan?