By Christina Crain, MSW. Director of Programs

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1 By Christina Crain, MSW Director of Programs

2 What we ll cover Medicare Eligibility Medicaid Eligibility Medicare Parts A, B, C and D New Improvements to Medicare under ACA The Medicare Savings Programs Low Income Subsidy under Part D

3 Medicare vs. Medicaid

4 Is Medicare the same as Medicaid? NO! Medicare eligibility is based on Social Security work history and is administered by the federal government. Medicaid is a means tested program funded in part by the Federal government but administered by each state. Eligibility for Medicaid is based on a person s age, disability and has income and asset guidelines

5 Who qualifies for Medicare? People 65 and older People under 65 with certain disabilities. People of any age with End Stage Renal Disease (ESRD) People under 65 who are disabled have a 24 month waiting period from the month they begin getting disability benefits from SSA. A person diagnosed with ALS (Lou Gehrig s disease) will get Medicare the month disability benefits begin.

6 Who qualifies for Medicaid? For Community Based Medicaid: Those aged 65 or older, blind or disabled Incomes below $912 / month for a single person or incomes below $1,381 /month for a married couple Liquid assets at or below $1,600 single person or $3,200 for a married couple Those with incomes above these amounts may still qualify through a spend-down process.

7 More on Medicaid Medicaid is a very complex program that has many parts to it. Now called Husky Health Different eligibility criteria for the various Medicaid programs Husky A, B for children and families Husky C is for aged, blind disabled Husky D is for low income adults For more information call your local CT DSS office

8 The and of Medicare Part A Hospital Coverage Part B Medical Coverage Part C Medicare Advantage Plans (sold by private insurance companies) Part D Prescription Drug Coverage (sold by private insurance companies)

9 Part A - Hospital Coverage Premium free for most folks who qualify for Medicare Helps pay for : Inpatient Hospital care Skilled Nursing Facility care (SNF) Home Health Care Hospice Care Hospital deductible in 2012 is $1,156 per benefit period Pays for up to 100 days in SNF with a daily co-pay of $ from days

10 Part B - Medical Coverage Covers doctor s services, tests, outpatient care, preventive care, durable medical equipment (DME). Part B does have a monthly premium that is income based. Part B has a $140 annual deductible. Part B covers 80% of Medicare-approved fees after deductible. Beneficiary responsible for 20% coinsurance.

11 Part B Income Related Premium Beneficiaries who file an individual tax return with annual income: Less than or equal to $85,000 Greater than $85,001 and less than or equal to $107,000 Greater than $107,001 and less than or equal to $160,000 Greater than $160,001 and less than or equal to $214,000 Beneficiaries who file a joint tax return with annual income: Less than or equal to $170,000 Greater than $170,001 and less than or equal to $214,000 Greater than $214,001 and less than or equal to $320,000 Greater than $320,001 and less than or equal to $428,000 Total Monthly Premium Amount: $96.40 ( Medicare eligible prior to Jan. 2010) $ (Medicare eligible after January 2010) $ ( those eligible after Jan. 2, 2011) $ $ $287.30

12 Part B - Covered Services Preventive services are covered with no cost sharing as of January 1, Annual Wellness visit with your primary care doctor also started in January Beneficiary pays nothing as long as physician accepts assignment. Welcome to Medicare one-time physical for those new to Medicare.

13 Enrollment Periods Initial Enrollment - the 7 month period around your 65 th birthday. This includes the 3 months prior to your birthday, the month of your birthday and the 3 months after your birthday. General Enrollment - January 1 st - March 31 st of each year. Coverage begins the following July 1 st. Special Enrollment an 8 month period that begins the month after employment ends or group health coverage ends, whichever happens first.

14 Part C - Medicare Advantage Private health plans run by private insurance companies that have a contract with Medicare. Tend to be HMOs or PPOs. Medicare Advantage plans have to provide basic benefits that Original Medicare Parts A and B cover. Plans also can offer prescription drug coverage and some additional benefits at an additional cost.

15 Part D - Prescription Drugs Prescription drug coverage sold by private insurance companies that are approved by Medicare. Helps pay for prescription drugs. Costs and covered drugs (formulary) vary from plan to plan. Enrollment is optional but if you don t enroll when you are first eligible and don t have other creditable coverage you will be penalized when you enroll at a later date.

16 Options under Medicare: Umbrella Program MEDICARE Choose one: TRADITIONAL PART A & PART B OR MEDICARE ADVANTAGE PLAN Then choose: Medigap or Retiree Plan Part D with or w/o Rx coverage

17 Medicare Supplement Plans - Medigap Sold by private insurance companies to cover the deductibles and co-insurance that Medicare does not pay. Twelve companies selling plans in CT in Plans are standardized to make them easier to compare. Prices vary by plan and company. Letter Plans A through D, F, G, K, L, M and N. Medigap plans cannot offer prescription drug coverage. But, you can purchase a Part D plan to help with drug costs. See handout for latest plans and rates.

18 Medicare Supplement Plans - Medigap

19 When can you buy a Medigap? Anytime throughout the year. CT has a continuous enrollment for Medigap Insurance If you buy a Medigap outside of your initial enrollment period, you may be subject to a waiting period for preexisting conditions if you are not replacing coverage with coverage.

20 Medicare Part D Plans Prescription drug plans (PDP) sold by private companies that are approved by CMS. In 2012, there are 30 plans available in CT. Least expensive plan is Humana s Walmart Preferred at $15.10 / month. Most expensive plan is Humana s Complete Plan at $110.20/ month. Buying a Part D plan is optional. However, if you don t purchase a plan when you are first eligible you may be penalized with higher premiums if you buy one later.

21 When can you enroll in Part D? When you first become eligible for Medicare Every year during the Annual Election Period which runs from Oct. 15 th to December 7 th of each year. Within 63 days of losing other creditable prescription coverage like an employer plan.

22 Part D Standard Benefit in 2012: Yearly Deductible Initial Coverage Period Coverage Gap a.k.a. donut Hole Catastrophic Coverage Ranges from $0 - $320 depending on plan Beneficiary pays 100% of drug costs until they meet their deductible Beneficiary pays roughly 25% of formulary drug costs and plan pays 75% till the total cost of formulary drugs reaches $2,930 Once the total cost of formulary drugs reach $2,930 beneficiary enters gap and pay 50% of formulary drug costs until they spend $4,700 out of pocket Once beneficiary spends $4,700 out of pocket, coverage gap ends and they now pay only 5% of formulary drug costs.

23 What s happening to the Hole? Consumers who hit the donut hole in 2012 will get a 50% manufacturers discount on brand name drugs that are on their plan s formulary For Generic drugs, they will get a 14% government discount in the donut hole. Further discounts will be phased in over next eight years till donut hole is completely closed in 2020.

24 Cost Sharing for Brand Name Drugs in the Donut Hole

25 Why everyone needs to choose wisely... Each Part D plan has their own list of drugs that they will cover (formulary). Premiums & Co-pays for drugs vary from plan to plan. Plans can impose drug restrictions such as: step therapy, prior authorization and/or quantity limits. Benzodiazepines and barbiturates are excluded from Part D coverage until 2013 / 2014, respectively; however, some plans have opted to provide coverage for these two classes of drugs.

26 Medicare Advantage Plans Private Insurance option that is an alternative to traditional Medicare. MA plans generally require patients to obtain services from certain network providers. Most MA plans include the Part D prescription coverage. Generally, MA plans have lower monthly premiums than Medigap plans but may have higher co-pays and fees for services.

27 Significant Changes to MA plans in 2012 MA plans are prohibited from imposing higher costsharing requirements than those charged under original Medicare for certain Medicare covered benefits: Chemotherapy Dialysis Skilled nursing care Provides a 45 day period (from Jan. 1 to Feb 14 th ) in which MA enrollees can drop their MA plan and return to traditional Medicare with a qualified Rx plan. There are 17 plans being offered in Fairfield County in Two special needs plans for individuals on Medicare & Medicaid.

28 Remember You can have Medicare A & B and buy a Medigap plan to pick up the co-pays and deductibles that Parts A & B don t cover, and you would also need to buy a Part D Plan for your prescription drugs OR You can buy a Medicare Advantage Plan which will administer all your health care coverage including prescription drugs. You CANNOT have a Medigap and Medicare Advantage Plan at the same time.

29 When can you enroll in a Medicare Advantage Plan? When you first become eligible for Medicare during your Initial Enrollment Period After you lose employer coverage during your special enrollment period During the Annual Election Period from October 15 th to December 7th

30 Programs to help people pay their healthcare costs: Medicare Savings Programs (MSP) QMB pays the Part B premium, as well as the 20% coinsurance and deductibles if consumer goes to a provider that accepts Medicare and Medicaid. SLMB pays only the Part B premium. ALMB also pays just the Part B premium. Low Income Subsidy (LIS) Helps pay prescription costs under Medicare Part D. Pays the deductible and most of the drug costs.

31 Eligibility Criteria for MSP QMB monthly income below $1, / single or $2, / married couple SLMB monthly income below $2, / single or $2, / married couple ALMB monthly income below $2, / single or $3, / married couple In CT, there are no asset limits to qualify for these programs.

32 Some important Facts If someone qualifies for a Medicare Savings Program, they will automatically be enrolled in the Low Income Subsidy for help with their drug costs. Those on MSP must do a re-determination application each year to verify that they are still eligible and continue to be enrolled in MSP.

33 Benefits of being on LIS Will cover all or some of the Part D monthly premium (depending on the plan you choose). Will cover the Part D deductible. Will cover most of the cost of formulary drugs with maximum co-pays of: $6.50 co-pay for formulary brand name drugs. $2.60 co-pay for formulary generic drugs. NO donut hole. NO late enrollment penalty. Can change your plan anytime throughout the year.

34 Don t Forget. The Annual Enrollment Period starts October 15 th and ends on December 7 th. Everyone should take this time to review their coverage and make sure you are in the best plan for Premiums change from year to year, the co-pays for your drugs can change as well as the formularies. Remember, what is a good plan for you this year, may not be the best plan for you next year! Be wise consumers of your healthcare needs.

35 Useful Resources or MEDICARE Plan comparison tool and much more The CHOICES Program at

36 Questions. Christina Crain, MSW Director of Programs The Southwestern CT Agency on Aging 10 Middle Street Bridgeport, CT (203) (800)

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