Medicare Open Enrollment MEDICARE

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1 Medicare Open Enrollment MEDICARE

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 2

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 osince 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 3

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 4

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 5

6 Key Dates September 16 CMS began mailing 2014 Medicare & You handbook 30 Most plans must provide Annual Notice of Change (ANOC)/Evidence of Coverage (EOC) to members* October 1 Plans may begin marketing 2014 plan data to be displayed on the Medicare Plan Finder (MPF) 8 Plan star ratings updated on MPF 15 Medicare s Open Enrollment Period begins December 7 Open Enrollment ends January 1 CY 2014 plan benefit period begins *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. 6

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 7

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? 8

9 Where to Get Plan Information 1. Medicare Plan Finder on Medicare.gov 2. The plan s website 3. Medicare & You handbook MEDICARE ( ) 5. State Health Insurance Assistance Program (SHIP) 9

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 10

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 11

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 MEDICARE Must contact plan directly to enroll Enrolled beneficiaries can call MEDICARE and ask to move to a higher quality plan 12

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 13

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 Note: The star rating in the handbook is the percent of people who rated their plan as the best. 14

15 MEDICARE MEDICARE ( ) 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

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 MEDICARE 16

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 MEDICARE ( ) TTY users call Enrolling in a new plan will disenroll you from your previous plan 17

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 18

19 Your Medicare Choices 1. Original Medicare May add Medigap (Medicare supplement insurance) May add Medicare prescription drug coverage 2. Medicare Advantage Plans With or without Medicare Prescription Drug Coverage 3. Other Medicare Health Plans Like Cost Plans, Medicare Medical Savings Accounts and Programs of All-Inclusive Care for the Elderly (PACE) Plans 19

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 20

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 21

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. 22

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 23

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-ofpocket and work with the plan to be reimbursed Medicaid card or letter showing eligibility for Extra Help 24

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 25

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,

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 27

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 28

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 29

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 30

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 31

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 32

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 33

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 34

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) 35

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 MEDICARE ( ) 36

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 37

38 Additional Medicare Publications Things to Think About When You Compare Medicare Drug Coverage CMS Product Number Choose Higher Quality for Better Health Care Have You Done Your Yearly Medicare Plan Review? Understanding Medicare Enrollment Periods Withholding Medicare Rx Premium from your Social Security Payment Available on Medicare.gov 38

39 Appendix A As of July 19, Electronic version available at 39

40 Appendix A As of July 19, Electronic version available at 40

41 Appendix A As of July 19, Electronic version available at 41

42 Appendix A As of July 19, Electronic version available at 42

43 Appendix A As of July 19, Electronic version available at 43

44 Appendix B People with Medicare and the Health Insurance Marketplace INFORMATION Frequently PARTNERS Asked Questions SHOULD KNOW People with Medicare and the Health Insurance Marketplace How will the Health Insurance Marketplace that starts in 2014 affect my Medicare coverage? The Health Insurance Marketplace is designed to help people who don t have any health insurance. You Frequently Asked Questions have health insurance through Medicare. The Marketplace won t have any effect on your Medicare coverage. How will the Health Insurance Marketplace that starts in 2014 affect my Medicare coverage? Your The Medicare Health Insurance benefits Marketplace aren t changing. is designed No matter to help how people you who get Medicare, don t have whether any health through insurance. Original You Medicare have health or a insurance Medicare through Advantage Medicare. Plan, you ll The Marketplace still have the won t same have benefits any effect and on security your Medicare you have now, and coverage. you won t have to make any changes. The Your Marketplace Medicare benefits provides aren t new changing. health insurance No matter options how you for get many Medicare, Americans. whether If you through have family Original and Medicare or a Medicare Advantage Plan, you ll still have the same benefits and security you have now, friends who don t have health insurance, tell them to visit to learn more about and you won t have to make any changes. their options. The Marketplace provides new health insurance options for many Americans. If you have family and friends who don t have health insurance, tell them to visit to learn more about their options. 44

45 Appendix B People with Medicare and the Health Insurance Marketplace Frequently Asked Questions Do I need to do anything with Marketplace plans during Medicare Open Enrollment (October 15 December 7, 2013)? Medicare s Open Enrollment isn t part of the new Health Insurance Marketplace. It s against the law for someone who knows that you have Medicare to sell you a Marketplace plan. Medicare Open Enrollment (October 15 December 7, 2013) is the time when all people with Medicare are encouraged to review their current health and prescription drug coverage, including any changes in costs, coverage and benefits that will take effect next year. If you want to change your coverage for next year, this is the time to do it. If you re satisfied that your current coverage will continue to meet your needs for next year, you don t need to do anything. For more information on Medicare Open Enrollment, visit or call MEDICARE. Note: The Health Insurance Marketplace Open Enrollment period (October 1, 2013 to March 31, 2014) overlaps with the Medicare Open Enrollment period (October 15 December 7, 2013). Therefore, people with Medicare who are looking to make Medicare coverage changes should make sure that they are reviewing Medicare plans and not Marketplace options. 45

46 Appendix B People with Medicare and the Health Insurance Marketplace Frequently Asked Questions What should I do if I m contacted about signing up for a health plan? The Medicare open enrollment period is a time when there s a higher risk for fraudulent activities. It s against the law for someone who knows that you have Medicare to sell you a Marketplace plan. DO NOT share your Medicare number or other personal information with anyone who knocks on your door or contacts you uninvited to sell you a health plan. Senior Medicare Patrol programs are teaching people with Medicare how to detect and report fraud, and protect themselves from fraudulent activity and identity theft. To learn more about health care fraud and ways to protect against it, visit or the Senior Medicare Patrol (SMP) program in your area (locate your SMP at This information is provided by the United States Department of Health and Human Services. 46

47 This training module is provided by the CMS National Training Program For questions about training products, To view all available training materials or to subscribe to our listserv, visit Training/CMSNationalTrainingProgram/index.html

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