Medicare Open Enrollment: What Steps Do Employers Need to Take? Presented by: Donna Dever and Greg Puig August 27, 2015

Transcription

1 Medicare Open Enrollment: What Steps Do Employers Need to Take? Presented by: Donna Dever and Greg Puig August 27, 2015

2 Introduction In this client clinic we will review: What is creditable coverage? What are the types of Medicare? Model notice requirements and deadlines Disclosure filing to CMS Common Medicare Open Enrollment questions

3 What is Medicare? A federal health insurance program for people who are age 65 or older, under 65 with certain disabilities, or any age with End-stage Renal Disease Run by the Centers for Medicare and Medicaid Services (CMS) Benefit decisions are controlled by the U.S. Congress Social Security Administration (SSA) handles enrollment and eligibility

4 Types of Medicare Original Medicare is administered directly by the federal government Part A Hospital Insurance helps pay for hospital, skilled nursing facility, home health and hospice Part B Medical Insurance helps cover medical services such as doctors, outpatient services, preventive services, lab tests, ambulance services, medical equipment and supplies Provided through private companies that have contracts with Medicare Part C Medicare Advantage combination of Parts A, B, and D Part D Prescription Drug Plans

5 Enrolling in Medicare You will automatically be enrolled in Medicare Parts A & B if you are already receiving Social Security benefits: When you turn age 65 OR On your 25 th month of disability You will need to apply for Medicare: If you are not yet collecting Social Security benefits OR If you decide to delay taking your benefits past your retirement age

6 Enrollment Periods Initial enrollment period for newly eligible (3:1:3 rule): Three months before Month of Up to three months after your 65 th birthday Special Enrollment Period (SEP): You may delay enrollment if covered by a group health plan based on current employment that is primary You will receive an eight month SEP once you stop working OR your coverage ends Annual Open Enrollment Period: October 15 th December 7 th of each year for coverage effective January 1 st

7 Medicare Part D and Creditable C overage The Medicare Modernization Act of 2003 (MMA) added voluntary prescription drug benefits to Medicare, known as Part D coverage. Beneficiaries who choose not to sign up at the first opportunity may have to pay more if they wait to enter the program later after the open enrollment period. Beneficiaries who have other sources of drug coverage - through a current or former employer or union, for example - may stay in that plan and choose not to enroll in the Medicare drug plan. If their other coverage is at least as good as the Medicare drug benefit, and therefore considered "creditable coverage, then the beneficiary can continue to get the care they have now as well as avoid higher payments if they sign up later for the Medicare drug benefit.

8 Notice of Creditable C overage Employers maintaining group health plans that provide prescription drug coverage must provide a notice indicating whether or not the prescription drug coverage is creditable, or is as good as the Medicare Part D prescription drug coverage Medicare Part D eligible individuals may include active employees, disabled employees, COBRA participants & retirees, as well as their covered spouses and dependents The notice, which must be sent regardless of whether the plan s coverage is creditable, is intended to help individuals make enrollment decisions

9 Timing of Notices Creditable coverage disclosure notices must be provided at the following times: 1. Prior to the Medicare Part D annual open enrollment 2. Prior to an individual s initial enrollment period for Part D 3. Prior to the effective date of coverage for any Medicare eligible individual who joins the plan 4. Whenever prescription drug coverage ends or changes so that it is no longer creditable, or becomes creditable 5. Upon a beneficiary s request If the creditable coverage disclosure notice is provided to all plan participants annually, before October 15 th of each year, items 1 & 2 above will be satisfied

10 Model Notices Group health plan sponsors must provide the annual Part D creditable coverage disclosure notices to Medicare eligible individuals prior to October 15, CMS has provided two model notices for employers to use: A model Creditable Coverage Disclosure Notice for when the health plan s prescription drug coverage is creditable; and A model Non-Creditable Coverage Disclosure Notice for when the health plan s prescription drug coverage is not creditable Coverage/CreditableCoverage/Model-Notice-Letters.html

11 Disclosure to CMS Plan sponsors are required to disclose to CMS whether their prescription drug coverage is creditable. The disclosure must be made to CMS on an annual basis, or upon any change that effects whether the coverage is creditable. At a minimum the CMS creditable coverage notice must be provided at the following times: Within 60 days after the beginning of the plan year Within 30 days after the termination of the prescription drug plan Within 30 days after any change in the creditable coverage status of the prescription drug plan Plan sponsors are required to provide the disclosure notice to CMS through completion of the disclosure form on the CMS creditable coverage webpage. CMS Creditable Coverage Disclosure Webpage

12 Enforcement and Penalties MMA provides no provisions for CMS to enforce penalties/sanctions against employers that fail to comply with the Disclosure Notice Other laws, such as ERISA, or the Medicare Secondary Payer Rules, may provide related penalties/sanctions Issue of lack of enforcement against employers may be reopened at a later date

13 C losing the C overage Gap (Donut Hole) The Affordable Care Act includes benefits to make Medicare Part D coverage more affordable. While in the coverage gap, beneficiaries will get: A discount on covered brand-name drugs Some coverage for generic and brand-name drugs Additional savings on generic and brand-name drugs during the coverage gap over the next few years until it s closed in 2020

14 Frequently Asked Questions Under Medicare Part D, how must the creditable coverage disclosure notices be provided? Health plan sponsors have flexibility on the form and manner of providing notices to beneficiaries. The notice need not be sent as a separate mailing. It may be provided with other plan participant materials - including, enrollment and/or enrollment materials Under Medicare Part D, may the creditable coverage disclosure notices be provided electronically? Yes, health plan sponsors may use the electronic disclosure standards under the Department of Labor (DOL) regulations to meet the creditable coverage disclosure requirements Do I have to provide the notice to my COBRA participants? Yes, the notice must be provided to all Medicare eligible beneficiaries Are employers required to use the model creditable coverage disclosure notices? No. However, in the event the model notice is not used plan sponsors must ensure that their notice includes the key components as defined by CMS

15 Sources CMS - Creditable Coverage Medicare.gov