SHIBA. Statewide Health Insurance Benefits Advisors. Medicare, Health Insurance, & the Affordable Care Act Updates for Summer 2013

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1 SHIBA Statewide Health Insurance Benefits Advisors Medicare, Health Insurance, & the Affordable Care Act Updates for Summer 2013 Liz Mercer Regional Trainer Sponsored by the: 8/8/2013 1

2 Today s overview What is SHIBA? Medicare basics: A, B, C and D How the Affordable Care Act affects: People on Medicare People not on Medicare How do you pick a health plan? Questions? 8/8/2013 2

3 What is SHIBA? Statewide Health Insurance Benefits Advisors A free program of the Office of the Insurance Commissioner We provide unbiased and confidential information about Medicare and other health insurance We are an educational service We don t sell anything! 8/8/2013 3

4 What is Medicare? Health insurance for people 65 and older Under 65 with certain disabilities Any age with End-Stage Renal Disease (ESRD) 8/8/2013 4

5 Your Medicare card Keep it in a safe place! 8/8/2013 5

6 The Four Parts of Medicare Part A Hospital Insurance Part B Medical Insurance Part C Medicare Advantage Plans (Includes Part A & B and sometimes Part D coverage) Part D Medicare Prescription Drug Coverage 8/8/2013 6

7 Medicare does not cover everything! Most people must pay some costs: Premiums (Part B or D), Co-pays, Deductibles Medicare does not cover: Routine eye exams, eyeglasses Routine dental care Hearing aids Most alternative medicine Long-term care 8/8/2013 7

8 People often have additional coverage SHIBA helps people understand how these options might work for them: Employer or Retiree plans Medicare Supplement (Medigap) insurance Medicare Advantage plans Medicare Part D Drug coverage Veterans, Military, Indian Health Services, etc. 8/8/2013 8

9 What help is there to pay Medicare s costs? Medicaid + Medicare For people with the lowest incomes, eligible people pay little or nothing for their health care costs Medicare Savings Programs Helps pay Part B premiums and sometimes Part A and Part B deductibles and coinsurance Extra Help Helps pay Part D costs 8/8/2013 9

10 Educate yourself! Medicare Plans and Medicare Drug Plans can change each year Costs, coverage, convenience Open Enrollment is Oct. 15 Dec. 7 Don t lose your chance to get your best coverage! SHIBA can help you Mark your calendars 8/8/

11 How the ACA impacts Medicare Does not cut Medicare benefits Does not eliminate Medicare Advantage plans Does not require people with Medicare to get more or different insurance Does improve Medicare benefits Does reduce Medicare costs 8/8/

12 ACA Medicare benefits already in place Don t have to wait for 2014! Increased preventive benefits Many with no co-pay or deductibles Discounts in the Part D Donut Hole Rebate in % Brand-name discount now Phasing it out by /8/

13 ACA closes the Medicare Donut hole 8/8/

14 Key ACA provisions to contain Medicare costs Restructures payments to Medicare Advantage plans to bring costs more in line with Original Medicare plans Reduces Medicare payments to hospitals with: Too many patient readmissions A high rate of patients who acquire infections while hospitalized Requires competitive bidding for Durable Medical Equipment New authority and resources to target waste, fraud and abuse 8/8/

15 Why Healthcare Reform? Reduce healthcare spending Improve access & quality Enhance patient protections 8/8/

16 National Health Expenditures per Capita, $9,000 $8,000 $7,000 $6,000 $5,000 $8,402 $8,149 $7,911 $7,628 $7,251 $6,868 $6,488 $6,114 $5,687 $5,241 $4,878 $4,000 $3,000 $2,854 $2,000 $1,000 $0 $1,110 $147 $ NHE as a Share of GDP 5.2% 7.2% 9.2% 12.5% 13.8% 14.5% 15.4% 15.9% 16.0% 16.1% 16.2% 16.4% 16.8% 17.9% 17.9% Notes: According to CMS, population is the U.S. Bureau of the Census resident-based population, less armed forces overseas and population of outlying areas, plus the net undercount. Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at (see Historical; NHE summary including share of GDP, CY ; file nhegdp10.zip). 8/8/

17 Who are the major players in Washington State? Office of the Insurance Commissioner Approves insurance plans, rates, agents Washington Health Benefits Exchange Creating Healthplanfinder New on-line way to get health insurance Customer support via In-Person Assisters and tollfree call center Washington State Health Care Authority Medicaid Expansion 8/8/

18 Timeline August 1, OIC approves 31 new plans for Washington s new health exchange September 3, Health Benefit Exchange Customer Call Center Opens October 1, HealthPlanFinder accepts enrollments ( Open Enrollment ) January 1, Coverage begins March 31, Open Enrollment ends 8/8/

19 What about the ACA for people NOT on Medicare? Some provisions already in place Covering children w/ pre-existing conditions No cap on life-time limits No out-of-pocket costs for preventive care Insurance companies must pay out 80 85% of their premiums in care And others! 8/8/

20 Coming in 2014 No one can be denied health coverage if they are sick Most people must have health insurance, or pay a fine All health plans must cover 10 Essential Health Benefits There s help if you can t afford insurance 8/8/

21 What happens if you don t get insurance? Individual Mandate Require all citizens and legal residents (there are some exceptions) to have health coverage by January 1, What happens if someone does not meet this deadline? Will they go to jail? Fees- for $95 It increases in later years NO! 8/8/

22 Essential Health Benefits = More Coverage 1. Ambulatory patient services 2. Emergency services 3. Hospitalization 4. Maternity and newborn care 5. Mental health & substance use disorder services, including behavioural health treatment 6. Prescription drugs 7. Rehabilitative and habilitative services & devices 8. Laboratory services 9. Preventive and wellness services & chronic disease management 10. Pediatric services, including oral & vision care

23 The four metal (metallic tier) plans: Platinum 90% Most generous and most expensive Gold 80% Less generous and less expensive Silver 70% Moderately generous and moderately expensive Bronze 60% Least generous and least expensive Catastrophic Varies Only for those under 30 or exempt from mandate 8/8/

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25 1. Find out your eligibility for Qualified Health Plans 2. Find out your eligibility for Medicaid, CHIP, and Premium Tax Credits/Cost Sharing Reductions 3. Compare your plan options 4. Choose a plan and enroll! 8/8/

26 The Real Question? What does this mean for me? 8/8/

27 How do you pick a health plan? Gather information Ask your providers what they accept Use a trusted on-line tool Double-check your facts Talk to SHIBA- we help people with Medicare review their options If not on Medicare, you may want to contact the Health Benefit Exchange 8/8/

28 Protect yourself! Whether or not you have Medicare, as you research your health care options: Keep a notebook Write down the names of people you talk to, the date, and their contact information Note what was said in the conversation Keep copies of any paperwork Be aware of fraud! 8/8/

29 Need help with other insurance questions? The Office of the Insurance Commissioner can also help you with questions, information, and complaints about all types of insurance, such as: Homeowner Auto Life Annuities Health And more! Call our Insurance Consumer Hotline Check out our Consumer Toolkit at