Got Coverage? Need Coverage? Getting Health Insurance during the Open Enrollment Period

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1 Got Coverage? Need Coverage? Getting Health Insurance during the Open Enrollment Period Jennifer Syria Health Insurance Specialist Centers for Medicare and Medicaid Services October 28, 2014

2 Webinar Summary Medicare Open Enrollment Overview of key dates Types of Medicare plans How to compare Medicare plans Where to get help Marketplace Open Enrollment Overview of the Marketplace Open Enrollment Notices 5 Steps in Staying Covered in the Marketplace Helpful resources 2

3 Medicare Open Enrollment October 15 December 7 For Coverage in Medicare

4 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 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,

6 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 6

7 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, copayments, 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? 7

8 Where to Get Plan Information 1. Medicare & You handbook MEDICARE ( ). TTY users should call Medicare Plan Finder on Medicare.gov/find-a-plan 4. The plan s website 5. State Health Insurance Assistance Program (SHIP) Look at the back of your Medicare & You handbook Check the web at Medicare.gov/contacts Call MEDICARE 8

9 Medicare and the 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 won t require them to do anything different with their Medicare Medicare Part A and Medicare Advantage coverage qualifies as minimum essential coverage October 2014 Open Enrollment

10 Marketplace Open Enrollment November 15, 2014 February 15, 2015 for coverage in

11 The Marketplace It s a way to shop for health coverage An individual or family can explore every qualified health plan in the area With one application you can learn all the programs for which you qualify Most people receive help paying premiums 90% of people who were uninsured will qualify for savings on health insurance It offers clear options with apples-to-apples comparisons All health insurance plans in the Marketplace present their price and benefit information in plan language 11

12 Health Insurance Savings The premium tax credit may be taken as advance payments (APTC) to lower monthly premium costs, or as a refundable credit on the tax return you file Eligibility is based on Household income and family size Obtaining health insurance through the Marketplace Ineligibility for government-sponsored coverage, affordable employer-sponsored insurance, or certain other minimum essential coverage Cost Sharing Reductions (CSR), lower out of pocket costs such as deductibles and copayments Eligibility based on Household income and family size Enrollment in a Silver level Marketplace plan 12

13 Marketplace Establishment Each state can decide to Create and run its own Marketplace Engage actively with the federal government in operating certain Marketplace functions Have a Marketplace established and operated by the federal government 13

14 Annual Open Enrollment Period November 15 February 15 Coverage can begin as early as January 1 if you enroll by December 15 14

15 Open Enrollment Notices Federally-facilitated Marketplace Renewal and Redetermination Process Enrollees will receive two notices prior to Open Enrollment A notice from the Marketplace Inform of Open Enrollment Dates Encourage return to Marketplace to update information/review plan options for 2015 A notice from the Issuer Inform enrollees if they will be reenrolled in the same plan or a similar plan in 2015, including plan ID # What the premium will be, including 2014 APTC 15

16 Eligibility Determination Notice All enrollees who return to the Marketplace will receive a 2015 eligibility determination notice showing updated APTC and CSR as applicable. Enrollees who do not return to the Marketplace will receive a 2015 eligibility determination notice, generally showing the same APTC and CSR as 2014 after December 15, If income > 500% FPL, or did not authorize the Marketplace access tax data, and didn t return to the Marketplace, their 2015 eligibility determinations notice will show $0 APTC and CSR 16

17 5 Steps for Staying Covered Step 1: Review Look for a letter in the mail from your health plan describing any plan changes. Premiums Cost-sharing Benefits Read the letter, an contact your health plan if you have questions. Write down important dates and information from the letter like December 15 th, and your 14- digit plan ID. 17

18 Step 2: Update Make sure your information is up-to-date. Even a small change can affect your premium tax credits and cost sharing reductions Income Household Personal information Even if none of your information has changed, you might be eligible for lower costs. Update information starting November 15 Can t access your Marketplace account? Follow the steps on the screen to reset your password. 18

19 Step 3: Compare New and more affordable plans may be available in your area this year. When comparing plans, consider: Are you happy with the changes to your current plan? Are your current doctors in the plan s network? Will your prescriptions be covered? What will your benefits and costs be? 19

20 Step 4: Choose You can choose any plan available to you in your area in 2015 If you wan to stay enrolled in your 2014 plan, use the plan ID in the letter you get your health plan. All 2015 Marketplace plans include all benefits and protections required by the health care law. 20

21 Step 5: Enroll December 15 th For changes to take affect on January 1 st, 2015 February 15 th Last date to make plan changes for 2015 Make sure to pay your premium. Contact your plan to confirm your enrollment 21

22 In-Person Assistance Marketplace in-person help is available Navigators Non-Navigator assistance personnel Certified application counselors Issuer application assisters Enrollment assistance contractor Agents and brokers To find help in your area, go to localhelp.healthcare.gov 22

23 Resources Medicare Open Enrollment Center on cms.gov at Enrollment-Center.html Download posters, drop-in articles, publications View public service announcement scripts Marketplace training materials Visit the product ordering website at Posters, stickers, brochures and other publications 23

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