Michigan Medicare Medicaid Assistance Program (MMAP)

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1 Michigan Medicare Medicaid Assistance Program (MMAP)

2 Parts A& B

3 Medicare Part A (hospital insurance) Solvent until years beyond last year s projection Suggests cost-savings measures are working Fraud recovery Competitive bidding Medicare Secondary Payer Recovery Provider and contractor payment changes

4 Part A Benefit Period Deductible: Hospital copay: SNF copay: Premium Part B Premium: COLA increase will be announced in October will affect Part B premiums Deductible:

5 Effective January 2014 Old Rule: PT only covered if patient improves New Rule: PT is covered even if it is to maintain current condition or prevent decline

6 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Reduces the number of providers Competitive pricing and sound business practices Began roll out in 2011

7 You should not be asked to pay in advance for Medicare s portion of payment You should not be asked to submit claim to Medicare To find out if your provider is a Medicare provider Ask them for their Medicare Provider Number Call 800-MEDICARE or go online

8 Most provisions do not apply to Medicare Intent to expand health care to the uninsured You do not need to enroll via the Marketplace or Exchanges Medicare Provisions of ACA Increased Medicare fraud enforcement More innovation projects for providers and insurers Closing the Coverage Gap in Part D Expansion of Medicare s Preventative Benefits

9 Medicare Part D

10 Created by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) Provides prescription drug coverage to Medicare beneficiaries through private insurance companies MMA adds Part D to the Medicare program Part A: Hospital Insurance Part B: Medical Insurance Part C: Medicare Advantage Plans Part D: Medicare Prescription Drug Coverage 10

11 Creditable coverage means that an insurance benefit is as good as - or better than - the coverage in Medicare s basic Part D benefit Examples of creditable coverage: Many retiree health plans TRICARE for Life Veterans Administration 11

12 A beneficiary with creditable coverage does not need to enroll in a plan now or perhaps ever unless s/he loses the creditable coverage A beneficiary with creditable cover needs to be very careful because many times the creditable coverage (retiree plan) will end if he/she enrolls in Part D. A beneficiary without creditable coverage may want to consider enrolling in a plan to avoid a late enrollment penalty 12

13 If you : Do not have creditable coverage AND Do not enroll in Part D THEN You must pay a Late Enrollment Penalty Penalty is added onto the monthly premium Will continue as long as enrolled in Part D

14 Penalty is calculated as 1% of the Part D base beneficiary premium ($33.13 in 2015) For each month a beneficiary does not have creditable coverage and is not enrolled in Part D The penalty amount changes each year as the Part D base beneficiary premium changes

15 Initial Enrollment Period (IEP) Annual Coordinated Election Period (AEP) Special Enrollment Periods (SEPs) 15

16 October 15 th through December 7 th Coverage effective January 1 st 16

17 SEPs enable beneficiaries to make Part D plan changes in special situations, including: Involuntary loss, reduction, or non-notification of creditable coverage When entering, residing in, or leaving a long-term care facility Moving Other exceptional circumstances Beneficiaries who qualify for Medicaid or a Medicare Savings Program (QMB, SLMB and QI) have a SEP that allows them to join or switch plans each month 17

18 People who are enrolled in either Part D plan with less than 3 Star Quality Rating Medicare Advantage plan with less than 3 Star Quality Rating During SEP, can switch into a plan that has either 4 or 5 stars CMS will send letter to beneficiaries enrolled in low-performing plans notifying them of SEP

19 Plans who received less than 3-star quality rating for 3 consecutive years Beneficiaries will not be able to enroll on Medicare s website Can enroll directly through the plan Warning will appear on Medicare s website

20 Enroll online at Enroll online at the plan s website Contact the company of choice to request an application packet Call MEDICARE for assistance in enrolling over the phone Call MMAP at

21 Catastrophic Coverage 5% Beneficiary Spending Medicare Part D Benefit Pharmaceutical Spending $6,680 New Partial Coverage Partial Coverage Brand 45% Generic 65% 25% Brand 65% Generic 45% $2,960 Deductible $320 + Monthly Premium * Numbers represent actual prescription drug cost.

22 2015: Beneficiaries who reach the donut-hole will pay: 65% for their generic medications 45% for brand name medications 2016 and beyond: Donut-hole will continue to be reduced each year until it is completely gone in 2020

23

24

25 Part D Premiums will be subject to income adjustments similar to Part B premiums Beneficiaries with significant income will pay sliding scale higher Part D premiums There are 4 income categories Each category has a set dollar amount associated with it

26 Individual tax filers with income: Joint tax filers with income: IRMAA for Part D < $85,000 < $170,000 $0 $85,000 to $107,000 $107,000 to $160,000 $160,000 to $214,000 Greater than $214,000 $170,000 to $214,000 $214,000 to $320,000 $320,000 to $428,000 Greater than $428,000 $12.30 $31.80 $51.30 $70.80

27 Cost Premium, Deductible, Co-pays Coverage Are my drugs covered? Tiers Prior Authorization, Quantity Limits, Step Therapy? Nationwide coverage for travelers Pharmacy Network, Preferred Mail order

28 Part D and Medicare Advantage Plans can change their benefits and costs annually Be sure to check Premium, deductible, co-payment changes Are your drugs still covered? Are your drugs still covered at the same tier? Is there another Plan that offers better coverage? Medicare.gov Plan Finder

29 Subsidy provided by Social Security Admin Helps with the cost of Part D: Premiums, Deductibles, Co-pays Financial Eligibility Guidelines (2014) Income: $17,505 (single)/$23,595 (married) Assets $13,440 (single)/$26,860 (married) 2015 guidelines announced in January

30 Part D plans cannot: Market themselves as Medicare endorsed Solicit from door-to-door Call people on national and state do not call lists Enroll people over the phone during a solicitation call Offer incentives or gifts that exceed $15 in value Market outside the plan s service area Engage in activities to mislead or confuse beneficiaries Conduct sales presentations or collect enrollment applications at health fairs 30

31 October Part D and Medicare Advantage Plan Information available on medicare.gov Plans can begin marketing- check your mailbox! Annual Notice of Change will be sent by your current plan Medicare & You 2015 books will begin to be sent October 10 Star Quality Ratings released on medicare.gov Plan Finder October 15- December 7 Enrollment Period January 1 Plan Period Begins

32 More Information Medicare & You Handbook MEDICARE MMAP

33

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