AASC 2014 National Service Coordinator Conference / Dallas

Transcription

1 AASC 2014 National Service Coordinator Conference / Dallas Medicaid s Best Kept Secret: Medicare Savings Programs August 20, 2014 AGENDA Who we are, what we do Medicare 101 Medicare Savings Programs Extra Help (LIS) Our program assistance Results Summary 2 1

2 WHO WE ARE, WHAT WE DO Altegra Health serves Medicare beneficiaries who are members of a Medicare Advantage (MA) plan that contracts with our company for outreach services Not involved in MA plan marketing or enrollment Plan members may include residents of HUD housing facilities with a Service Coordinator We help low income members access a wide variety of available benefits: Medicare Savings Programs QMB, SLMB, QI-1 Low Income Subsidy (LIS) aka Extra Help Community Link Programs 3 SOME OF OUR CONTRACTED-HEALTH PLANS Aetna/Coventry Humana Kaiser Permanente Wellpoint United HealthCare Blue Cross Blue Shield of MI, MA, NC and RI Fallon SCAN BS of CA Tufts 4 2

3 MEDICARE 101 Parts A, B, C and D 5 MEDICARE PART A and PART B Medicare Part A funded by a payroll tax Inpatient hospital Hospice care Limited home health services post-hospital 100 days of skilled nursing facility care Medicare Part B funded by beneficiary premiums and general revenues from federal government Physician services Mental health services Outpatient hospital care Home health X-rays and other diagnostic procedures Preventative services such as mammography screening 6 3

4 MEDICARE PART C and PART D Medicare Part C Funded by beneficiary premiums and general revenue from federal government Medicare Advantage Plans Beneficiaries choose to enroll in a private plan to receive Medicare covered services Medicare pays a fee to health plans and the plans provide benefits covered under Parts A, B and D Medicare Part D funded by beneficiary premiums, general revenues and state payments Helps pay for outpatient prescription drugs Benefits provided by private plans that contract with Medicare Two types of plans: stand-alone Prescription Drug Plans (PDPs) and Medicare Advantage Plans 7 MEDICARE SAVINGS PROGRAMS QMB/SLMB/QI-1 8 4

5 MEDICARE SAVINGS PROGRAMS (MSPs) Provides help with Medicare costs Eligibility is determined by state/county Medicaid agencies Eligibility is based on gross income and assets (some states do NOT have an asset test) Eliminates late enrollment penalties Enrolls the applicant in Part B outside of an enrollment period if s/he already has Part A MSP enrollees are deemed eligible (automatically eligible) for Extra Help/LIS QMB, SLMB and QI-1 are the federal program names. Some states call them by other names 9 MEDICARE SAVINGS PROGRAMs, cont d Qualified Medicare Beneficiary (QMB) Income Limit Single - $993 / Couple - $1331 Pays all Medicare premiums, co-pays and deductibles (recipient must see a provider contracted with Medicare/Medicaid) No retro begins month after month of approval Specified Low-Income Medicare Beneficiaries (SLMB) Income Limit Single - $1187 / Couple - $1593 Pays Medicare Part B premium only Up to 3 months retro Qualified Individual (QI-1) Income Limit Single - $1333 / Couple - $1790 Pays Medicare Part B premium only Block grant funding must be renewed annually Currently authorized through 3/31/15 Up to 3 months retro, depending on the state Income limits include $20 general income disregard 10 5

6 MEDICARE SAVINGS PROGRAMs, cont d Asset limits are higher than full Medicaid 2014 limits: $7,160/1 and $10,750/2 Some assets don t count Some states have a higher asset limit or no asset limit AL, AZ, CT, DE, DC, ME, MN (higher), MS, NY, VT Some states have higher income limits than the federal standards AK, CT, DC, HI, IL, ME, MS No estate recovery on MSPs (by federal law) SSA shares LIS data with states for MSP 11 MEDICARE SAVINGS PROGRAMs, cont d Most states require proof of income and assets, but some allow applicants to self declare information and it s only verified if questionable A birth certificate is not required for Medicare recipients born in the U.S. Child support is not counted as income to custodial parent MSP applicants have the right to get help with the application process from any individual or organization they wish It takes approximately 90 days from the date of approval before refund is received and SSA check increases 12 6

7 EXTRA HELP (LIS) Low Income Subsidy 13 EXTRA HELP or LOW INCOME SUBSIDY (LIS) People with income under 150% of the FPL (and assets below certain limits) can get Extra Help with their out-of-pocket prescription expenses Extra Help reduces or eliminates monthly premiums, annual deductibles, Rx copays, and may eliminate the coverage gap Donut Hole People who are eligible for Medicaid (including MSP) or SSI-only are deemed eligible for Extra Help People who lose eligibility for Medicaid (including MSP) or SSI-only during the year must apply for Extra Help to remain eligible 14 7

8 EXTRA HELP/LIS cont d Level of assistance depends on income and assets Allows enrollment in Part D any time of the year, even outside of enrollment periods No late enrollment premium penalties Extra Help enrollees can switch Part D or Medicare Advantage Plans any time throughout the year 15 PROGRAM ASSISTANCE 16 8

9 PROGRAM ASSISTANCE - Overview Builds a strong relationship with health plan members by providing valuable social program benefits. Members can save on healthcare premiums, prescription drugs, daily living expenses and much more Improves communication and care compliance 17 PROGRAM ASSISTANCE The Need Most of the 47 million+ Medicare beneficiaries do not take advantage of the needs-based programs available to them 18 9

10 PROGRAM ASSISTANCE Our Approach We work on behalf of health plans to identify, engage and help their Medicare members who qualify for Medicaid or Medicare Savings Programs (MSPs). More money for plan members Services are provided at no cost to the member We do not sell or enroll members into health plans We build member loyalty to their health plan by educating and helping members apply for other social and community programs that save them money and improve their quality of life. Increased member satisfaction Increased member retention 19 PROGRAM ASSISTANCE Our Approach, cont d PROGRAM ASSISTANCE APPLICATION ASSISTANCE Electronic Signature-ready Application Quality Review Status Follow-Up 20 10

11 COMMUNITY ASSISTANCE Helps plan members learn about and obtain assistance from numerous public and private social and community programs Community Link includes live advocate support Social Service Checkup online tool Outreach to members via health plan co-branded collateral materials Increased member satisfaction and retention 21 COMMUNITY LINK Available social program categories 22 11

12 RESULTS 23 NATIONAL RESULTS Enrolled over 345,000 Medicare beneficiaries into MSPs Submitted over 400,000 LIS/Extra Help applications Recertified over 230,000 individuals for MSPs Assisted with over 250,000 applications for social program enrollment Enrollment figures since

13 NATIONAL RESULTS, cont d Altegra has helped Medicare beneficiaries save $786 million in Part B premiums. 25 SUMMARY 26 13

14 SUMMARY Altegra Health helps Medicare Advantage Plans and their members MSPs provide Medicare Part B payment plus Extra Help enrollment Social program assistance provides even more cost savings and important benefits Increases member satisfaction/tenure Allows Service Coordinators to assist other residents who are not enrolled in a Medicare Advantage Plan contracted with Altegra Health 27 Vicki Jessup, Senior Director of Government Relations x7777 Vicki.Jessup@altegrahealth.com Linda Bylow, Director of Government Relations x5114 Linda.Bylow@altegrahealth.com AltegraHealth.com 14