Transcript 2015 Open Enrollment Presentation

Medicare Open
Enrollment
What you need to know for 2016
SHINE Overview

SHINE= Serving the Health Insurance Needs of Everyone

Provides free and unbiased insurance information
and counseling to Medicare beneficiaries

Educates beneficiaries and empowers them to make
informed decisions about their health insurance

There are over 600 SHINE counselors available
throughout Massachusetts to help
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What is Open Enrollment?

Open Enrollment is the ONE TIME OF YEAR
when all people with Medicare can review,
compare and enroll in Medicare health and
drug plans

Open Enrollment dates:
 October 15th 2015: Open Enrollment begins
 December 7th 2015: Open Enrollment ends
 January 1st 2016: Health/drug coverage begins
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Why Is Open Enrollment
Important To Me?

This is your annual opportunity to review your health and
drug plans. This is important because:
• Your health needs may change year to year
• Your health or drug plan may change the costs, benefits,
and drug coverage they offer every year

By reviewing your plans costs and benefits and comparing
them with the other options available for the upcoming
year, you could potentially save money and ensure that you
receive the health care benefits and drug coverage you need
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What To Do During Open
Enrollment
1) Review your Medicare supplemental and drug
coverage options and decide which option will be best
for you for next year
2) Compare plan prices, coverage and benefits
3) Decide whether to stay in your current plan or enroll in
a new plan
4) Enroll in a new plan by the December 7th deadline
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Medicare Supplement Coverage Options
Step 1: Decide how you want to get your coverage
MEDICARE ADVANTAGE PLAN
ORIGINAL MEDICARE
PART A
Hospital
Insurance
&
PART B
Medical
Insurance
OR
PART C
Combines Part A, Part B
and usually Part D
Step 2: Decide if you need a Prescription Drug Plan
PART D
Stand Alone PDP
Prescription Coverage
Included in Part C
Step 3: Decide if you need to add supplemental medical coverage
MEDIGAP
Supplement Core plan OR
Supplement 1 plan
END
If you join a Medicare Advantage Plan
with drug coverage (MAPD), you
cannot join another drug plan and
you don’t need and cannot be sold a
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Medigap policy
Medicare Advantage Plans
(Part C)

Medicare Advantage plans (HMO’s, PPO’s)
• Coverage provided through private plans within
networks
• Referrals may be needed
• May have co-pays and deductibles
• Prescription drug coverage usually included

Medicare Advantage plans tend to attract people who
are not high utilizers of medical services who want a
lower premium plan
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Medicare Advantage Plan
Pro’s

Pro’s of a Medicare Advantage Plan:
• Convenience of having only one plan (drug plan can
be included)
• More choices available (HMO’s, PPO’s…)
• Lower premiums than Medigap plans
• Potential for better coordination of care (HMO’s
provide this)
• Additional benefits such as hearing, dental, vision and
annual exams
• No hospital stay required for SNF coverage benefit 8
Medicare Supplement Plans
(Medigaps)

Medigaps
• Sold by private insurance companies
• No network restrictions or referrals needed
• Low to no co-pays or deductibles
• Prescription drug coverage is NOT included

Medigap plans tend to be bought by people with a high utilization
of medical services such as doctors and hospital services
• They are also popular amongst individuals who travel in
foreign countries and who like to be able to choose which
doctor they see without a referral
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Medigap Plan Pro’s

Pro’s:
• Can see any provider that accepts Medicare (no
networks)
• No referrals or PCP is needed
• Continuous open enrollment periods
• Many plans offer travel coverage
• All plans are standard and with only 2 types of
plans available, choosing a plan is easier
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Medicare Prescription
Drug Coverage (Part D)

Provides outpatient prescription drug coverage

All Medicare beneficiaries are eligible
• Can have Part A and/or Part B

Coverage for Part D is provided by:
• Prescription Drug plans (PDP’s), also known as
stand alone plans
• Medicare Advantage Prescription Drug Plans
(MAPD’s)
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Do I Need to Have A Part D?

You must have some form of creditable drug coverage to avoid a
penalty
• Creditable coverage= Coverage that is as good as Medicare
drug coverage (ex. Employer/retiree coverage, VA coverage)

A penalty is added to your Part D premium if you don’t enroll
when first eligible and if you didn’t have other creditable coverage
• Penalty is 1% of national base premium for EACH month you
didn’t have coverage
• Is a lifetime penalty

The penalty applies even if you take NO prescription drugs!
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Anatomy of a Drug Plan

Cost components
• Premiums: Monthly cost
• Deductibles: Annual cost
• Co-pays & co-insurance: Paid at pharmacy
• Formularies: List of medications covered
• Drug tiers: Pricing ladder
• Restrictions: Quantity limits, prior authorization, or
step therapy

All of these cost components can change yearly,
therefore it is important to review your coverage during
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Open Enrollment
How To Compare Plans

You can compare health and drug plans for next year using an
online tool from Medicare that uses your personal information
to create a personalized report
• Medicare Plan Finder Tool
Go to: Medicare.gov
 Select: “Find Health and Drug Plans”
 Enter: Your Medicare information and drugs
 Search for: A Health Plan (aka: Medicare Advantage Plan)
with or without drug coverage, or a Prescription Drug Plan
SHINE is also available to help you compare plans and
understand your options
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

Questions To Yourself When
Making a Decision

When deciding on a plan for next year, ask
yourself these questions:
? Will my plan cover all of the drugs I take
? How much will my plan cost
? Does my plan have a deductible
? Will my doctor/hospital take my Medicare
Advantage Plan
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Options For Changing Plans
During Open Enrollment

If you are in a Medicare Advantage (MA) plan:
• Can change to a different MA plan
• Can change to Original Medicare and enroll in a Part
D along with a Medigap, if desired

If you have only Original Medicare:
• Can enroll in an MA plan

If you are in a Part D plan:
• Can drop or switch Part D plans
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Assistance Programs May Help
Lower Your Costs



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There are several assistance programs to help pay Medicare
cost-sharing including:
• Extra Help (Low Income Subsidy/LIS)
• Prescription Advantage
• MassHealth
These programs are based on income and/or assets
You can see what benefits you may be eligible for using an
online tool called Benefits Check Up (Benefitscheckup.org)
A SHINE Counselor can also help you determine which
programs you may qualify for and assist you in applying
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Where to Go For Help


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SHINE: 1-800-AGE-INFO (1-800-243-4636), press 3
Medicare: 1-800-MEDICARE (1-800-633-4227)
MCPHS Pharmacy Outreach Program: 1-866-633-1617
• Provides a comprehensive review of your meds & prescription drug coverage
and offers assistance with accessing affordable prescription drug programs

Prescription Advantage: 1-800-AGE-INFO, press 2
• State-sponsored pharmacy assistance program that helps to lower your
prescription drug costs

Medicare Advocacy Project (MAP): 1-866-778-0939
• Assists beneficiaries in obtaining the Medicare-related health insurance
coverage to which they are entitled

Senior Medicare Patrol: 1-800-892-0890
• Works to prevent healthcare errors, fraud and abuse
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