Transcript Document

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A health insurance program for
people:
 65 years of age and older
 Under age 65 with certain
disabilities
 With End Stage Renal Disease
(ESRD)
 With Amyotrophic Lateral
Sclerosis (ALS) a/k/a “Lou
Gehrig’s Disease”
 Signed into law by President
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Johnson in 1965
Administered by the Centers for
Medicare & Medicaid Services
(CMS)
Enrollment
– Social Security (SSA)
– Railroad Retirement Board
(RRB)
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Medicare beneficiaries show their “red, white and blue card” when obtaining
Original Medicare health benefits.
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Medicare is financed by a combination of:
Payroll taxes (41%)
General revenues (39%)
Beneficiary premiums (12%)
Interest and other sources
Part A is funded mainly by a dedicated tax of 2.9% of earnings paid by employers
and employees (1.45% each) deposited into the Hospital Insurance Trust
Fund.
Part B is funded by general revenues and beneficiary premiums. The standard
premium for 2013 is $104.90. Beneficiaries with higher incomes ($85,000 or
more/individual; $170,000 or more/couple, will pay a higher, income-related
monthly Part B premium.
Part C (Medicare Advantage) plans are not separately financed. They provide
benefits under Parts A, B and D.
Part D (Prescription Drug) is funded by general revenues, beneficiary premiums,
and state payments.
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Part A
Part B
Original
Medicare
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Part A
Part B
Part C
Medicare
Advantage Plans
Part D
Original
Medicare
Prescription
Drug Plans
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Part A
Hospital
• Inpatient Hospital
• Skilled Nursing Facility (SNF)
• Home Health Care
• Hospice
(Original Medicare)
Part B
Medical
• Medically necessary services, i.e., physicians and
outpatient care
• Some preventive care
• Durable Medical Equipment (Original Medicare)
Part C
Medicare Advantage
Part D
Medicare Prescription Drugs
• Combines Medicare Parts A and B and sometimes Part D.
These plans cover medically necessary services that
Original Medicare covers. Plans can charge premiums,
co-payments, co-insurance or deductibles for these
services.
• Helps cover prescription drugs and their costs.
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Apply 3 months before age 65
 Don’t have to be retired
 Contact the Social Security Administration
Enrollment automatic if receiving
 Social Security
 Railroad Retirement benefits
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When a person is enrolled in Medicare, they will have choices that affect:
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Cost
Doctor selection
Benefits
Convenience
Medicare laws and coverage are difficult to understand. Each beneficiary
receives an annual copy of the Medicare & You Handbook. Some
beneficiaries have a very good understanding of Medicare while others
depend on the Sales Agent as the “expert”.
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Social Security determines if a person has to pay a premium for Medicare
Part A. A beneficiary may not qualify for premium-free Part A coverage if
the individual or spouse:
 Did not pay Medicare taxes while employed, or
 Did not work enough years (10 years)
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Most people receive Part A premium free because either the individual or
spouse worked 40 or more quarters of Medicare-covered employment.
Individuals with 30-39 quarters will have a Part A premium of $248 per
month.
The Part A premium is $451.00 per month for people who are not
otherwise eligible for premium-free hospital insurance and have less than
30 quarters of Medicare-covered employment.
If the beneficiary isn’t eligible for premium-free Part A, and doesn't buy it
when they're first eligible, they can sign up between January 1st –March
31st (General Enrollment Period ) each year. Their coverage will begin
July 1st .
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Part A Late Enrollment Penalty
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Their monthly premium may go up 10%. They'll have to pay the higher
premium for twice the number of years they could have had Part A, but didn't
sign up. For example, if the beneficiary was eligible for Part A for 2 years but
didn’t sign-up, they will have to pay the higher premium for 4 years.
If the beneficiary didn’t sign up for Part A when they were first eligible
because they were covered under a group health plan based on current
employment, they will have a Special Enrollment Period (SEP) in which they
can sign up without incurring a late enrollment penalty.
The SEP is anytime that they or their spouse (or family member, if they’re
disabled) is working, and they’re covered by a group health plan through the
employer or union based on that work; or
The 8-month period that begins the month after the employment ends or the
group health plan insurance based on current employment ends, whichever
happens first.
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Hospital inpatient care
Skilled nursing facility (SNF) care
Home health care
Hospice care
Blood
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A “benefit period” begins the day a beneficiary is admitted to a hospital or
skilled nursing facility (SNF). The benefit period ends when they haven’t
received any hospital care (or skilled care in an SNF) for 60 days in a row.
If a beneficiary goes into a hospital or a Skilled Nursing Facility after one
benefit period has ended, a new benefit period begins. They must pay the
inpatient hospital deductible for each benefit period. There is no limit to
the number of benefit periods.
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Part A: (pays for inpatient hospital, skilled nursing facility, and some home
health care). For each benefit period, Medicare pays all covered costs
except the Medicare Part A deductible during the first 60 days and
coinsurance amounts for hospital stays that last beyond 60 days and no
more than 150 days.
For each benefit period an individual pays:
• A total of $1,184 for a hospital stay of 1-60 days.
• $296 per day for days 61-90 of a hospital stay.
• $592 per day for days 91-150 of a hospital stay (Lifetime Reserve
Days).
• All costs for each day beyond 150 days
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Generally covers all drugs
 During a covered hospital or skilled nursing facility stay
 And receiving drugs as part of treatment
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Skilled Nursing Facility Coinsurance
 A beneficiary pays $0 for days 1-20 of a SNF stay each benefit period
following a qualifying 3 day hospital stay per benefit period.
 $148.00 per day for days 21 through 100 each benefit period.
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Medicare covers 100 days of skilled care in a SNF each benefit period.
The Medicare beneficiary pays 100% after day 100 of a SNF stay each
benefit period.
A new benefit period will renew the 100 days of coverage.
A physician must certify that the beneficiary needs skilled care in the SNF
on a daily basis.
This is not custodial long term care.
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Home health care is health
care/palliative care offered in the
patient’s home by healthcare
experts.
The objective of home health care is
for individuals to stay in their
homes instead of using
residential or institutionalized
care.
Care must be provided by a
Medicare-certified home health
agency.
The type of care includes:
 Wound care
 Evaluation (psychologically/
medically)
 Drug management
 Pain management
 Speech therapy
 Physiotherapy
 Occupational therapy
 Also includes durable medical
equipment and medical supplies
used at home.
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A Medicare-approved hospice program is for those who are terminally ill (the
last 6 months of life).
› Medicare Part A will pay for care provided by a Medicare-certified
hospice, usually in the home, but can also be provided in a hospital or
other facility.
› Care includes drugs for pain relief – co-pay is up to $5/drug
› No co-pay for Medicare approved inpatient respite care.
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1. Who determines if a person has to pay a premium for Part A?
a. Medicare
b. CMS
c. Social Security
d. IRS
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2. When does a Part A benefit period end?
a. The day of discharge from the hospital or SNF.
b. When the person hasn’t received any hospital or SNF care for 60
days in a row.
c. After all lifetime reserve days are used
d. December 31st.
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3. Home Health Care does not include:
a. Wound care
b. Physical, speech and occupational therapy
c. Adult Day Care
d. Durable Medical Equipment used at home
e. Drug management
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4. When is Part A premium free?
a. Once a person turns 65
b. Never
c. When the individual or their spouse has worked over 10 years of
Medicare-covered employment
d. They are an Armed Forces veteran
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5. Medicare-approved hospice care is for those terminally ill with a life
expectancy of:
a. 3 months
b. 6 months
c. 9 months
d. 1 year
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Part B helps cover medically-necessary services like doctors' services,
outpatient care, home health services, durable medical equipment and
other medical services. Part B also covers some preventive services.
How Much Does Part B Cost?
 Most people will pay the standard premium amount which, for 2013 is
$104.90. If they don't sign up for Part B when they are first eligible, they
may have to pay a late enrollment penalty.
 The yearly deductible for 2013 is $147.00. (They pay 20% of the
Medicare-approved amount for services after they meet the $147.00
deductible.)
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Initial Coverage Election Period
(ICEP) – Turning 65
› 7 months
› starting 3 months before
month of eligibility – the
month of eligibility and 3
months after
› Eligibility
 First day of the month of a
beneficiary’s 65th birthday,
unless
 The birthday falls on the
first of the month; then the
beneficiary is eligible the
month prior.
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Late Enrollment
General Enrollment Period (GEP)
› January 1st through March 31st each year
› Coverage effective July 1st
› Premium penalty
 10% for each 12-month period eligible
but not enrolled
 Paid for as long as the person has Part B
 Limited exceptions
 Beneficiary must wait until April 1st (three months before the
effective date of July 1st) before they can enroll in an Medicare
Advantage plan.
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An individual may delay enrolling in Part B with no penalty if:
› Covered under employer or union group health plan
 Based on current employment
 Person or spouse
 Will get a Special Enrollment Period (SEP)
 Ends 8 months after the employer or union coverage ends.
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Doctors’ services
Outpatient medical/surgical
services & supplies
Diagnostic tests
Dialysis
Outpatient therapy
Outpatient mental health services
Some preventive health care
services
Durable Medical Equipment
(DME)
Other medical services
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Abdominal Aortic Aneurysm
Alcohol Misuse Counseling
Bone Mass Measurement
Breast Cancer Screening
(Mammogram)
Cardiovascular Screening
Colorectal Cancer Screening
Depression Screening
Diabetes screening
Flu Shot
Hepatitis B Shot
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Immunizations (shots)
One-time “Welcome to
Medicare” Physical Exam
Obesity screening and
counseling
Pap Test and Pelvic Exam
Pneumococcal Shot
Prostate Cancer Screening 16
Prostate Specific Antigen (PSA)
Sexually transmitted infections
screening and counseling
Smoking Cessation
Yearly “Wellness” Exam
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Part B covers a limited set of outpatient drugs
– Injectable and infusible drugs
• Not usually self-administered
• Furnished and administered as part of a physician service
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Oral drugs or DME drugs
covered by Part B
 Supplier must be DME
provider
 Drug must be medically
necessary and must be
according to guidelines
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Drugs administered through Part
B-covered Durable Medical
Equipment (DME)
 Such as nebulizer or pump
 Only when used with DME
in patient’s home
Oral drugs with special coverage
requirements
 Anti-cancer drugs
 Anti-emetic drugs
 Immunosuppressive drugs
 And other non-oral forms
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Part B can pay for some ancillary services normally covered under Part A
when received during hospital and SNF stays if:
 Person does not have Part A coverage
 Part A coverage for the stay has run out
 Note: Stay is not covered
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1. How much is the Part B deductible for 2013?
a. $96.40
b. $99.90
c. $147.00
d. $1,156.00
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2. How long must a Part B late enrollee pay the 10% penalty?
a. One year
b. One month for each month eligible but not enrolled
c. For as long as the person has Part B
d. Until the first leap year
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3. Which is not a Part B covered service?
a. Abdominal aortic aneurysm
b. Colorectal cancer screening
c. Shingles vaccine
d. Pneumococcal immunization
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4. Upon turning 65, the enrollment period for Part B is:
a. 4 months
b. 7 months
c. 9 months
d. 1 year
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5. An individual may delay enrolling in Part B with no penalty if there is
coverage under an employer’s or union group’s health plan. The individual
will have an SEP ending how many months after the employer/union coverage
ends?
a. 2
b. 7
c. 3
d. 8
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 Sold by private insurance companies
 Costs vary by plan, company and location
 Covers “gaps” in Original Medicare (varies by Plan)
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 Deductibles, coinsurance, copayments
 Does not work with Medicare Advantage Plans
Up to 10 standardized plans A – N
Generally must have Medicare Parts A and B
There is a monthly premium for the Medigap coverage
They do not work with Medicare Advantage Plans
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Medicare SELECT is a type of Medigap policy sold in some states that
requires you to use hospitals and, in some cases, doctors within its network to
be eligible for full insurance benefits (except in an emergency).
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Medicare SELECT can be any of the standardized Medigap Plans.
These policies generally cost less than other Medigap policies.
If you do not use a Medicare SELECT hospital or doctor for nonemergency services, you will have to pay what Medicare does not pay.
Medicare will pay its share of approved charges no matter which hospital
or doctor you choose.
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May be able to buy a Medigap policy any time
 If insurance company will sell to the beneficiary
Medigap open enrollment period (OEP)
 6-months when insurance company must sell
 One OEP begins at the age of 65 or older and enrolled in Part B
 Can’t be changed or replaced
 Some states have more generous rules
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May be able to buy a Medigap policy any time
 If insurance company will sell to the beneficiary
Medigap open enrollment period (OEP)
 6-months when insurance company must sell
 One OEP begins at the age of 65 or older and enrolled in Part B
 Can’t be changed or replaced
 Some states have more generous rules
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Variety of plans:
 Health Maintenance Organization (HMO) Plans
 Some have a Point-of-Service option
 Preferred Provider Organization (PPO) Plans
 Private Fee-for-Service (PFFS) Plans
 Special Needs Plans (SNP)
 Medical Savings Account (MSA) Plans
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Eligibility requirements
› Live in plan’s service area
› Enrolled in Medicare Part A
› Enrolled in Medicare Part B
› Does not have End-Stage Renal Disease (ESRD) at time of enrollment
 Some exceptions:
 have had a successful kidney transplant over 36 months ago
 EGH plan is same organization offering the MA Plan and the MA
plan will be the primary provider of their health care coverage
 Want to switch to another plan within the same company
 Have a special needs plan available in their area for people with
ESRD
 Currently is enrolled in an MA plan that stops being offered in
their area
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A person can join MA Plan or other plan
 When first eligible for Medicare
 Initial Coverage Election Period
 During specific enrollment periods
 Annual Election Period
 Special Enrollment Period
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Annual Election Period (AEP)
Medicare Advantage Disenrollment Period (MADP)
Special Enrollment Period (SEP)
 Move out of the plan’s service area OR move
and have new MA or Part D options available
 Plan leaves Medicare program
 Employer/Union Group Health Plan (EGHP)
 Full and partial dual eligibility (Medicare & Medicaid)
 Low Income Subsidy
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October 15th through December 7th
› Can choose new plan
 MA Plan
 Medicare Prescription Drug Plan
 Original Medicare
› New plan effective January 1st
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Generally receive all Medicarecovered services through the
plan
Can include prescription drug
coverage
May have to see certain doctors
or go to certain hospitals to get
care
 Emergency care covered
anywhere in the U.S.
Benefits and cost-sharing may be
different from Original Medicare
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Generally must still pay Part B premium
 Some plans may pay all or part
May pay an additional monthly premium
Will have other out-of-pocket costs
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Copayment amounts set by plan
Usually must use network doctors and hospitals
May pay in full for care outside plan’s network
 Covered if emergency or urgently needed care
 POS option allows visits to “out-of-network”
providers (The provider must accept the plan’s
terms and conditions of payment.)
May need to choose primary care doctor
 Sometimes need a referral to see a specialist
 Doctors can join or leave
May include prescription drug coverage
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Can see any doctor or provider that accepts Medicare
› Don’t need referral to see specialist
› Don’t need referral to see out-of-network provider
› Copayment and coinsurance amounts set by plan
› Will usually pay more for out-of-network care
› The provider must accept the plan’s terms and conditions of payment.
May receive Medicare prescription drug coverage
Regional PPOs
› Available in most areas of the country
› Have annual limit on out-of-pocket costs
 Varies by plan
› May have higher deductible and/or premium
than other PPOs
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Can see any Medicare-approved doctor or hospital that accepts the plan
› Can get services outside service area
› Do not need referral to see a specialist
› Plan sets copayment amounts
If offered, can get Medicare prescription drug coverage
› If not offered, can join a stand-alone Medicare Prescription Drug Plan
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PFFS must meet access requirements; Network and Non-network counties
› Network counties must have contracts with a sufficient number and
range of providers
Non-employer PFFS
› Must meet Medicare access requirements
 If two or more network-based MA Plan
options exist
Employer and non-employer PFFS Plans may meet access requirements:
› Through a contracted network of providers that meet CMS
requirements
› By paying not less than the Original Medicare payment rate
› Having providers deemed to be contracted as providers
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Designed to provide
– Focused care management
– Special expertise of plan’s providers
– Benefits tailored to enrollee conditions
 Must include prescription drug coverage
 Individuals are identified as:
 Having a severe or disabling chronic condition
 Dual Eligibles
 Institutionalized beneficiaries
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In a Medicare Medical Savings Account (MSA), a high deductible health
insurance plan is combined with a bank account.
Medicare deposits a particular amount of money per year into the bank
account and the member is allowed to use the money to pay for any
health-care-related expenses throughout the year, but only Medicarecovered expenses count toward the deductible.
It should be noted, however, that the deposit made by Medicare is often
less than the yearly deductible, which means that if the member gets sick
or medically needs care, they will likely have to spend more than the
amount originally deposited into the account.
After the member reaches their deductible, the plan will cover their
Medicare-covered services.
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A Medicare Savings Program receives assistance
from Medicaid to pay for Medicare expenses.
Assistance categories include:
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Qualified Medicare Beneficiaries (QMB)
Specified Low Income Medicare Beneficiaries (SLMB)
Qualified Individuals (QI)
Qualified Disabled and Working Individuals (QDWI)
These are State specific programs.
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Programs of All-inclusive Care for the Elderly (PACE)
 Combine services for frail elderly people
– Medical
– Social
– Long-term care services
– Include prescription drug coverage
 Might be better choice than nursing home
 Only in states that offer it under Medicaid
 Qualifications vary from state to state
– Contact state Medical Assistance office for information
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People with Medicare have certain
guaranteed rights to:
› Get their health care services
when needed
› To learn about all treatment
choices in clear language that
can be understood
› Receive easy-to-understand
information
› Have personal medical
information kept private
Additional rights and protections
– Access to health care
providers
– Know how doctors are paid
– Fair, efficient, and timely
appeals process
– Fast appeals in certain health
care settings
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Plan must say in writing how to appeal if it:
› Will not pay for a service
› Does not allow a service
› Stops or reduces a course of treatment
Can ask for fast (expedited) decision
› Plan must decide within 72 hours
See plan's membership materials
› Include instructions on how to file an appeal
or grievance
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1. Which is not a Medicare Advantage plan?
a. HMO
b. PPO
c. PFFS
d. ACO
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2. During which enrollment period can an individual not join and/or switch
Medicare Advantage plans?
a. AEP
b. ICEP
c. MADP
d. SEP
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3. Members joining a Private Fee for Service plan:
a. Can see any provider that accepts the plan
b. Must obtain a referral to see a specialist
c. Can see any Medicare approved provider that accepts the plan
d. Can only receive services in their area
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4. A Special Needs Plan (SNP) must include prescription drug coverage.
a. True
b. False
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5. An HMO POS option allows visits to “out of network” providers.
a. True
b. False
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Medicare Part D
Available to all people with Medicare
Provided through
› Medicare Prescription Drug Plans
› Medicare Advantage and other
Medicare plans
› Some employers and unions
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Initial Coverage Election Period (ICEP)
› 7 months
› Starts 3 months before month of eligibility
Annual Election Period (AEP)
› October 15th through December 7th
› Can join, drop, or switch coverage
 Effective January 1st of following year
Medicare Advantage Disenrollment Period (MADP)
› January 1st through February 14th
Special Enrollment Period (SEP)
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People who wait to enroll may pay a penalty
– Add 1% of national base premium “1% penalty calculation” which is
$.31 in 2012 for each month eligible but not enrolled
– Must pay the penalty as long as enrolled in a Medicare drug plan
– Is waived if an individual qualifies for Extra Help
Unless they have other coverage at least as good as Medicare drug
coverage
– “Creditable coverage”
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Prescription drug coverage that pays as much as or more than Medicare’s
standard prescription drug coverage.
Entities providing creditable drug coverage include:
 Coverage under MAPD or PDP
 Group health plan
 Military coverage including the TRICARE program
 VA coverage (it is not Part D)
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A network pharmacy is a pharmacy where Plan members can get their
prescription drug benefits. They are called “network pharmacies” because
they contract with the Plan.
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An Out-of-Network Pharmacy is a pharmacy that does not have a
contract with the Plan to coordinate or provide covered drugs to members
of the Plan. Most drugs the member gets from out-of-network pharmacies
are not covered by the Plan, unless certain conditions apply.
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Costs vary by plan
› In 2013 members may pay
 Monthly premiums
 Annual deductible, no more than $325
 Copayments or coinsurance
 Very little after $4,750 out-of-pocket
 May offer supplemental benefits
 Plan information and costs available
› www.medicare.gov
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In general, Out-of-Pocket includes
all payments for Medications listed
on a plan's formulary and purchased
at a Network or participating
Pharmacy. This includes payments
that are made by others on a
member’s behalf.
If a member switches Medicare Part
D plans during the plan year, their
Out-of-Pocket will be transferred to
their new plan -- it travels with them.
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Out-of-Pocket includes the amount of the Initial Deductible (if any) and the co-payments or coinsurance during the Initial Coverage stage. While in the Coverage Gap, it includes what a
member pays when they fill a prescription and the amount of the 2013 Coverage Gap
Discount for brand-name drugs (52.5%).
Out-of-Pocket also includes payments made for a member’s drugs by any of the following
programs or organizations: "Extra Help" from Medicare; Indian Health Service; AIDS drug
assistance programs; most charities; and most State Pharmaceutical Assistance Programs
(SPAPs).
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During 2013, members who reach the coverage gap in their Medicare Part D
coverage, will automatically get a 52.5% discount on covered brand-name drugs.
They will receive the discount when they have the prescription filled at a
pharmacy or order them through the mail, until they reach the catastrophic
coverage phase.
They will also get a 21% discount on generic drugs while in the coverage gap.
Although the member will pay only 47.5% of the price for the brand-name drug,
the entire drug cost will count toward the amount they need to qualify for
catastrophic coverage.
For generic drugs, only the amount the member pays will count toward getting
them out of the coverage gap.
The initial coverage limit is $2,970 for 2013.
Catastrophic coverage for 2013 begins when your out-of-pocket reaches $4,750.
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Plan premium payments.
Non-Formulary medications - prescription drugs not included on the
plan’s drug list.
"Bonus Drugs" - drugs covered by the plan’s supplemental coverage.
Medication not covered by all Medicare Part D plans - for instance, overthe-counter drugs, drugs received during a hospital stay, or drugs
prohibited from Part D coverage by law.
Drugs purchased outside of the United States.
Payments made for drugs by any of the following programs: employer or
union health plans; TRICARE; VA; Worker’s Compensation; and some
other programs
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Plans can manage access to covered drugs
– Tiers
– Prior authorization
– Step therapy
– Quantity limits
Plans must have processes in place
– Members obtain medically necessary prescriptions
– Request coverage determinations and appeals
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Low Income Subsidy (LIS), also known as Extra Help, is a fully funded
federal program administered though SSA.
Extra Help assists individuals with their monthly prescription premiums,
yearly deductibles, copayments, coinsurance, and coverage gap.
In order to qualify for Extra Help (LIS) the individual’s income and
resources must meet the following criteria:
› Single person — 2012 Updated amounts: Income less than $16,755
and resources less than $13,070
› Married person living with a spouse and no other dependents — 2012
Updated amounts: Income less than $22,695 and resources less
than $26,120
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

Who may automatically qualify
› People with Medicare who get
 Full Medicaid benefits (Duals)
 Supplemental Security Income (SSI)
 Help from Medicaid paying Medicare premiums
(Medicare Savings Programs)
Others must apply and qualify
87
88


The Part D-Income Related
Monthly Adjustment Amount
(Part D-IRMAA) is an additional
amount some individuals are
required to pay by law for
Medicare Part D Drug Coverage
based on their Income.
Beneficiaries will pay this
premium separate from their Part
D Premium and it will go
directly to Medicare, not to their
plan.



CMS will disenroll individuals who
fail to pay the Part D-IRMAA from
their prescription drug plan.
This includes disenrollment from
their MA plan or employer group
plan if it includes Part D coverage.
If later the beneficiary re-enrolls in
Part D, they may incur a Late
Enrollment Penalty for break in
coverage.
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Part
A
Part
B
Part
C
Part
D
90
2. How much will a member pay for brand name drugs during 2013?
a. 52.5%
b. 21%
c. 47.5%
d. 50%
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3. Creditable prescription drug coverage is provided through:
a. Medicare prescription drug plans
b. Medicare Advantage and other Medicare plans
c. Some employers and unions
d. All of the above
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4. Prescription drug coverage that pays as much as or more than Medicare’s
standard prescription drug coverage is called:
a. Incredible drug coverage
b. A pipe dream
c. Creditable drug coverage
d. Credulous drug coverage
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5. For 2013, an individual reaches Catastrophic Coverage at which amount?
a. $2,840
b. $4,450
c. $4,550
d. $4,750
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95