Transcript Medicare Annual Enrollment

Medicare Annual
Enrollment
Important Medicare Updates for 2015
SHINE Overview
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SHINE stands for Serving the Health Insurance Needs
of Everyone
Provides free and unbiased insurance information
and counseling to Medicare beneficiaries
Over 600 SHINE counselors available throughout
Massachusetts to help
SHINE Counselors are available at many Senior
Centers, Councils on Aging (COA), Community
hospitals and many other community-based sites
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2014–2015 Important Dates
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October 15th 2014: Open Enrollment begins
• Medicare beneficiaries can change health and
prescription coverage
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December 7th 2014: Open Enrollment ends
• Enrollment requests must be received by the 7th
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January 1st 2015: Coverage begins
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Your Medicare Coverage Choices
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
PART D
Included in Part C
Step 3: Decide if you need to add supplemental medical coverage
MEDIGAP
Supplement Core 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
Part B Preventive Benefits
 ACA provides access to many free preventive benefits
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Mammograms
Some pap smear and pelvic exams
Colorectal Screenings
Diabetes Self-Management Training/Tests
Bone Mass Measurements
Prostate Cancer Screening
Obesity screening/counseling
Depression screening/counseling
Annual Wellness Visit
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Update individual’s medical & family history
Record height, weight, body mass index, blood pressure and other
routine measurements
Provide personal health advice and coordinate appropriate referrals5
and health education
Open Enrollment Options
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If 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)
 Members of
MA plans must have Medicare Parts A &
B and must continue to pay the Part B premium
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If in Original Medicare:
• Can enroll in an MA plan
If in a Part D plan:
• Can drop or switch Part D plans
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Medicare Supplement Plans
2015
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Supplement Plans (Medigaps)
• Sold by private insurance companies
• Coverage varies for deductibles and co-insurance
• No network restrictions
• Drug coverage is NOT included
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2015 updates
• Continuous open enrollment
• If changing plans, cancel enrollment in old plan
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Medicare Advantage Plans
2015
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MA plans (HMO’s, PPO’s)
• Coverage provided through private plans within
networks
• Prescription drug coverage usually included
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2015 Updates
• Plan changes will be announced to members on
September 30th
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Medicare Supplement vs.
Medicare Advantage
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Medicare Prescription
Drug Coverage
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Also called Part D
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Provides outpatient prescription drugs
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All Medicare beneficiaries are eligible
• Can have Part A and/or Part B
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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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Anatomy of a Drug Plan
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Cost components
• Premiums: Monthly cost
• Deductibles: Annual cost
• Co-pays and co-insurance: Paid at pharmacy
• Formularies: List of medications covered
• Drug tiers: Pricing ladder
• Restrictions: Quantity limits, prior authorization, or
step therapy
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Amounts change periodically, therefore it is important
to review coverage during Open Enrollment
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Part D Coverage
2014 vs. 2015
Standard Coverage Levels
2014
2015
Deductible
$310
$320
Initial Coverage Limit
$2,850
$2,960
“Out-of-pocket” Threshold
$4,550*
$4,700*
Catastrophic Cost-sharing
5% or
$2.55/$6.35
5% or
$2.65/$6.60
* In 2015, after $2,960 in retail costs, the beneficiary pays 45% of brand
name drug costs and 65% of generic drug costs until total out-ofpocket costs equal $4,700
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Part D Changes for 2015
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Plan changes announced September 30th
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Important to compare plans every year
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Assistance Programs May Help
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There are several assistance programs to help pay
Medicare cost-sharing including:
• Extra Help (Low Income Subsidy/LIS)
• Prescription Advantage
• Patient Access Programs
• See handout “Concerned about Medicare Costs?”
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These programs are based on income and/or assets
A SHINE Counselor can help you determine which
programs you may qualify for and assist you in
applying
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Resources
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SHINE: 1-800-AGE-INFO (1-800-243-4636), press 3
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Medicare: 1-800-MEDICARE (1-800-633-4227)
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MCPHS Pharmacy Outreach Program: 1-866-633-1617
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Prescription Advantage: 1-800-AGE-INFO, press 2
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Medicare Advocacy Project (MAP): 1-866-778-0939
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Senior Medicare Patrol: 1-800-892-0890
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Remember!
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This is the time of year to make changes to your
Medicare Advantage or Prescription Drug Plan
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Ask yourself:
 Will my plan cover the drugs I take?
 How much will my plan cost?
 Will my doctor/hospital take my Medicare
Advantage Plan?
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