Transcript Insert Regional Office and Contact Info

Medicare Annual Enrollment
Important Medicare
Updates for 2014
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SHINE Overview
• SHINE stands for Serving the Health Insurance
Needs of Everyone
• Provides free and unbiased insurance information
and counseling to Medicare beneficiaries
• 650 volunteer 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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2013 – 2014 Important Dates
• October 15, 2013 - Open Enrollment begins
– Medicare beneficiaries can change health and
prescription coverage
• December 7, 2013 - Open Enrollment ends
– Enrollment requests must be received by the 7th
• January 1, 2014 – Coverage begins
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Your Medicare Coverage Choices
Step 1: Decide how you want to get your coverage
ORIGINAL MEDICARE
Part A
Hospital
Insurance
OR
MEDICARE ADVANTAGE PLAN
(like an HMO or PPO)
Part C
Combines Part
C A, Part B
and usually Part D
Step 2: Decide if you need a Prescription Drug Plan
Part B
Medical
Insurance
Part D
Drug coverage is limited to
plan
offered by HMO or PPO.
Part D
Stand Alone PDP
Step 3: Decide if you need to add
supplemental medical coverage
End
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 Medigap policy.
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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
– 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 referrals
and health education
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Open Enrollment Options
• If in a Medicare Advantage 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 in Original Medicare, can enroll in an MA plan
• If needed, change your Prescription Drug Plan
• Member of MA plans must have Medicare Parts A
& B (must continue to pay Part B premium)
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Medicare Supplement Plans 2014
• Supplement Plans (a.k.a., Medigaps)
– Sold by private insurance companies
– Coverage varies for deductibles and co-insurance
– No network restrictions
– Drug coverage is NOT included
• 2014 updates
– More plans available (see handout)
– Continuous open enrollment
– If changing plans, cancel enrollment in old plan
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Medicare Advantage Plans 2014
• MA plans are HMO’s and PPO’s
– Coverage provided through private plans within
networks
– Prescription drug coverage usually included
• 2014 Updates
– Plan changes will be announced to members on
September 19th
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Medicare Supplement vs.
Medicare Advantage
Original Medicare +
Medigap Supplement 1
Medicare Advantage Plan
Higher monthly premium but
no co-pays/co-insurance
Generally lower premiums
but has co-pays
Freedom to choose doctors
Generally restricted to network
No referrals necessary
May need referrals for specialists
Some routine services not covered
(vision, hearing)
May include extra benefits
(vision, hearing, fitness)
Covered anywhere in U.S.
Only urgent and emergency services
Provided outside certain area
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Medicare Prescription
Drug Coverage
• Also called Part D
• Provides outpatient prescription drugs
• All Medicare beneficiaries are eligible
– Can have Part A and/or 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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Anatomy of a Drug Plan
• Cost components
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Premiums – monthly
Deductibles – annual
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
• Amounts change periodically, important to
review coverage during Open Enrollment
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Part D Coverage
2013 vs. 2014
Standard Coverage Levels
2013
2014
Deductible
$325
$310
Initial Coverage Limit
$2,970
$2,850
“Out-of-pocket” Threshold
$4,750*
$4,550*
Catastrophic Cost-sharing
5% or
$2.65/$6.60
5% or
$2.55/$6.35
* In 2014, after $2,850 in retail costs, the beneficiary pays 47.5% of
brand name drug costs and 72% of generic drug costs until total outof-pocket costs equal $4,550.
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Part D Changes for 2014
• Plan changes announced September 19th
• Plans will now cover barbiturates regardless of
your medical condition. Restrictions had
applied in past years.
• Important to compare plans every year
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Assistance Programs May Help
• There are several assistance programs to help pay
Medicare cost-sharing
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“Extra Help”
Prescription Advantage
Patient Access Programs
See handout “Concerned about Medicare Costs?”
• These programs are based on income and/or assets
• A SHINE Counselor can help you determine which
programs you may qualify for and assit you in
applying
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Resources
SHINE
1-800-AGE-INFO, press 3
(1-800-243-4636)
Medicare
1-800-MEDICARE
(1-800-633-4227)
MCPHS Pharmacy Outreach Program
1-800-633-1617
Prescription Advantage
1-800-AGE-INFO, press 2
(1-800-243-4636)
Medicare Advocacy Project
1-866-778-0939
Senior Medicare Patrol
1-800-892-0890
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Remember!
• This is the time of year to make changes to
your Medicare Advantage or Prescription Drug
Plan
• 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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