Presenter: Francine Chuchanis, MA Akron Canton Area Agency on Aging

Transcription

1 Presenter: Francine Chuchanis, MA Akron Canton Area Agency on Aging

2 7 months to enroll Initial Enrollment Period Automatic if collecting social security benefit Can enroll online Can enroll at Social Security Administration If miss Initial Enrollment - Can enroll Jan.1 March 31 Coverage begins first day of month of 65 th birthday

3 October 15 December 7, 2013 Annual Notice of plan changes By September 30 Plan non-renewals by October 2 -can enroll in new plan through 2/28/14 Time to look at coverage Time to change plans if necessary

4 Costs Provider network Health Care utilization Changes in medications Moved to different county

5 Traditional Medicare Medicare Advantage Plans

6 Parts A (hospital) & B (medical) Most pay no premium for Part A monthly cost is $426 if purchased $1216 deductible/benefit period Hospital coinsurance :$0 days 1-60, $304 days $608 days SNF Stays: $0 for days 1-20, $152 days day hospital stay required Skilled care only, no custodial care

7 Medical Coverage Standard Premium - $ (salary adjusted) Annual Deductible - $147/year Coinsurance 20% No Balance Billing in Ohio

8 Can delay if you or spouse have coverage with current employer Medicare pays second if employer has more than 20 employees If delay call Social Security when you lose coverage You have 8 months to enroll in Part B even if you have COBRA coverage

9 Will need Part D Drug Coverage unless have creditable coverage May need to purchase Medi-gap/Supplemental Policy private insurance

10 Private insurance you buy to cover Medicare co-pays/extend coverage Works with Traditional Medicare only Standard benefits across the US 10 different plans 6 provide foreign travel emergency coverage The more coverage, higher the cost

11 First 6 months you are both age 65 and enrolled in Part B Medicare Advantage plan leaves Medicare up to 63 days You move out of service area You leave Medicare Advantage Plan after 1 st year of enrollment into Medicare at age 65 You drop Med-Sup, join Medicare Advantage Plan, then decide to leave in less than 1 year You leave Medicare Advantage because you were misled

12 Still pay Part B monthly premium plus any premium for the plan Many include services not covered by Traditional Medicare Out of Pocket Maximums apply can vary significantly May limit providers you can use in network only May include drug coverage

13 Number of plans remains stable Some increases in premiums Several increases in out of pocket maximum Most provide coverage in Part D Reduction in number of plans providing gap coverage

14 Geographic Area Costs premium, cost sharing compared to Traditional Medicare, drug costs & coverage, out of pocket maximum Plan Ratings Provider Network Extra Benefits

15 Enroll in Stand Alone Plan Obtain through a Medicare Advantage Plan most include Do not need if have creditable coverage employer plan, retiree insurance, VA benefits

16 Reduced maximum deductible from $325 to $310 ACA - Donut hole discounts for generic drugs increased from 21% to 28%, brand name discounts will remain at 52.5 % Donut hole scheduled to be gone by 2020 Those with higher costs will pay less in 2014 due to decrease in donut hole exit point from $4750 to $4550 in 2014

17 Maximum Deductible - $310 Initial Coverage Limit - $2850 (total retail cost of drugs) DONUT HOLE BEGINS Out of Pocket Threshold - $4550 ( true out of pocket, does not include amount paid by plan or premium) Catastrophic co-pays - $2.55/$6.35, or 5% whichever is greater

18 No significant reduction in number of plans 32 Less plans offer gap coverage 15 plans offer coverage beyond the standard coverage (Enhanced) 10 Plans have a $0 premium for those eligible for Extra Help or on Medicaid Ohio benchmark = $28.93

19 Premium & Deductibles Co-pays Donut Hole Coverage Plan ratings Formularies Restrictions step therapy, quantity limits, prior authorization Mail Order Network Pharmacies National Coverage

20 Ohio Department of Insurance (OSHIIP) Area Agency on Aging 10B

21 Medicaid is for those with limited finances & resources Most health care costs are covered for those on both Apply through County Department of Job & Family Services Expected changes in 2014 in Ohio for duals

22 Low Income Subsidy/Extra Help Part D: Resources below $13,300 (individual), $26,580 (married) Income below $17, 235 (individual), $23,265 (married) Medicare Savings Programs: QMB, SLMB Pay Part B premium For some will pay deductibles, coinsurance and any Part A Premium Call Area Agency on Aging to Apply

23 Free Preventive Services through Traditional Medicare Continuous reduction in coverage gap pay less for generic drugs Jimmo v. Sebelius can no longer stop skilled therapy services in nursing homes, outpatient therapy facilities or through home health agencies because a patient is not improving due to a chronic condition Changes in Traditional Medicare costs not yet available

24 Traditional Medicare only covers skilled care in a nursing home after a 3 day hospital stay If a patient is not admitted and remains in observation status, this does not count as a hospital stay & is considered outpatient treatment Effective 10/1/13 2 midnight rule for physicians Make sure you do not remain in observation status if you are hospitalized overnight Some efforts in Congress to stop this practice H.R & S. 569

25 Affordable Care Act DOES NOT REPLACE MEDICARE You CANNOT enroll in a Medicare Advantage Plan or in Medicare Part D through the Marketplace Generally, Medicare WILL NOT interact with the Marketplace THE MARKETPLACE IS NOT FOR PEOPLE WITH MEDICARE

26 You DO NOT need a new Obama Care Card Government officials DO NOT ask for personal information It is ILLEGAL to sell a Marketplace plan to a Medicare beneficiary If you sign up for insurance through the Marketplace - You could LOSE your Medicare

27 Coordination of Benefits with Medicare same rules For people who have NO health insurance Low income individuals can get help purchasing coverage Small businesses can receive tax credits Not coverage provided by the government - coverage is through insurance companies law sets certain requirements

28 Thank you

29 Thank you!