Medicare Open Enrollment and Transitioning from the Health Connector to Medicare
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1 Medicare Open Enrollment and Transitioning from the Health Connector to Medicare
2 SHINE Overview SHINE = Serving the Health Insurance Needs of Everyone on Medicare Mission: To provide no cost and unbiased health insurance Information, counseling and assistance to Massachusetts residents with Medicare and their caregivers 14 Regional Offices cover entire state 700 SHINE counselors (60% volunteers) available in the community to help SHINE@state.ma.us 2
3 What SHINE Does Assist people in understanding their Medicare and MassHealth rights and benefits Educate people about all of their health insurance options Educate consumers with limited resources on how to pay for health care costs. For example: Low Income Subsidy & Medicare Savings (Buy-In) Programs Screen for public benefits (State and Federal) 3
4 Medicare 101 Federal health insurance program for: Individuals age 65 and over Individuals under age 65 with a disability NOT a comprehensive health insurance program Gaps in Medicare coverage mean beneficiary must pay a portion of medical expenses 4 parts of Medicare: Part A (Hospital Insurance) Part B (Medical Insurance) Part C (Medicare Advantage) Part D (Prescription Drug Coverage) 4
5 New Medicare Cards Social Security Number Removal Randomly generated Medicare Beneficiary Identifier (MBI) will replace the SSNs on new Medicare cards Replacing SSNs on all Medicare cards will protect: Private health care and financial information Federal health care benefit and service payments Transition period will begin April 1, 2018 through December 31,
6 Medicare Eligibility 65 years or older and eligible for Social Security (earned 40 credits/quarters) 65+ with spouse or ex-spouse (marriage lasted at least 10 years) who qualifies for Medicare Under 65 who has received Social Security Disability (SSDI) for 24 months Enrollments and eligibility determinations: Social Security Administration ; Create My Social Security Account
7 Enrollment Periods 7 months around 65 th birthday Initial General Jan. 1-March 31 if Part B enrollment missed A,B,C,D B OPEN Special C,D B,C,D Oct. 15-Dec. 7, change health or drug plan 7 Qualifying events (move, retire, etc.)
8 Initial Medicare Enrollment 7 month window around the month in which a person becomes entitled to Medicare If 65+: One s Initial Enrollment Period (IEP) is the 7 month window around the month she/he turns 65 If under 65: One s IEP is the 7 month window around the 25 th month of SSDI entitlement The month in which one enrolls determines the coverage start date Potential penalties for late enrollment 8
9 Enrolling In Medicare Social Security processes Medicare applications Common myth that Medicare will know when a person turns 65. This is NOT TRUE unless the person is already receiving Social Security benefits A person must notify Social Security of their intent to enroll in Medicare Medicare and Social Security are two entirely separate entitlement programs 9
10 Delaying Medicare Parts B & D There is a lifelong penalty for not signing up for Medicare Part B when initially eligible Also, Connector coverage may NOT creditable for Medicare Part D (drug coverage). If enrolling late into Part D, there is also a lifelong penalty 10
11 Part C and D Special Enrollment Periods (SEP) Can enroll, disenroll, or change Part C or Part D Must have qualifying events or circumstances Length of SEP depends on the qualifying event Penalty may apply 11
12 Common Parts C & D Special Enrollment Periods Qualifying Event/Circumstance Enrolled in Medicaid (MassHealth), Extra Help, and/or Medicare Savings Program Enrolled in Prescription Advantage Moved to a new geographic service area Leaving employer group health plan coverage, including COBRA Residing in a long term care facility Length of SEP Continuous 1 per calendar year 2 months after move 2 months after loss of coverage Continuous Want to enroll into a 5-star plan 12 1 per calendar year
13 What is Medicare Open Enrollment? Medicare Open Enrollment is the ONE TIME OF YEAR when all people with Medicare can review, compare, enroll or dis-enroll in: Part C (Medicare Advantage) Part D (Prescription Drug Plans) Medicare Open Enrollment dates: October 15 th : Open Enrollment begins December 7 th : Open Enrollment ends January 1 st : Health/drug coverage begins 13
14 Why Is Open Enrollment Important? This is the annual opportunity to review health and drug plans. This is important because: Health needs may change year to year Health or drug plan change the costs, benefits, and drug coverage they offer every year By reviewing plans costs and benefits & comparing them with other options available for the upcoming year, there is potential to save money & ensure appropriate coverage 14
15 Medicare + Other Benefits MassHealth & Medicare members (Dual eligibles), those on Extra Help (Low Income Subsidy) and Medicare Savings Program (Masshealth Buy In) consumers can: Change their plans ANYTIME, so the deadline of December 7 th is not as critical 15
16 Transitioning from the Health Connector to Medicare Why is it important for those on the Health Connector to pay attention when they become eligible for Medicare? There are enrollment, financial and coverage factors that could have negative consequences. What do we mean by this? 16
17 Transitioning from the Health Connector to Medicare For those in a Health Connector plan entitled to Premium free Medicare Part A (which means they earned 40 credits while working under Social Security and paying into Medicare): If they don t sign up for Medicare when they are initially eligible, they will LOSE any tax credits they are receiving Loss of subsidy can add up to hundreds of dollars 17
18 Transitioning from the Health Connector to Medicare For those in a Health Connector plan who have to purchase Part A (have less than 40 credits/quarters under Social Security) when they become eligible for Medicare: They can keep their Connector plan They will continue to receive tax credits and subsidies 18
19 Take Aways Enroll in Medicare as soon as becoming eligible for premium free Part A Disenroll in Health Connector plan by calling the plan Don t miss deadlines to sign up for Medicare Plans are improving notification to members approaching 65 19
20 Where to Go For Help Social Security Administration: To enroll in Medicare SHINE: AGE-INFO ( ), press 3 English and Spanish Medicare: MEDICARE ( ) MCPHS Pharmacy Outreach Program: Review of meds & drug coverage, refers affordable prescription drug programs 20
21 QUESTIONS? 21
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