Medicare Annual Open Enrollment Period Updates. October 27, 2017 AgeOptions All rights reserved.

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1 Medicare Annual Open Enrollment Period Updates October 27, 2017 AgeOptions All rights reserved.

2 Medicare Annual Enrollment Period The Annual Enrollment Period (AEP) takes place October 15 to December 7 of each year Can make any Medicare Part D plan changes at this time (enroll, disenroll or switch plans) Includes stand alone PDP s and Medicare Advantage plans New Part D plan enrollments are effective January 1, 2018 Beneficiaries should have received an Annual Notice of Change (ANOC) from their Part D plans by October 1 st that lists premium, plan and formulary changes for

3 2018 Medicare Part D Information 2018 Medicare Part D plan information is available through the Medicare Plan Finder at Includes information for stand-alone, Medicare Advantage and Special Needs Plans 2018 Medicare Part D landscapes are available at: Coverage/PrescriptionDrugCovGenIn/index.html MMW Topical Brief on Medicare Part D and the Annual Enrollment Period

4 Part D Costs in 2018 Monthly premium (continue paying all year) Varies by plan Yearly deductible (if applicable) $0 - $405 Initial Coverage Limit (ICL) The beneficiary pays a co-pay or co-insurance for each prescription and the Part D plan pays the rest Donut hole (Coverage Gap) During the donut hole a beneficiary receives discounts on the full price of generic and brand name formulary drugs 65% discount on brand name drugs 56% discount on generics Until $3,750 (count what the beneficiary and the plan pays for formulary drugs) Begins once the beneficiary s covered drug expenses reach $3,750 ( the ICL) The donut hole continues until a beneficiary meets TrOOP True Out-of-Pocket Threshold (TrOOP) TrOOP is the amount the beneficiary has paid for formulary drugs out of pocket Note that TrOOP may include costs paid not only by the beneficiary, but also manufacturer discounts, a charity program, or the Extra Help program $5,000 = TrOOP Once TrOOP is met, the beneficiary enters Catastrophic Coverage and pays less for formulary drugs for the remainder of the calendar year Beneficiaries in catastrophic coverage pay no more than 5% or $3.35/$8.35 for generics/brand names whichever amount is greater 4

5 Donut Hole Discounts In 2018, people who enter the Part D donut hole will receive 65% discount on brand name drugs (50% from the manufacturer and 15% government subsidy) 56% discount on generics - entire discount provided to the plan by a government subsidy The 50% manufacturer discount counts towards TrOOP, but subsidies provided by the government do not Discounts increase over the next couple of years until 2020 when the donut hole will be closed A snapshot of Donut Hole discounts through 2020 Discounts a beneficiary receives in the Donut Hole for formulary drugs Brand Name Drugs % 60% 65% 70% 75% Generic Drugs 42% 49% 56% 63% 75%

6 Donut Hole What Counts? In 2018, the donut hole will begin at $3,750, To get to the donut hole count the total cost of the drug the beneficiary s co-pay and what the plan pays To get out of it, beneficiary must meet TrOOP ($5,000 in 2018), count what s paid by: The beneficiary, family member or other person on their behalf (beneficiary s co-pay) 50% manufacturers discounts on brand name drugs Medicare s Extra Help program (through Social Security) A charity program If the beneficiary finds a cheaper price than their plan pays (like a store discount card), they can send the receipt to their plan and it will count. Not out of country. These are called your True Out-of-Pocket (TrOOP) costs Explanation of Benefits (EOB) shows TrOOP costs to date

7 Donut Hole What Does NOT Count Premiums Any payment for a drug that is not on the plan s formulary Any amounts paid by employer or retiree plan Government subsidies given to the plans during the donut hole 56% generic discount and 15% brand name discount Drugs purchased outside the U.S. 7

8 Part D Income Related Monthly Adjustment Amount (IRMAA) Medicare beneficiaries with annual incomes greater than $85,000 ($170,000 if married and filing a joint tax return) are required to pay an extra IRMAA amount each month in addition to their Part D plan premium Created in 2010 as a provision of the Affordable Care Act Affects less than 5% of Medicare beneficiaries The same beneficiaries usually also pay a Part B IRMAA SSA notifies beneficiaries who are required to pay an IRMAA amount The IRMAA amount is paid to the federal government and not to the Part D plan o Deducted from a beneficiary s Social Security check or billed directly if the beneficiary is not yet receiving benefits Beneficiaries must pay the IRMAA amount or they may be disenrolled from their Part D plan

9 2018 Part D IRMAA Amounts 2018 Medicare Part D Income-Related Monthly Adjustment (IRMAA) Based on 2016 tax returns Beneficiaries who file an individual tax return Beneficiaries who are married and filing a joint tax return $85,000 or less $170,000 or less $0 $85,001 $107,000 $170,001 - $214,000 $13.00 $107,001 - $160,000 $214,001 - $320,000 $33.60 $160,001 $214,000 $320,001 - $428,000 $54.20 Greater than $214,000 Greater than $428,000 IRMAA amounts (in addition to the Part D plan monthly premium) $74.80

10 Part D Late Enrollment Penalty Late enrollment penalty if a beneficiary does not enroll in Part D when first eligible If they join later, they pay: 1% extra premium each month they were eligible but did not enroll in a plan (based on the national Part D base premium which is $35.02 in 2018) Must pay this penalty for as long as they are enrolled in a Part D plan The penalty is waived if a beneficiary is eligible for Extra Help or has other credible prescription drug coverage Example: Amy did not enroll in Part D until 12 months after her IEP ended She will have a 12% penalty. In 2018 it will be $4.20 (.12% x $35.02 (national Part D base premium) = $4.20)

11 2018 Stand Alone Part D Plans in Illinois Stand-alone prescription drug plans (PDPs) cover only prescription drugs 24 PDPs available in Illinois (does not include plans under sanction) Monthly premiums range from $ $ Some plans have a deductible up to $405 Plans may cover some drugs that do not apply to the deductible 8 $0 deductible plans 8 plans offer $0 premiums to beneficiaries with full Extra Help 8 plans offer additional coverage in the gap Co-payment of co-insurance for drugs depend on which tier a drug is on Some plans offer tier 1 drugs for $0 or $1 (usually commonly preferred generics)

12 Basic Plans 11 basic plans offered in Illinois in 2018 Standard Part D benefit structure that is actuarially equivalent Plans can vary the deductible and cost sharing amounts as long as the benefit remains actuarially equivalent Basic plans are not allowed to offer coverage in the gap Extra Help will help eligible beneficiaries pay the monthly premium for a Part D plan that is basic and up to the Extra Help benchmark 2018 Extra Help benchmark in Illinois is $27.50

13 Enhanced Plans 13 Enhanced PDPs offered in Illinois in 2018 Offer a wide range of benefits that may include No deductible Coverage in the donut hole Broader list of covered formulary drugs May also cover drugs that are excluded from Medicare drug coverage by law (these drugs will not count towards TrOOP) Often charge higher premiums and higher cost sharing amounts than Basic plans Monthly premiums are comprised of Basic premium and an enhanced benefit portion The Extra Help program (also known as Low-Income Subsidy or LIS) will not pay for the enhanced portion of the benefit even if the total drug premium is under the benchmark

14 2018 MA Plans in Illinois Different types of MA plans, each with different rules HMOs, PPOs, SNPs and PFFS 997 MA-PD plans offered. Options include: 621 local HMOs 221 local PPOs 102 regional PPOs 53 PFFS plans Monthly premiums range from $0 - $ Annual drug deductibles range from $0 - $405 Maximum Out-of-Pocket (MOOP) amounts range from $2,000 to $6,700 for in-network Part A and Part B medical expenses (does not include Part D costs) Some plans may have an annual health deductible Contact plan for additional information

15 2018 Special Needs Plans in Illinois (SNPs) 22 SNPs offered in Illinois 13 plans for institutionalized individuals 9 plans for individuals with chronic or disabling conditions One plan for individuals with End Stage Renal Disease (ESRD) requiring dialysis 3 plan options for cardiovascular disorders, chronic heart failure and diabetes 5 plan options for beneficiaries with dementia In Cook County in 2018, 5 SNPs are offered 2 plan options for institutionalized individuals 3 plan options for individuals with chronic or disabling conditions One plan for individuals with ESRD requiting dialysis One plan for individuals with cardiovascular disorders, chronic heart failure and diabetes One plan for beneficiaries with dementia

16 Important Changes to Special Needs Plans for Dual-Eligibles Beginning in 2018, SNPs for dual-eligibles will no longer be offered in Illinois HFS will no longer contract with dual-eligible SNPs after December 31, 2017 Currently in 2017, two companies offer a total of 21 SNPs in Illinois for dual-eligibles Community Care Alliance and WellCare These two companies mailed letters to their members in the beginning of October notifying them that their D-SNP will not be renewed in 2018 Individuals must choose new coverage for 2018 SNPs for beneficiaries with chronic health conditions or for people who live in institutions, like a nursing homes, will not change

17 Current D-SNP Members If eligible for MMAI Beneficiaries that live in MMAI geographic areas and have not opted out in the past will receive a passive enrollment notice from Client Enrollment Services in November and again in December Notice will educate them about the MMAI program and their plan options Individuals will have the option of choosing a plan, opting-out, or allowing passive enrollment into the plan listed in the notice to take place Should confirm that their providers are in the MMAI plan s network Note individuals can change or opt-out of MMAI plans at any time during the year Beneficiaries that opt out will return to original Medicare and fee-forservice Medicaid for their health services and will be auto-assigned to a stand-alone Part D plan if they do not choose one on their own Individuals receiving long term care supports and services that choose to opt-out of MMAI, must choose a MLTSS plan at the time they contact Client Enrollment Services to opt-out of MMAI

18 D-SNP members in Non-MMAI areas or Opted Out of MMAI Beneficiaries in D-SNPs that live in a non-mmai geographic area or have opted out of MMAI in the past, will not be passively enrolled into MMAI These individuals will be returned to original Medicare and fee-for-service Medicaid for their health services effective January 1, 2018 Will be auto-assigned to a stand-alone Part D plan if they do not choose a Part D or MA plan on their own Individuals who had previously opted out of MMAI, also have the option of opting back into MMAI at any time by contacting Client Enrollment Services Individuals will continue to qualify for Extra Help and a continuous special enrollment period that allows them to change plans at any time during the year

19 2018 Extra Help/Low-Income Subsidy (LIS) Cost Sharing Amounts Full Extra Help No or low monthly premium $0 annual deductible Co-pays either $1.25/$3.70 (generics/brand names) or $3.35/$8.35 (generics/brand names) Partial Extra Help No or low (sliding scale) monthly premium Annual deductible between $ 0 - $83 Co-pays of $3.35/$8.35 (generics/brand names) or 15% coinsurance Cost sharing amounts depend on the beneficiary s income and subsidy level Beneficiaries with Extra Help that live in an institution or receive Home and Community Based Services through a Medicaid waiver pay $0 drug co-pays with their Part D plans 2018 Extra Help income and asset levels will be announced in early 2018

20 Extra Help Choosing the Right Part D Plan Beneficiaries with Extra Help can enroll in any Medicare Part D plan they choose, but they will be responsible for a portion of the premium if they enroll in a plan that is above the Extra Help benchmark ($27.50 for Illinois in 2018) in an enhanced Part D plan Extra Help will continue to help pay the annual deductible and drug copays, regardless of which Part D plan a beneficiary enrolls in Certain plans offer a $0 monthly premiums to beneficiaries with full Extra Help For a list of 2018 stand-alone, Medicare Advantage, and Special Needs Plans that offer $0 premiums with full Extra Help visit Remember! Extra Help beneficiaries receive a continuous SEP that can be used at any time throughout the year

21 Letters, Letters Letters! Encourage beneficiaries to open their mail! CMS is mailing out different letters to individuals with Part D and Extra Help notifying them about how their plan or benefits are changing for 2018 A chart of the different letters including copies, when they are being mailed and what action the beneficiary needs to take may be found at: Coverage/LimitedIncomeandResources/Downloads/Co nsumer-mailings.pdf 21

22 Letters, Letters, Letters Extra Help Grey letter loss of deemed status (mailed in September) Tan letter choosers (mailed in early November) Blue letter (1) plan reassignment due to premium increase /above benchmark (mailed in late October) Blue letter (2) reassignment due to plan termination (mailed in late October) Blue letter (3) reassignment due to Medicare Advantage plan leaving the Medicare program (mailed in late October/early November) Orange letter change in LIS co-payments (mailed in October) 22

23 Medicaid Spenddown and Extra Help People with Medicare who meet their Medicaid spenddown at least once during the year, automatically qualify for Extra Help/LIS How long they receive Extra Help depends on when they meet their spenddown Spenddown met at least once between January 1 and June 30 = qualify for Extra Help for the remainder of the calendar year Spenddown met at least once between July 1 and December 31 = qualify for Extra Help for the remainder of the calendar year and the entire next year

24 Part D Transition Policy For beneficiaries who are new to a Part D plan and find out within the first 90 days of enrollment that a Part D drug is not on the formulary or has drug restrictions such as step therapy or prior authorization Plan is required to provide a temporary one-time 30-day fill during the first 90 days of coverage Once a transition fill is supplied by a plan, the plan notifies the member that it is only a one-time fill Gives the member enough time to request a formulary exception or find an alternate drug on the formulary that works as well

25 Part D Transition Policy Who does the transition policy apply to? People new to a Part D plan for the first time People who switch Part D plans (anytime during the year) Dual-eligibles who were randomly assigned to a Part D plan Newly eligible Medicare beneficiaries who switched from over coverage such as employer or COBRA coverage People who experience a change in level of care -E.g., people who move from a hospital to a skilled nursing People residing in long-term care facilities -eligible to receive a 31-day transition fill (including multiple 31-day fills during the first 90 days of enrollment) In some cases, current enrollees affected by a plan s formulary change from year to the next o If the plan did not work with the beneficiary prior to the new contract year to find another equivalent formulary drug or complete a formulary exception before the new coverage year began

26 Transition Supply Policy - Resources CMS: ansitionreminder_ pdf NCOA Center for Benefits Access, Getting to know Part D Transition Supply: 26

27 Part D and Medication Therapy Management (MTM) Programs Programs offered by Part D plans (including MA plans) Free service offered to eligible Part D beneficiaries Comprehensive review of all your medications by a pharmacist or healthcare provider to: Improvise medication safety and use Reduce adverse drug interactions Determine if drug costs can be lowered Must meet certain criteria Have multiple chronic conditions Taking multiple Part D medications Likely to have at least $3,967 in total Part D costs in 2018 (what you and the plan pay)

28 Where to Find MTM Programs on the Medicare Plan Finder

29 More Updates!

30 Medigap OEP for People with Disabilities Under 65 Medicare beneficiaries with disabilities under age 65 who missed their Medigap OEP, may only purchase select Medigap plans that offer guaranteed issue during certain times. These plans include: BCBS of Illinois from October 15 December 7 Health Alliance from October 15 December 7 Beneficiaries 65 and older can apply for a Medigap plan at any time of the year but A company is allowed to deny them coverage of charge them more higher premiums due to a pre-existing condition In Illinois, BCBS and Health Alliance will offer guaranteed issue policies to people 65 and older any time during the year To view the Medicare Supplement Premium Comparison Guide, visit the Illinois SHIP website at

31 Medicare Advantage Disenrollment Period January 1 February 14 of each year Allows people in Medicare Advantage plans to disenroll from their MA plan and return to Original Medicare They receive a SEP to enroll in a stand-alone PDP but Not allowed to switch or enroll in another Medicare Advantage plan Beneficiaries who wish to enroll in or switch Medicare Advantage plans should make changes during the Medicare OEP (October 15 th December 7 th ) Beginning in 2019, a new Medicare Advantage Open Enrollment and Disenrollment Period will be available January 1st March 31st of every year An MA beneficiary will be a able to make a one-time change to another MA or return to Original Medicare and enroll in a stand alone PDP Section of the Cures Act

32 Marketplace Open Enrollment Period Marketplace Open Enrollment Period is shorter this year: November 1, 2017 December 15, 2017 Plan changes effective January 1, 2018 Individuals should compare their options to find a plan that works for them and Review plan premiums, deductible, co-pay amounts, and provider networks Individuals should also update their Marketplace application and report any change of address, income, or household size. May impact the amount premium tax credit they receive Income and household size changes can be reported at anytime during the year To compare plan Marketplace plan options, update applications or report changes, individuals may contact the Marketplace at (800) or visit Unbiased, free, and trained help is available or Marketplace funding for advertising was decreased by 90% for upcoming OEP Important to remind people that coverage is still available, that they should compare plans, and update their information by contacting the Marketplace

33 Questions??

34 Alicia Donegan, AgeOptions (708) Since 1974, AgeOptions has established a national reputation for meeting the needs, wants and expectations of older adults in suburban Cook County. We are recognized as a leader in developing and helping to deliver innovative community-based resources and options to the evolving, diverse communities we serve. For more information, resources, and to join our MMW list, visit our MMW webpage at: