Medicare Beneficiary Ombudsman Topics
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1 Medicare Beneficiary Ombudsman Topics Presented by: Catherine Rippey, MBO 2017 SMP/SHIP Conference July 12, 2017
2 Medicare Beneficiary Ombudsman Activities 2
3 Medicare Program Enrollment 2017 Average Medicare Monthly Projected Enrollment in Millions Part A and/or Part B 57.7 Aged 48.7 Disabled 9.0 Original Medicare Enrollment 37.7 Medicare Advantage and Other Health Plan Enrollment, including employer waiver plans 19.9 MA Enrollment 18.3 Part D (Medicare Advantage with Rx Coverage and Prescription Drug Plans) 42.3 June 2017 Current Topics 3
4 Consumer Assistance Process 4
5 Medicare Transitions Marketplace to Medicare Part A Conditional Buy-in Retroactive Part A 5
6 Marketplace to Medicare Periodic Data Matching (PDM) notices notify consumers who are dually enrolled in Medicare and a Marketplace plan. Round 1 notices (September 2016) o Individuals ages 65 and over o Dually-enrolled in Medicare and the Marketplace o Receive financial assistance (Marketplace subsidies) Round 2 notices (February 2017) o Individuals ages 65 and over o Dually-enrolled in Medicare and the Marketplace o Do and do not receive financial assistance Round 3 notices (June 2017) 6
7 Part B Enrollment Opportunity (Equitable Relief) Offered to impacted consumers through September 30, Applies to Medicare beneficiaries currently enrolled in Medicare Part A and a Marketplace plan. Allows individuals to enroll in Part B outside the Medicare General Enrollment Period and without a penalty. May allow for penalty relief for those enrolled in Part B with a late enrollment penalty. 7
8 Part A Conditional Buy-In Numerous older adults and people with disabilities who are eligible for Medicare Part A but lack ample work experience are required to pay monthly premiums. The Part A Buy-In Agreement allows beneficiaries to receive Part A coverage without paying monthly premiums. By enrolling in the Qualified Medicare Beneficiary (QMB) program in their state. 1 1 Social Security Administration. (April 21, 2015). HI State Buy-In and Group Payer Provisions for QMBs. Retrieved on February 15, 2016 from 8
9 Part A Conditional Buy-In (cont.) CMS formed a workgroup and proposed a corrective action plan to: Identify problems/areas of confusion among SSA/CMS/States Implementing system changes, if needed (SSA only) Offering ongoing support to States with high numbers of processing issues Providing training and fact sheets for SSA, States, and other partners Creating a Web portal for information sharing 9
10 Retroactive Part A Some beneficiaries delay Medicare enrollment past age 65. When they enroll later they will be retroactively enrolled in Part A for a period of up to 6 months. HSAs contributions made during this period may be subject to tax liabilities. CMS encourages beneficiaries who delayed Part A enrollment to end their HSA contributions 6 months prior to their enrollment date 10
11 Looking Ahead Part B enrollment Full retirement age is increasing but Medicare eligibility stays the same o More beneficiaries delay enrollment in Part B past age 65 due to other coverage May result in penalties, coverage gaps, reduced access to care CMS is working to: o Improve notifications and outreach materials o Provide better education to individuals transitioning from other health insurance (i.e. Marketplace or employer group) 11
12 Looking Ahead (cont.) Part D drug pricing Medicare Plan Finder estimates Part C and D plan and drug costs Beneficiaries report they are sometimes unprepared for cost increases after the new plan year begins 12
13 Resources Medicare and Marketplace Equitable Relief Fact Sheet: Enrollment/Medicare-and-the- Marketplace/Overview1.html PDM Notices: 13
14 Resources Employer Community Page: Education/Find-Your-Provider- Type/Employers-and-Unions/Employercommunity.html 14
15 Contact Information Catherine Rippey, Medicare Beneficiary Ombudsman Phone: Fax:
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