Michigan Medicare Medicaid Assistance Program (MMAP)
Parts A& B
Part A Benefit Period Deductible: $1,364 Hospital copay: $341 (Days61-90) $682 (Days 91-150) SNF copay: $170.50 /day Premium: up to $437 Part B Premium: $135.50 Deductible: $185
Observation status = Medicare Part B Hospital admission = Medicare Part A The Issue: Part B Copayment Skilled Nursing Facility: Medicare only pays after a 3 day hospital admission under Part A Prescriptions Tip: Make sure you verify admission status with admitting physician and hospital.
Hospitals must issue the MOON to people with Medicare in Original Medicare and Medicare Advantage Plans Hospitals began using the MOON form on March 8, 2017 Available in Both English and Spanish PDF and Word formats Must be delivered within 36 hrs after observation services begin.
Social Security Number Removal Initiative Replace Medicare cards Medicare number will not be SSN April 2018-April 2019 Prevent Identity Theft
New cards began mailing in April 2018 Your Medicare card will NOT be your SSN! Instead, you will get a unique 11- digit alphanumeric number Your benefits stay the same. You don t have to do anything.
Scammers are posing as Medicare reps, calling and asking for current Medicare numbers and offering to send a new card. Do not give your info out over the phone! Report incidents like this to MMAP.
Part A Retroactive 6 months to Medicare eligibility Must stop contributions to HSA 6 months prior to Medicare enrollment Tax Implications Counsel beneficiaries to decline Medicare if they want to continue with their HSA.
Medicare Supplemental Insurance
Michigan Resident Household Income $27,315/year (single) $37,035/ year (couple) Medicare Supplement from AARP/United Healthcare BCN BCBSM Priority Health
Helps pay for monthly Medigap premiums. Administered by the Michigan Health Endowment Fund (MHEF) If you are: Under 65 with disability You pay: $125 less 65-74 years old $40 less 75 years and older $65 less
Apply online at: Michiganmedigapsubsidy.com Call MHEF at 1-866-824-9772 (TTY: 1-866-824-7002), M-F, 8:00 a.m. to 6:00 p.m. The call is free. Fill out and send in a paper application. IMPORTANT NOTE: The Michigan Medigap Subsidy is guaranteed to run through the end of 2019 only. It may run through 2021if funds permit. Need assistance? Call MMAP! 1-800-803-7174
Effective 2020 No new Medigap Plan C or F will be sold Plans can choose to keep existing members, but no 2020 New to Medicare Beneficiaries can enroll in C or F come 2020 Medigap A, B, D, G, K, L, M, and N will continue to be sold
Medicare Part D
If you : Do not have creditable coverage AND Do not enroll in Part D THEN You must pay a Late Enrollment Penalty Penalty is added onto the monthly premium Will continue as long as enrolled in Part D
Penalty is calculated as 1% of the Part D base beneficiary premium ($33.19 in 2019) For each month a beneficiary does not have creditable coverage and is not enrolled in Part D The penalty amount changes each year as the Part D base beneficiary premium changes
Part D Premiums are subject to income adjustments similar to Part B premiums Beneficiaries with significant income will pay sliding scale higher Part D premiums There are 6 income categories Each category has a set dollar amount associated with it
Individual tax filers with income: Joint tax filers with income: IRMAA for Part D/ Part B < $85,000 < $170,000 $0/ $134 $85,001 to $107,000 $170,001 to $214,000 $12.40/ $187.50 $107,001 to $133,500 $214,001 to $267,000 $31.90/ $267.90 $133,501 to $160,000 $267,001 to $320,000 $51.40/ $348.30 $160,001 to $500,000 $320,001to $750,000 $70.90/ $428.60 Above $500,000 Above $750,000 $77.40 July 2017 Current Topics 19
Catastrophic Coverage 5% or $3.40 G- $8.50 B Beneficiary Spending Medicare Part D Benefit Pharmaceutical Spending New Partial Coverage Partial Coverage Brand 25% Generic 37% 25% Brand 75% Generic 63% $8,417.60 Total or $5,100 OOP $3,820 Deductible $415 + Monthly Premium * Numbers represent actual prescription drug cost.
2019: Beneficiaries who reach the donut-hole will pay a maximum of: 37% for their generic medications (down from 44%) 25% for brand name medications (down from 35%) 2019 and beyond: Donut-hole will continue to be reduced each year until it is completely gone in 2020 (A look ahead 2020 25% Generic, 25% Brand Name)
Subsidy provided by Social Security Admin Helps with the cost of Part D: Premiums, Deductibles, Co-pays Financial Eligibility Guidelines (2019) Income: $1,537/mo.(single)/$2,078/mo.(married) Assets $14,100 (single)/$28,150 (married) Guidelines will change again March-April 2019.
Nursing home Medicaid or Home and Community based Waiver remains at $0 Deductible and copay Up to 100% FPL- up a little $1.25 generic and $3.80 brand name Full Extra Help (over 100% FPL)- up a little to $3.40/ $8.50 Partial Extra Help- Deductible up to $85.00/ Cost Sharing remains at 15%
Initial Enrollment Period (IEP) Annual Coordinated Election Period (AEP) Special Enrollment Periods (SEPs) 24
October 15 th through December 7 th Coverage effective January 1 st 25
SEPs enable beneficiaries to make Part D plan changes in special situations, including: Involuntary loss, reduction, or non-notification of creditable coverage When entering, residing in, or leaving a long-term care facility Moving Other exceptional circumstances Beneficiaries who qualify for Medicaid or a Medicare Savings Program (QMB, SLMB and QI) have a SEP that allows them to join or switch plans once each calendar quarter 26
People who are enrolled in either Part D plan with less than 3 Star Quality Rating Medicare Advantage plan with less than 3 Star Quality Rating During SEP, can switch into a plan that has either 4 or 5 stars CMS will send letter to beneficiaries enrolled in low-performing plans notifying them of SEP
Enroll online at www.medicare.gov Enroll online at the plan s website Contact the company of choice to request an application packet Call 1-800-MEDICARE for assistance in enrolling over the phone Call MMAP at 1-800-803-7174 28
Plans who received less than 3-star quality rating for 3 consecutive years Beneficiaries will not be able to enroll on Medicare s website Can enroll directly through the plan Warning will appear on Medicare s website
Part D and Medicare Advantage Plans can change their benefits and costs annually Be sure to check Premium, deductible, co-payment changes Are your drugs still covered? Are your drugs still covered at the same tier? Is there another Plan that offers better coverage? Medicare.gov Plan Finder Note: Plans cannot change coverage midyear
Cost Premium, Deductible, Co-pays Coverage Are my drugs covered? Tiers Prior Authorization, Quantity Limits, Step Therapy? Nationwide coverage for travelers Pharmacy Network, Preferred Mail order
2019 Change from 2018 Total PDP s 29 +5 # of Enhanced Plans 18 +7 # of Basic Plans 11-2 # of $0 Deductible Plans 9 +1 Lowest Premium $0 Deduct. SilverScript Choice $30.80 +$1.70 % $0 Deductible Plans 31% -2% # Plans Premium < $25 6 +2 % Plans Premium < $25 21% -4%
Lowest PDP Premium Envision Rx Plus Highest PDP Premium Prescription Blue Option B 2019 Change from 2018 $14.50 +$1.90 $89.30 -$13.30 Avg. PDP Premium $42.19 +$0.06 # PDPs w/ Gap Coverage 5-1 Lowest Cost Plan w/ Gap Coverage Aetna Medicare Rx Select $17.10
Lowest Premium $0.00 Aetna, BCN Advantage, HAP Senior Plus, Humana Choice, Meridian, Paramount Elite, Priority Medicare Highest Premium $313.00- Medicare Plus Blue PPO Assure Number of MA plans Livingston 35 Macomb 45 Monroe 37 Oakland 48 St Clair 34 Washtenaw 35
If a person is in a MA plan and switches/disenrolls and has a dental rider rider is still in effect. Must be canceled separately
Part D plans cannot: Market themselves as Medicare endorsed Solicit from door-to-door Call people on national and state do not call lists Enroll people over the phone during a solicitation call Offer incentives or gifts that exceed $15 in value Market outside the plan s service area Engage in activities to mislead or confuse beneficiaries Conduct sales presentations or collect enrollment applications at health fairs 36
October 1 2019 Part D and Medicare Advantage Plan Information available on medicare.gov Plans can begin marketing- check your mailbox! Annual Notice of Change will be sent by your current plan Medicare & You 2019 books will begin to be sent October 10 Star Quality Ratings released on medicare.gov Plan Finder October 15- December 7 Enrollment Period January 1 Plan Period Begins
More Information www.medicare.gov Medicare & You Handbook 1-800-MEDICARE MMAP 800-803-7174 38