Eighteen Things to Know About Medicare for 2018 Updated May 2018

18 Things to Know About Medicare New Medicare Cards Income Related Monthly Adjustment Amount Part B Enrollment Periods COBRA and Medicare Limited Equitable Relief Medicare & Marketplace MAGI Medicaid Transition to Medicare Medicaid Requirement to Enroll in Medicare Medicare Savings Programs (MSP) Medicare and QMB

18 Things to Know About Medicare Repeal of Physical Therapy Cap Observation and Medicare Medigap and Medicaid/QMB Medigap Changes – 2020 Part D Extra Help/LIS Limitation on LIS Special Enrollment Period EPIC and Part D Medicare Advantage Open Enrollment Period VA and Medicare

New Medicare Cards Replace HICN (Health Insurance Claim Number) With Medicare Beneficiary Identifier (MBI) MBI will be randomly generated identifier 11 Characters including numbers and upper case letters Not including Social Security number Not including current suffixes Mailing new cards beginning June 2018 Contact Social Security Admin to confirm address Beneficiaries in Medicare Advantage plan continue to use plan card

Income Related Monthly Adjustment Amount Income-Related Monthly Adjustment Amount (IRMAA) Income above $85,000 Single/$170,000 Couple Subject to higher Part B premium + Part D surcharge Modified Adjusted Gross Income (MAGI) AGI + tax-exempt interest income (line 8b) Based on tax return from two years prior 2018 Part B Premium based on 2016 tax return May be able to appeal with Life Changing Event Change in marital status or Change in work status 2018 – Lower top 2 Income Thresholds 2019 - New Threshold $500,000/$750,000

Enrollment

Part B Enrollment Periods Initial Enrollment Period (IEP) 7 months surrounding month you turn 65 Delays Part B if enroll after month turn 65 Special Enrollment Period (SEP) Must have been covered continuously through active employment since first Medicare eligible OR enroll in IEP and then drop Part B when coverage through active employment begins 8 months following loss of active employment General Enrollment Period (GEP) January – March (Effective July 1) Late enrollment penalty (10% per 12 months)

COBRA and Medicare Does not extend Medicare enrollment period People with COBRA when first Medicare eligible And who do NOT have Part B NOT entitled to Part B Special Enrollment Period Can only enroll in General Enrollment Period Even if later covered under Active/Current employment Even if COBRA is free/subsidized by former employer COBRA may not continue to pay as primary If you do not enroll in Medicare when first eligible

Limited Equitable Relief – Medicare and Marketplace Available now through September 30, 2018 Individuals receiving premium/cost-sharing assistance with Qualified Health Plan (QHP) Who later become Medicare eligible May have delayed Part B Because QHP with assistance more affordable BUT actually no longer eligible for assistance AND cannot delay Part B without penalty Can request Equitable Relief to enroll in Part B And/or waive late enrollment penalty Contact Social Security for Equitable Relief

Medicaid/MSP

MAGI Medicaid Transition to Medicare People with Medicaid becoming eligible for Medicare MAGI Medicaid Higher income limit, no resource test Medicaid for people with Medicare Lower income limit, resource test Receive form from LDSS to screen for Medicaid/MSP May continue to receive Medicaid for several months If Parent/Relative Caretaker, can continue with MAGI Medicaid budgeting Request reimbursement for Part B premium in this period Enroll in Part A and Part B and Part D drug plan Will be disenrolled from Medicaid plan Will receive Full Extra Help automatically MAGI Medicaid Transition to Medicare

Medicaid Requirement to Enroll in Medicare NYS requiring Medicare eligible Medicaid recipients to enroll in Medicare As condition of continuing to receive Medicaid Medicare Eligibility vs. Premium-Free Part A Eligible for Medicare if US citizen Or legal permanent resident for 5 years Eligible for premium-free Part A 40 quarters/10 years work history Part A Buy-In QMB will pay both Part A and Part B premium

Medicare Savings Programs Qualified Medicare Beneficiary (QMB) $1,032/month individual - $1,392/month couple Covers premiums, deductibles and coinsurance Specified Low Income Beneficiary (SLMB) $1,234/month individual - $1,666/month couple Covers Part B premium ONLY Qualified Individual 1 (QI-1) $1,386/month individual - $1,872/month couple Can deduct health insurance premiums from income NO resource limit for NYS residents SLMB/QI can be effective retroactive up to 3 months Automatically qualify for Part D Full Extra Help

Original Medicare

Medicare and QMB Misunderstanding: Providers can bill beneficiaries with QMB if do not accept Medicaid Providers not allowed to bill beneficiary for any Medicare Part B cost-sharing Regardless of whether in Original Medicare or Medicare Advantage Regardless of whether provider accepts Medicaid Regardless of whether provider receives any payment from Medicaid NEW: Starting July 2018 Beneficiary MSN (Medicare Summary Notice) and Provider RA (Remittance Advice) will reflect QMB And MSN $0 cost-sharing for beneficiary responsibility

Repeal of Physical Therapy Cap Retroactive to January 2018 Prior to 2018, Limit on Physical, Speech and Occupational Therapy Included therapy provided in office, home (if not receiving Medicare covered home health care) and outpatient hospital Automatic Exceptions available based on condition or situation $2,010 Threshold Therapist must certify medical necessity $3,000 Threshold Medicare may review services

Observation and Medicare Medicare Outpatient Observation Notice (MOON) Notice that beneficiary is outpatient, not inpatient Receiving observation services more than 24 hours MOON Required as of March 8, 2017 Observation services covered under Part B With fixed co-pay rather than 20% coinsurance Drugs covered under Part D Hospital pharmacy probably out of network Need to pay up to charge and submit claim to Part D plan Part D plan will only reimburse up to their rate Days under observation don’t count toward 3-day stay Required for coverage of Skilled Nursing Facility

Medigap

Medigap and Medicaid/QMB Medigap plans are Guaranteed Renewable Can continue Medigap even if qualify for Medicaid/QMB But cannot purchase new Medigap plan If receive Medicaid/QMB Because Medicaid/QMB duplicate Medigap benefits Beneficiary with Medigap Who later qualifies for Medicaid/QMB May want to keep Medigap plan also To insure access to most providers Medigap may pay entire Medicare cost-sharing With Medicaid/QMB, providers may need to “write off” balance after Medicare

Medigap Changes - 2020 NEW: 2020 Newly eligible beneficiaries cannot purchase Medigap plan that covers Part B deductible Currently Plans C and F Replaced by Plans D and G And new High Deductible Plan G For newly eligible beneficiaries Current beneficiaries can keep their C, F or High Deductible Plan F A newly eligible beneficiary is defined as an individual who is neither a person who: Has attained age 65 before January 1, 2020; or Was entitled to Medicare Part A benefits by disability or ESRD before January 1, 2020

Part D

Part D Extra Help/LIS Part D Extra Help/LIS – Things to Know Automatic Extra Help/LIS Medicaid and/or Medicare Savings Programs Medicaid Spenddown Meet spenddown for 1 month Get LIS for calendar year Meet spenddown for 1 month (July – December) Get LIS for all of following year Apply for Extra Help/LIS Dependent relatives increase family size/income limits (Relative’s income not counted)

Limitation on Extra Help/LIS Special Enrollment Period NEW: Limitation on Extra Help/LIS Special Enrollment Period (SEP) Currently beneficiaries with LIS can change Part D/MA plans at any time NEW: Will be limited to 1 change per quarter During first 9 months of year Limited to Annual Election Period in last quarter October 15 – December 7

EPIC and Part D Fee and Deductible Plans Either pay Fee or meet Deductible On sliding scale based on income EPIC supplements all Part D plans BUT does not cover Part D Deductible EPIC requires enrollment in Part D BUT does not require enrollment in Part D first Special Enrollment Period Available for all EPIC members One election every calendar year Can enroll or switch plans

Medicare Advantage Open Enrollment Period Replaces Medicare Advantage Disenrollment Period (January 1 – February 14) NEW: Beginning in 2019 January – March Medicare Advantage (MA) plan change Change from MA plan to MA plan or to Original Medicare With or without Part D CANNOT change from Original to MA plan One change effective 1st of following month

VA and Medicare Medicare Misunderstanding: Veterans do not need to enroll in Medicare Cannot delay Part B Subject to late enrollment penalty Counted toward Medigap waiting period For pre-existing conditions Can delay Part D VA is considered to be creditable drug coverage Allows for Part D SEP to disenroll from Part D plan Including Medicare Advantage plan with Part D