Medicare Open Enrollment MEDICARE

Objectives  Following this session you should be able to Provide an overview and relate key dates Know how to compare Medicare plans Describe how to join a new plan Explain LIS reassignment Be aware of notices to beneficiaries Refer to helpful resources Medicare Open Enrollment 2012 September 2012

2013 Overview  Medicare Advantage premiums are projected to remain stable Average weighted premium will increase by $1.47 (4.7%) However, if beneficiaries switch to lower cost plans at the same rate in 2013 as they did in 2012, we expect the average premium to increase by only $.57 (1.8%) 99.6 percent of beneficiaries have access to an MA plan The number of plan choices will increase by 7% Medicare Open Enrollment 2012 September 2012

2013 Overview  Part D estimated average basic premium and estimated total premium will slightly increase Average premium projected to be $30 in 2013  People who reach the “donut hole” 52.5% discount on covered brand name drugs 21% discount on covered generic drugs Medicare Open Enrollment 2012 September 2012

Medicare Open Enrollment 2012 Open Enrollment for People with Medicare  From October 15 to December 7 you can Join or switch a Medicare prescription drug plan Join or switch a Medicare Advantage Plan  Take time to review health and drug plan choices Choose the plan that fits your needs  Coverage begins on January 1, 2013 You’ll have membership card/materials in hand September 2012

Medicare Open Enrollment 2012 Key Dates September16-30CMS mails the Medicare & You handbook 30Most plans must provide Annual Notice of Change (ANOC)/Evidence of Coverage (EOC) to members* October1Plans may begin marketing 2013 plan data to be displayed on the Medicare Plan Finder (MPF) (Tentative) 11Plan ratings updated on MPF (Tentative) 15Medicare’s Open Enrollment Period begins December7Open Enrollment ends January1CY 2013 plan benefit period begins *Dual eligible Special Needs Plans have the option to send a combined ANOC/EOC by 9/30 or send the ANOC and Summary of Benefits by 9/30 and the EOC by 12/31. September 2012

Comparing Plans  Each year Medicare Plans can change costs and coverage Plans mail Evidence of Coverage/Annual Notice of Change  Gives details about plan coverage, costs, etc. – For the next year  Some plans may choose to leave Medicare Plans mail notice of non-renewal Members have a Special Enrollment Period Medicare Open Enrollment 2012 September 2012

Medicare Open Enrollment 2012 Things to Consider  Coverage Are the services or drugs you need covered? Do you have or are you eligible for other health and drug coverage?  Costs Premiums, coinsurance (copays), deductibles What is the out-of-pocket limit for medical care?  Are your doctors/hospitals part of the plan?  Are your prescription drugs covered?  What are the plan’s quality ratings?  Are the offices/pharmacies/hospitals convenient?  Do you travel for long periods during the year? September 2012

Where to Get Plan Information 1.Medicare Plan Finder on 2.The plan’s website 3.Medicare & You handbook MEDICARE ( ) 5.State Health Insurance Assistance Program (SHIP) Medicare Open Enrollment 2012 September 2012

1. Medicare Plan Finder  More detailed comparison using Medicare Plan Finder select “Find Health and Drug Plans” Check the plan’s quality summary rating  5-Star and low-performing plan icons See which drugs are on the plan’s formulary Compare the cost ranges for plans in your area Medicare Open Enrollment 2012 September 2012

Medicare Open Enrollment Star Special Enrollment Period  Enroll one time any time during the year in a 5-Star Medicare Advantage Plan 5-Star Medicare Advantage with Prescription Drug Plan 5-Star Prescription Drug Plan Even if already in a 5-Star Plan  New plan starts first of month after enrolled  Star ratings on Plan Finder October 11 Updated yearly September 2012

Medicare Open Enrollment 2012 Low-Performing Medicare Plans  Plans that receive a summary rating of less than 3-Stars for at least 3 years in a row Ratings are on Medicare Plan Finder Medicare & You doesn’t have full, updated ratings  Changes for low-performing plans in 2013 No online enrollment for low-performing plans No enrollment through Medicare Must contact plan directly to enroll  Enrolled beneficiaries can call Medicare and ask to move to a higher quality plan September 2012

2. Contact the Plan  Plan sites have the most comprehensive information Unlike Medicare Plan Finder, you can’t compare other plans  Call plan or check their website On Medicare Plan Finder Contact information in Medicare & You handbook  Phone number  Web address Medicare Open Enrollment 2012 September 2012

3. Medicare & You Handbook  Has basic plan information Mailed each fall to beneficiary households Good for quick comparison Plan information not comprehensive  Only one quality rating  Mailed September  CMS Publication No Medicare Open Enrollment 2012 Note: The star rating in the handbook is the percent of people who rated their plan as the best. September 2012

MEDICARE  MEDICARE ( ) Say “Medicare Number” if available Say “Agent” if it is not  Available 24 hours a day, 7 days a week  Support is offered in multiple languages Tell customer service representative preferred language  TTY users should call Medicare Open Enrollment 2012 September 2012

5. State Health Insurance Assistance Programs (SHIPs)  Program for people with Medicare And their families  Free personalized counseling and assistance Funded through Federal grants to states  Find your local SHIP contact Look at the back of your Medicare & You handbook Check the web at Call MEDICARE Medicare Open Enrollment 2012 September 2012

How to Join a New Plan  May be able to enroll in Medicare Health Plan or Medicare Prescription Drug Plan by Paper Application Calling the Plan Enrolling on the plan’s website or on Call MEDICARE ( ) TTY users call  Enrolling in a new plan will disenroll you from your previous plan Medicare Open Enrollment 2012 September 2012

Medicare Open Enrollment 2012 If You Have Other Coverage IMPORTANT  If you have other coverage, like from an employer or union Check with your plan’s benefits administrator before making any changes to your coverage Otherwise, you could lose coverage for you and your dependents September 2012

Your Medicare Choices 1.Original Medicare Medigap (Medicare supplement insurance) policies Medicare Prescription Drug Coverage 2.Medicare Advantage Plans With or without Medicare Prescription Drug Coverage 3.Other Medicare Health Plans Like Cost Plans and Programs of All-Inclusive Care for the Elderly (PACE) Plans September 2012 Medicare Open Enrollment 2012

Original Medicare  Run by the Federal government  Provides hospital (Part A) and doctor (Part B) coverage  See any doctor or hospital that accepts Medicare  You pay Part B premium (Part A free for most people) Deductibles, coinsurance or copayments  Can buy a Medigap policy to help pay some of these costs  Get Medicare Summary Notice (MSN)  Can join a Medicare Rx Plan to add drug coverage September 2012

Medicare Open Enrollment 2012 Medigap Policies (Medicare Supplement Insurance)  Pay the “gaps” in Original Medicare coverage  Private health insurance for individuals  Sold by private insurance companies  Follow Federal/state laws that protect you  Must state “Medicare Supplement Insurance”  Don’t work with Medicare Advantage Plans September 2012

Medicare Open Enrollment 2012 Medigap and Open Enrollment  If you drop a Medicare Advantage (MA) Plan and join Original Medicare during the Open Enrollment Period There is no guarantee that an insurance company will sell you a Medigap policy You may have to meet medical underwriting requirements  Unless you have a guaranteed issue right  Example: If your MA Plan leaves Medicare  Contact Medigap insurers in your area to see what might be available to you September 2012

Medicare Open Enrollment 2012 Medigap and Open Enrollment  If your Medicare Advantage Plan does not renew and you join Original Medicare and you are age 65 or older You have a special right to buy a Medigap policy  Called a guaranteed issue right From 60 days before to 63 days after your coverage ends If you’re under age 65, you may not be able to buy a Medigap policy until you turn age 65.  Check with your State Health Insurance Assistance Program or State Insurance Department September 2012

Medicare Advantage Plans  Health plan options approved by Medicare  Run by private companies  Part of the Medicare program Sometimes called “Part C” Available in most areas of the country  Medicare pays a set amount to plan for your care  Most MA plan include prescription drug coverage Medicare Open Enrollment 2012 September 2012

Medicare Open Enrollment 2012 Who Can Join a Medicare Advantage Plan?  Eligibility requirements Live in plan service area Entitled to Medicare Part A (Hospital Insurance) Enrolled in Medicare Part B (Medical Insurance) No End-Stage Renal Disease (ESRD) at enrollment  Some exceptions  To remain enrolled a person must also Pay the plan’s premium on time Provide necessary information to the plan Follow the plan rules  You can only belong to one MA plan at a time September 2012

Medicare Open Enrollment 2012 How Medicare Advantage Plans Work  Receive services through the plan All Part A and Part B covered services Some plans may provide additional benefits  Receive a separate plan membership card  Medicare pays plan monthly for your care  You may have to visit network doctors/hospitals  May be different than Original Medicare Benefits Cost-sharing September 2012

Medicare Open Enrollment 2012 Medicare Advantage Plan Costs  Must still pay Part B premium Some plans may pay all or part for you  May pay additional monthly premium  You pay deductibles, coinsurance and copayments Different from Original Medicare Varies from plan to plan Costs may be higher if out-of-network September 2012

Medicare Open Enrollment 2012 Medicare Advantage Plans and Open Enrollment  If you are in a Medicare Advantage (MA) Plan You can switch to another MA Plan by joining a new MA plan You will be automatically disenrolled from your old plan You can switch back to Original Medicare by joining a stand-alone Medicare drug plan o If you do you should consider/see if you can get a Medigap policy REMEMBER: If you have other health or drug coverage, like from an employer or union, check with your benefits administrator before you make any changes to your coverage. September 2012

Medicare Open Enrollment 2012 Leaving a Medicare Advantage Plan  Between January 1–February 14 You can leave an MA plan and switch to Original Medicare If you make this change, you may also join a Medicare Prescription Drug Plan to add drug coverage Coverage begins the first of the month after the plan gets enrollment form Check whether you could get a Medigap policy September 2012

Medicare Prescription Drug Coverage  Also called Medicare Part D  Available for all people with Medicare  Provided through Medicare Prescription Drug Plans (PDPs) Most Medicare Advantage Plans Some other Medicare plans  Must include range of drugs in each category Medicare Open Enrollment 2012 September 2012

Medicare Open Enrollment 2012 Who Can Join a Part D Plan?  You must have Medicare Part A and/or Part B  You must live in the plan’s service area  You must proactively choose and enroll in a Part D plan  You can’t live outside the U.S. or be incarcerated September 2012

Medicare Open Enrollment 2012 Prescription Drug Plans and Open Enrollment  If you change your PDP, enroll in a new PDP or join an MA Plan with drug coverage (MAPD) You are automatically disenrolled from old plan  If you drop a Medicare Advantage Plan and join Original Medicare You can enroll in a PDP  If you didn’t get Medicare drug coverage when you were first eligible, and did not have coverage “as good as” Medicare Part D, you may have to pay a penalty when you enroll People with Extra Help don’t pay a penalty September 2012

Medicare Open Enrollment 2012 Need a Rx Before You Get Your Membership Materials  Take as much information to the pharmacy/provider as possible, including Your red, white, and blue Medicare card A photo ID An acknowledgement or confirmation letter, or an enrollment confirmation number from the plan If your enrollment can’t be confirmed, you can pay out-of-pocket and work with the plan to be reimbursed Your Medicaid card or letter showing eligibility for Extra Help September 2012

Reassignment Process  Each Fall, CMS reassigns Low Income Subsidy (LIS) (Extra Help) beneficiaries with 100% premium subsidy to a new Medicare plan if Plan is terminating Plan premium increases  Over regional LIS premium subsidy amount or  Converting to enhanced benefit  Reassignment is random Basic plans only People who chose their current plan won’t be reassigned September 2012 Medicare Open Enrollment 2012

Non-Renewing Medicare Plans  Sometimes plans don’t renew all of their plans Usually based on the plans’ business decisions Or on CMS sanctions or contract terminations  You may join another Medicare Advantage or Medicare Prescription Drug Plan  Plans must notify members affected No later than the beginning of October (90 days before the end of the year) Those affected get Special Enrollment Period  October 15, 2012 – February 28, 2013 Medicare Open Enrollment 2012 September 2012

Beneficiary Notices  Terminating Medicare Prescription Drug Plans  Medicare Advantage Plan Termination  Prescription Drug Plan Premium Increase  “Choosers”  Reassignment Formulary Notice  See Appendix A for complete list Medicare Open Enrollment 2012 September 2012

Medicare Open Enrollment 2012 Prescription Drug Plan Premium Increase  CMS sends letter in late October on BLUE PAPER version 2 Current plan’s premiums increasing over LIS benchmark, or converting to enhanced plan Reassigned to new plan effective January 1, 2013  Unless they join a new plan by December 31, 2012  Action Keep the notice Compare new 2013 plan with others Can choose to change plans September 2012

Medicare Open Enrollment 2012 Medicare Advantage Plan Termination  CMS sends letter in late October/early November BLUE PAPER version 3 Current plan is leaving Medicare Program Health coverage will revert back to Original Medicare If LIS, Reassigned to a PDP plan effective January 1, 2013  Unless they join a new plan by December 31, 2012  Action Keep the notice Compare new 2013 plan with others Can choose to change plans September 2012

Medicare Open Enrollment 2012 Terminating Medicare Prescription Drug Plans  CMS sends letter in late October BLUE PAPER version 1 Current plan is leaving Medicare Program Reassigned to new plan effective January 1, 2013  Unless they join a new plan by December 31, 2012  Action Keep the notice Compare new 2013 plan with others Can choose to change plans September 2012

Medicare Open Enrollment 2012 “Choosers”  People who have Low Income Subsidy (LIS) with 100% premium subsidy Chose current plan AND Have premium liability in 2013 >$0  Does not include Choosers in benchmark plans that remain below benchmark LIS people with partial subsidies (75%, 50%, or 25%)  CMS conducts outreach instead of reassignment Will receive tan letter September 2012

Medicare Open Enrollment 2012 “Choosers” Outreach Notices  In the Spring (April) New this year, but will be sent out from now on Reminder that there are $0 premium plans available Printed on TAN paper  In the Fall (October) Informs of the premium liability Responsible for paying a portion unless they join a new plan Printed on TAN paper  Action May want to look for a new plan Compare current plan with others Can choose to change plans September 2012

Medicare Open Enrollment 2012 Reassignment Formulary Notice  CMS sends letter in December BLUE PAPER version 4 Sent to people affected by reassignment Summarizes which Part D-covered drugs they took in 2012 will or will not be covered by their new Medicare drug plan for 2013  Unless they join a new plan by December 31, 2012  Action Keep the notice Compare new 2013 plan with others Can choose to change plans September 2012

Resources  Landscape of plans  Plan Finder  Medicare & You handbook  State Health Insurance Assistance Program  MEDICARE ( ) September 2012 Medicare Open Enrollment 2012

Resources  Open Enrollment Center on cms.gov at Topic/Open-Enrollment-Center.html Download poster, sticker, conference card  Product ordering website at Drop-in articles Live-read PSAs Publications September 2012

Medicare Open Enrollment 2012 Additional Medicare Publications CMS Product Number Things to Think About When You Compare Medicare Drug Coverage Choose Higher Quality for Better Health Care11226 Have You Done Your Yearly Medicare Plan Review?11220 Understanding Medicare Part C & D Enrollment Periods Withholding Medicare Rx Premium from your Social Security Payment Available on September 2012

Medicare Open Enrollment 2012 Appendix A

Medicare Open Enrollment 2012 Appendix A

Medicare Open Enrollment 2012 Appendix A

Medicare Open Enrollment 2012 Appendix A

Medicare Open Enrollment 2012 Appendix A

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