The Health Care Law: What it Means for People with Medicare

Welcome 2

Agenda  What’s changing  What’s not changing  When changes take place  Q & A 3

How The Law Improves Medicare  Protects guaranteed Medicare benefits  Improves Medicare benefits Lowers prescription drug costs Adds more preventive benefits 4

What’s The Doughnut Hole?  Medicare Part D coverage gap Fall into the doughnut hole after total drug costs reach $2,970 Leave the doughnut hole when total out-of-pocket drug costs reach $4,750 5

Medicare Drug Coverage Discount: 52.5% for Brand 21% for Generic Initial BenefitCatastrophic Benefit You pay: Deductible and 25% of drug costs You pay: 5% of drug costs Doughnut Hole

Doughnut Hole Disappears  52.5% discount on brand name drugs  21% discount on generic drugs  By 2020, the doughnut hole will disappear  Part D cost sharing will remain AARP’s Doughnut Hole Calculator 7

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Adds More Preventive Care Benefits  Yearly wellness visit  Screenings for diabetes and cancers  No co-payments or deductibles Call Medicare at

Improves Access To Primary Care Doctors  Primary care doctors get bonus payments  Medicare gives extra payments where shortage of providers 10

Improves Care Coordination  Must have a face-to-face visit from a health practitioner  A physician must certify home health services  Visit must occur within 90 days before you receive home health care or 30 days after you start care 11

Medicare Advantage Plans  Alternative to Original Medicare  Offered by Medicare-approved private insurance companies  Pays for the same basic health care services as Original Medicare  May also pay for additional services 12

Changes To Medicare Advantage Plans  Guaranteed Medicare benefits are protected  Choose either a Medicare Advantage plan or Original Medicare 13

More Emphasis On Quality & Value  Bonuses for providing quality care  Use some of the bonus for extra benefits and rebates  Can’t charge more than Original Medicare for certain services  Must limit how much they spend each year on administrative expenses 14

How Medicare Advantage Plans Are Paid  Subsidies to private insurance companies will be lower  Changes in payments will result in savings to the Medicare program 15

What Lower Subsidies Could Mean  May drop extra services  May raise premiums and co-payments  May leave the Medicare program 16

What Lower Subsidies Could Mean  You will receive a notice of changes, if any  You can stay with your plan, switch your plan, or go to Original Medicare Contact your Medicare Advantage plan or call Medicare at

Part D Income-Related Premiums  Income levels for higher premiums start  $85, single person  $170, married couple 18

Reduces Waste, Fraud & Abuse  Cuts inefficient care  Identifies fraudulent providers  Reduces overpayments to insurance companies  Protects personal information Call Medicare at

Remember!  Helps lower prescription drug costs  Protects guaranteed Medicare benefits  Improves Medicare-covered benefits  Makes some changes to Medicare Advantage plans  Reduces waste, fraud and inefficiencies 20

For More Information  The Health Care Law  HealthLawAnswers.org HealthLawAnswers.org  MiLeydeSalud.org MiLeydeSalud.org  Medicare   SHIP 

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