Dual Eligibles and Medicare: Ongoing Issues California Medicare Coalition Webcast – April 9, 2008 Presented by David Lipschutz California Health Advocates.

Slides:

Advertisements

Similar presentations

Optima Medicare (PPO) Plans CY Medicare Medicare is a Federal health insurance program for those age 65 or older or individuals at any age who have.

Advertisements

Medicare and New and Existing Opportunities for Financial Assistance National Association of Health Underwriters June 2009.

Illinois Cares Rx What Happens Behind the Scenes.

Medicare Part D John A. Geib 10/3/05. Medicare Modernization Act (MMA) 2003 and How the MMA impacts California’s Medi-Cal Program Largest change in healthcare.

Adam J. Falk, Esq. FELDESMAN TUCKER LEIFER FIDELL LLP Legal issues for Medicaid Plans Under Part D in Serving Dual Eligibles MEDICAID HEALTH PLANS OF AMERICA.

New York State EPIC Program January 2012 Changes.

California Medicare Coalition Medicare and Part D: Who Regulates What? Federal and State Responsibilities The California Medicare Coalition is supported.

Medicare Part D Nari Wang Health Law Unit 199 Water Street New York, NY Center for Independence of the Disabled, NY February 23, 2010.

Medicare Part D: 2007 Presented by MMA Project Team Oregon Dept. of Human Services.

Medicare Part D and HIV/AIDS: What a Clinician May Want to Know Laura Cheever, M.D., ScM Deputy Director, Chief Medical Officer HIV/AIDS Bureau Health.

1 HOBBS STRAUS DEAN & WALKER, LLP WASHINGTON, DC | PORTLAND, OR | OKLAHOMA CITY, OK | SACRAMENTO, CA To Insure or Not to Insure Opportunities for Tribes.

Welcome We’re glad you’re here!. Medicare Basics.

AREA AGENCY ON AGING AND DISABILITY STATE HEALTH INSURANCE ASSISTANCE PROGRAM (SHIP) 2012 Medicare 101.

“Serving the senior market since 1982”. Source: CMS National Training Program Medicare 101 Introduction to Medicare Original Medicare Plan Medicare Supplement.

© 2005 National Mental Health Association The Medicare Drug Benefit: What Is It and What Does it Mean for Mental Health? Get Educated, Get Enrolled An.

Enrollment Guidance for Medicare Part D Plans Presented by America’s Health Insurance Plans (AHIP) and The National Association of Health Underwriters.

Medicare Open Enrollment

Medicare and the New Prescription Drug Benefit Presented by Tricia Neuman, Sc.D. Vice President and Director, Medicare Policy Project The Henry J. Kaiser.

Medicare Prescription Drug Coverage Extra Help with Medicare Prescription Drug Costs for Those Who Need it Most.

Medicare Prescription Drug Coverage. What’s Different About Prescription Drug Information? One size does not fit all, more than ever before Distinct messages.

California Health Advocates (c) The Impact of Health Reform on Medicare California Medicare Coalition (CMC) Conference Call May 5, 2010 Presented.

Medicare Modernization Act, Part D Prescription Drug Benefit Presentation for County Program Administrators September 1, 2005.

Medicare Open Enrollment MEDICARE

MEDICARE ADVANTAGE SPECIAL NEEDS PLAN AN OVERVIEW.

Medicare Improvement for Patients and Providers Act of 2008 Preliminary Summary of Beneficiary and Plan Provisions July 14 th,

California Department of Health Services California Dual Eligibles’ Transition to Medicare Part D Presentation to National Medicaid Congress by Teresa.

7/7/15 1 Sponsored by the: SHIBA Statewide Health Insurance Benefits Advisors Medicare Open Enrollment Period Do your yearly checkup!

Joint Informational Hearing The Federal Medicare Prescription Drug Act: State Readiness, Implementation, and Consumer Issues Bonnie Burns, Training and.

The Marketing of Medicare Advantage and Part D Plans Presented by David Lipschutz and Bonnie Burns Winter/Spring 2007 This California Medicare Coalition.

© 2005 National Mental Health Association The Medicare Drug Benefit: What Is It and What Does it Mean for Mental Health?

Medicare in Minnesota 2012 Your Medicare: Making the Best Possible Decisions October 2011 Presented by Stephanie Minor Senior LinkAge Line® Program Consultant.

1 Medicare Prescription Drug Improvement and Modernization Act & Beneficiaries With Mental Illnesses Presentation to NAMI Convention June 19, 2005 Andrew.

Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Roy Trudel, CMSO National Eligibility Workers Association 07/12/05.

What’s in the Mail? Overview of Medicare Prescription Drug Coverage Beneficiary Communications Employer Forum Conference Call October 13, 2005.

MEDICARE PART D Are We Ready? Are We Ready?. Medicare Part D Overview Medicare Part A and B covers individuals Age 65 and older Age 65 and older Those.

California Health Advocates (c) Update on Medicare: MIPPA 2008 and Situ v. Leavitt Presented August 2008 by David Lipschutz & Elaine Wong Eakin.

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Presented by Tricia Neuman, Sc.D. Vice President and Director, Medicare Policy.

Medicare 101 Module 1B. Medicare 101 9/18/20152 Medicare 101 Introduction to Medicare Original Medicare Medicare Supplement Insurance (Medigap) Medicare.

Slide -1 Medicare Prescription Drug Benefit Denise S. Stanley, Pharm.D. Atlanta Regional Office Centers for Medicare & Medicaid Services March 17, 2006.

January National Medicare & You Training Program Amy Larrick, CMS NAACP April 27, 2006.

Medicare and Patient Assistance Sean M. Dougherty Senior Director Medicare Strategy & Patient Assistance Programs Government, Public Policy And Managed.

STATE PERSPECTIVES ON IMPLEMENTATION OF MEDICARE PART D: COORDINATING MEDICARE AND MEDICAID COVERAGE THROUGH SPECIAL NEEDS PLANS James M. Verdier Mathematica.

California Health Advocates (c) Update on Medicare Law: Review of Current and Pending Legislation and Rules Presented June 2008 by David Lipschutz.

Medicare Part D Symposium Thursday, September 1, 2005 Sacramento, CA Cathy Senderling Senior Legislative Advocate, CWDA.

The New Medicare Prescription Drug Benefit: An Overview Prepared by: Michelle Kitchman, M.H.S. Kaiser Family Foundation For the: California Senate Health.

11/8/051 Medicare Prescription Drug Benefits Employee Workshop November 2005.

Helping People Eligible for Extra Help What You Need to Know about LIS National Medicare Training Program Audio-conference Training September 26, 2007.

0 Beneficiary Choices in Medicare Part D and Plan Features in 2006 Supported by PhRMA September 13, 2006.

40,000 volunteers staffed more than 50,000 enrollment events across the country 90 percent of people with Medicare have drug coverage More than 80 percent.

Slide -1 Medicare Prescription Drug Coverage Atlanta Regional Office Centers for Medicare & Medicaid Services September 12, 2005.

Avalere Health LLC | The intersection of business strategy and public policy The Medicare Modernization Act: The Impact on States and Low-Income Beneficiaries.

Implications of the 2003 Medicare law for older adults and people with disabilities Translating “Legislative Sausage” into Understandable Choices Diane.

A Social Innovator for Healthcare, Economic Security, and Personal Dignity. Update on Medicare for Youth & Adults with Disabilities Health & Disability.

Medicare Prescription Drug Congress MMA and Medicaid Gale Arden Director, Disabled & Elderly Health Programs Group CMSO CMS October 2005.

National Conference of State Legislatures National Medicaid Congress June 5, 2006 State Pharmaceutical Assistance Programs, Medicaid & Part D: 2006 State.

Special Needs Plans Sandra Bastinelli, MS, RN Acting Director, Division of Special Programs Medicare Advantage Group Center for Beneficiary Choices.

1. 2 Y e s 3 Y e s The initial enrollment period for people with Medicare and some Medicaid is the same as for other enrollees. If these individuals.

NSCLC copyright LAAC Armchair Training Medicare Part D and Low Income Seniors and Individuals with Disabilities Basic Review & Current Hot Topics.

Medicare Open Enrollment For Coverage in 2016 Starts October 15, 2015 Ends December 7, MEDICARE Medicare.gov.

1 Providing Effective Community- Based LTC in a Managed Care Environment Mary Guthrie, MBA.

Overview of the Medicare Drug Benefit Presented by Tricia Neuman, Sc.D. Vice President and Director, Medicare Policy Project The Henry J. Kaiser Family.

Medicare Prescription Drug Coverage Tim Cutler, PharmD Marilyn Stebbins, PharmD Clinical Pharmacists Mercy Medical Group - a service of CHW Medical Foundation.

1 Medicare Prescription Drug Coverage AKA Medicare Part D Or Medicare Modernization Act MMA.

Medicare and Medicaid Week 3.

2018 Medicare Prescription Drug Benefit

“Determining Eligibility And Enrollment for Low-Income Beneficiaries”

HIV Program Policy Updates

State Implementation of MMA

2019 Medicare Prescription Drug Benefit

Understanding Your Medicare Plan Options

Presentation transcript:

Dual Eligibles and Medicare: Ongoing Issues California Medicare Coalition Webcast – April 9, 2008 Presented by David Lipschutz California Health Advocates This webcast is supported by The California Endowment

California Health Advocates (c) Our Focus California Health Advocates is dedicated to Medicare beneficiary advocacy and education for Californians. Policy – Public policy research and recommendations for improved rights and protections, partner with national Medicare organizations based in Washington D.C. Training – Professionals and informal helpers, vibrant web resources, newsletter and regional forums Advocacy – Bring the experience of Medicare beneficiaries to the public through media and educational campaigns with the legislative staff at federal and state levels.

California Health Advocates (c) Acknowledgments National Senior Citizens Law Center Center for Health Care Rights Health Assistance Partnership Also see: Center for Medicare Advocacy – Medicare Rights Center –

California Health Advocates (c) Outline Overview – Dual Eligibles and Medicare Part D Enrollment Issues Auto-Assignment and Benchmark Plans Reassignment Point of Sale (POS) Process Medicare Advantage & Dual Eligibles Marketing Misconduct Low Income Subsidy (LIS) Eligibility Best Available Evidence (BAE) Other Issues

California Health Advocates (c) Overview Part D benefit only available through private, commercial plans Stand-alone prescription drug plans (PDPs) Medicare Advantage-Prescription Drug Plans (MA-PDs) Individuals dually eligible for Medicare and Medi- Cal (Medicaid) must be enrolled in a Medicare Part D drug plan in order to obtain drug coverage Medi-Cal still covers many drugs excluded under Part D

California Health Advocates (c) Overview (cont’d) Medicare Modernization Act (MMA) created a Part D Low-Income Subsidy (“LIS” or “Extra Help”) available for qualifying individuals Helps pay for some Part D costs Some people automatically eligible for LIS Full Dual Eligibles, Medicare Savings Program Others must actively apply (through SSA)

California Health Advocates (c) Auto-Assignment LIS enrollees auto-assigned to a Part D plan unless they are already enrolled in one Auto-enrollment is random assignment into a standard plan with fully subsidized premium (“benchmark plan”) Problems with delays …

California Health Advocates (c) Benchmark Plans PDP qualifies as a benchmark plan only if it offers basic coverage w/ premiums at or below the regional benchmark level Full subsidy LIS enrollees can enroll in benchmark plans without paying any premium 2008 benchmark in CA = $19.80 (down from $21.03) 9 benchmark plans in CA – same # as 2007, but some different actors

California Health Advocates (c) Plan Reassignment ½ of the benchmark and other plans for which LIS enrollees paid no premium in 2007 (“de minimis” plans) are not benchmark or de minimis plans in 2008 De minimis plans – charge above benchmark but are still premium-free for LIS enrollees Many benchmark plans raised premiums so they are no longer benchmark plans in 2008 In CA, including UnitedHealth (AARP), Humana Std., - 2 biggest plans Approximately 500,000 duals in CA were reassigned

California Health Advocates (c) Plan Reassignment (cont’d) Some LIS enrollees reassigned, others not CMS reassigned people who remained in PDP into which CMS auto-assigned them If plan sponsor offers another benchmark plan for 2008, individual was reassigned to that plan Everyone else – random assignment Group that was NOT reassigned – “choosers” LIS enrollees who chose their own Part D plan instead of being auto-assigned Approx 97,000 in CA at end of 2007 Should have received a letter explaining that they have to pay portion of premiums unless they switched to a benchmark plan

California Health Advocates (c) Data Issues Several data systems must share Medicare and Medi-Cal information in order for a dual eligible to be effectively enrolled into a Part D plan and show LIS eligibility See NSCLC webcast “Behind the Scenes of Medicare Part D: Data Transfers and the Point of Sale Mechanism” System delays often result in gaps between eligibility for LIS and enrollment in Part D plans leading individuals to pay out of pocket (if they are able)

California Health Advocates (c) Point of Sale (POS) CMS Point of Sale (POS) Facilitated Enrollment Process (a.k.a. Wellpoint) for dual eligible beneficiaries who should have been automatically enrolled, but do not appear in a plan’s records Provides drug fill and assigns to a plan Pharmacist can choose whether or not to use POS process

California Health Advocates (c) Dual Eligibles & Medicare Advantage Plans Dual Eligibles can enroll in Medicare Advantage (MA) plans if they wish How much value does a Dual Eligible get by enrolling in a particular MA plan? Specific care coordination? Access to more (or fewer) providers? Easier – or more difficult – access to Medi-Cal benefits? Any benefits not already entitled to? If so, how much more, and is it worth it? More out-of-pocket expenses?

California Health Advocates (c) Duals and SNPs Special Needs Plans (SNPs) are Medicare Advantage plans designed to serve 1 of 3 types of “special needs individuals”: Dual Eligibles Institutionalized Individuals with severe or disabling chronic conditions SNPs can disproportionately enroll or limit enrollment to the designated population or even a subpopulation Many Dual Eligibles were “passively enrolled” Moratorium on SNPs – legislation passed at end of 2007 extends existing SNPs through December 2009, but freeze on any new SNPs in areas where not offered as of 1/1/08

California Health Advocates (c) Marketing Misconduct Ongoing egregious conduct by agents, driven partly by plan compensation CMS implemented some new marketing rules, but abuse is ongoing Duals and other LIS enrollees attractive targets because they can enroll year-round In addition to Dual Eligible SNPs, some other MA plans specifically target Dual Eligibles E.g., certain Private-Fee-for-Service (PFFS plans)

California Health Advocates (c) Marketing Misconduct (cont’d) Undoing the damage of marketing misconduct Prospective Disenrollment Duals have an ongoing Special Enrollment Period (SEP) right to change plans monthly Retroactive Disenrollment See, e.g., Health Assistance Partnership materials at

California Health Advocates (c) LIS Eligibility Individuals who are eligible for LIS must go through an annual process to determine continuing eligibility Redeeming by CMS LIS enrollees who appear in info sent by state to CMS between July and December will be re- deemed for following year (including SOC) In CA, 47,000+ not re-deemed for 2008 Redetermination by SSA Most LIS folks passively redetermined as eligible in 2008 without receiving any notice from SSA Active redetermination – certain people selected for review (e.g. subsidy changing events)

California Health Advocates (c) LIS – Best Available Evidence (BAE) CMS “Best Available Evidence” policy – process through which Dual Eligibles and other LIS enrollees can show evidence of their LIS subsidy status E.g. copy of Medi-Cal card, copy of state document (including print out of electronic system) that confirms active Medicaid status (see 6/27/07 CMS Memo) Ongoing problems using this system E.g. plan customer service reps unaware of and/or unwilling to use process

California Health Advocates (c) Recent Rules … Ongoing Special Enrollment Period (SEP) CMS created an ongoing SEP right for all LIS enrollees (only used to apply to Dual Eligibles and Medicare Savings Program) Waiver of Late Enrollment Penalty Individuals who qualify for LIS and enroll in a Part D plan by end of 2008 will be exempt from Part D late enrollment penalty CMS has extended policy from 2006 and 2007

California Health Advocates (c) Other Issues… State budget crisis and Medi-Cal cuts E.g. provider reimbursement cuts – 10% Proposal to have state stop paying Part B premiums for Duals with a SOC Ongoing MEDICARE problems Language Access At MC, say “I speak ____” See materials by NSCLC, NHeLP, others

California Health Advocates (c) Questions…? California Health Advocates ■ Sacramento Office – (916) Elvas Avenue, Suite 104, Sacramento, CA ■ Los Angeles Office – (213) Wilshire Blvd., Suite 2860, Los Angeles, CA Health Insurance Counseling & Advocacy Program (HICAP) 1 (800)