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

2 Welcome

 What’s changing  What’s not changing  When will changes take place  Questions and answers 3 Agenda

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

What is the Doughnut Hole?  Medicare Part D coverage gap You fall into the doughnut hole after your total drug costs reach $2,970 You leave the doughnut hole when your 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 Will Gradually Disappear  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

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

Improves Access to Primary Care Doctors  Primary care doctors who treat people with Medicare get bonus payments  Medicare gives extra payments in areas of the country with a shortage of providers 10

Improves Care Coordination of Medicare Home Health Services  Must have a face-to-face visit from certain health practitioners  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

What are 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, but may also pay for additional services 12

How the Law Changes Medicare Advantage Plans  Guaranteed Medicare benefits are protected  You can choose either a Medicare Advantage plan or Original Medicare 13

Medicare Advantage Plans  More emphasis on quality and value: Plans will get bonuses for providing quality care Plans must use some of the bonus for extra benefits and rebates to people with Medicare Advantage Plans can’t charge more than Original Medicare for certain services Plans must limit how much they spend each year on administrative expenses  14

Medicare Advantage Plans  How Medicare Advantage plans are paid Subsidies that Medicare currently pays to private insurance companies will be lower to bring payments more in line with Original Medicare Changes in Medicare Advantage payments will result in savings to the Medicare program 15

Medicare Advantage Plans  What lower subsidies could mean  Some plans may drop extra services  Some plans may raise premiums and co-payments  Others may decide to leave the Medicare program 16

Medicare Advantage Plans  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

Other Changes to Medicare  Part D Income-related premiums Income levels for higher premiums start at  $85,000 for a single person  $170,000 for married couples filing joint tax returns 18

Other Changes to Medicare  Reduces waste, fraud and abuse Cuts inefficient care Identifies fraudulent providers Reduces overpayments to insurance companies Protects personal information Call Medicare at

Key Points to Remember About the Health Care Law  Helps lower your 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 on the Health Care Law 21

For More Information on Medicare Medicare

24 Has the Health Care Law helped you? Share your personal story

25 Has the Health Care Law helped you? Share your personal story

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