1. Eighteen Things to Know About Medicare for 2018 Updated May 2018

2. 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

3. 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

4. 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

5. 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
New Threshold $500,000/$750,000

6. Enrollment

7. 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)

8. 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

9. 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

10. Medicaid/MSP

11. 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

12. 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

13. 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

14. Original Medicare

15. 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

16. 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

17. 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

18. Medigap

19. 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

20. Medigap Changes
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

21. Part D

22. 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)

23. 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

24. 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

25. 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

26. 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