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

2. 2 What is SHIBA? Statewide Health Insurance Benefits Advisors  A free program of the Office of the Insurance Commissioner  We provide unbiased and confidential information about Medicare and other health insurance  We are an educational service  We don’t sell anything!

3. Today’s overview 3  Quick overview of Medicare  What is Medicare Open Enrollment?  Stand-alone Part D prescription drug plans  Medicare Advantage (Part C) plans  Do you need help paying for your plan?  How to choose a plan

4. 4 Protect yourself! As you research your options:  Keep a notebook  Write down the names of people you talk to, the date and their contact information  Note what was said in the conversation  Keep copies of any paperwork  Beware of fraud!

5. 5 What is Medicare? Health insurance for people:  Age 65 and older  Under age 65 with certain disabilities  Any age with End-Stage Renal Disease (ESRD)

6. 6 The four parts of Medicare 7/7/15

7.  Today, we’ll talk about plans/programs available to most people on Medicare Medigaps; Medicare Advantage Plans (Part C) and Medicare Drug Plans (Part D)  There may be different considerations or timelines for people with: Employer or retiree coverage Veterans or Indian Health Services Medicaid or other assistance for low-income people  Talk to SHIBA if you have questions 7 People have many options that work with Medicare

8. 8 Decide how you want to get your Medicare coverage

9. What is a Medigap policy?  Also called: Medicare Supplement insurance policies Sold by private companies  Fill the payment gaps in Original Medicare Deductibles, coinsurance, copayments  Your doctors and providers bill Medicare, your Medigap pays after Medicare A or B pays  Standardized plans - all plans with same letter Have same coverage Only the costs are different 9

10.  Don’t cover outpatient Rx (Part D) Most people will want to sign up for a stand-alone Part D plan to go with their Medigap  Don’t have the same Open Enrollment rules  You can buy one anytime a carrier will sell to you Not everyone can get one - may be health screenings - check with SHIBA  Cannot have a Medicare Advantage plan at the same time 10 Medigaps

11. What is Medicare’s Open Enrollment Period to join a drug plan or Medicare Advantage Plan?  Every year from Oct. 15 – Dec. 7  People with Medicare can join, switch or drop a Medicare Part D or Medicare Advantage (Part C) plan  Changes take effect Jan. 1 of the next year Medicare also calls this the “Annual Enrollment Period”- it means the same thing! 11

12. 12 Why do a yearly Open Enrollment checkup?  Plans change!  Coverage changes!  Costs change!  Your needs change!

13. Sometimes plans can stop offering coverage  Usually, if you do nothing during Open Enrollment, you will remain in the same Part D or Medicare Advantage (Part C) plan  BUT if your plan is changing or no longer going to offer coverage, it will notify you  Read your mail from your plan!  Ask questions if you don’t understand your options 13

14.  It’s optional You can choose a plan and enroll  Plans have formularies Lists of covered drugs Must include range of drugs in each category  You pay the plan a monthly premium  You pay deductibles and copayments  There is Extra Help to pay Part D costs If you have limited income and resources 15 How Medicare Part D works

15.  You must have either Part A or Part B or both  You must live in the plan’s service area  You can’t live outside the U.S.  You must actively enroll to join  You can only have one plan at a time To join a new plan or change plans, you must submit an application to enroll 15 Who can join Part D?

16.  Consider: Do you have already have “creditable” drug coverage? o Coverage as good as Medicare’s o Example: Employer plan through you or your spouse Will that coverage end when you retire? How much do your current drugs cost? What if you get sick and need drugs later?  Without creditable coverage Late enrollment may mean you pay a penalty 16 Should I join a Part D plan?

17. 17 What do Part D plans cost?  For coverage in 2016, you will generally pay: Monthly premium* varies by plan Possible deductible, no more than $360* Copayments or coinsurance* If costs paid by both you and your drug plan reach $7,063*, you will only pay a 5% copay for the rest of the year (Catastrophic coverage) *These amounts can change each year.

18.  Join when you are first eligible for Medicare Initial Enrollment Period - usually 7 months surrounding your 65 th birthday  Join, switch or drop: During the Open Enrollment Period Oct. 15 – Dec. 7 - Coverage starts Jan. 1 During Special Enrollment Periods o Examples: Moving, losing/changing other coverage, enrolling in a 5-Star plan, getting Extra Help 18 For BOTH Medicare Advantage & Part D Plans

19. 19 What about the coverage gap (Donut Hole)?  The Affordable Care Act is phasing out the Donut Hole by 2020  In 2016, the Donut Hole will start when the cost for your prescription drugs paid by you and your drug plan reach $3,310  In the Donut Hole in 2016, you’ll pay: 45% of the retail costs for brand name drugs 58% of the retail costs for generic drugs You will get credit for the full retail cost

20. 20 ACA closes the Medicare “Donut hole”

21. 21 What about pharmacies?  Medicare drug plans work with certain pharmacies You generally must use plan pharmacies You may save by using “preferred pharmacies”  Some plans also offer mail mail mail order  Check with the plan - are its pharmacies convenient for you?

22.  Plans are Medicare-contracted plans with all the rights and protections of Original Medicare  Your doctors and providers bill the plan, not Medicare  You still get the services provided under Medicare Parts A and B  Plan may include prescription drug coverage (Part D) If so, all the rules about drug costs, enrollment, etc. are the same as in a stand-alone Part D plan  Plan may include extra benefits –benefits are limited Examples: vision, hearing or dental benefits  Benefits and cost-sharing may be different Make sure to go over these costs before you join! 22 How Medicare Advantage (Part C) works

23. Who can join Medicare Advantage?  You must have Medicare Parts A and B  You must live in the plan’s service area  You must live inside the U.S.  You cannot have End Stage Renal Disease Permanent kidney failure requiring dialysis or a transplant  You must actively enroll to join 23

24.  Consider: Most offer comprehensive coverage o Including Part D drug coverage Do your doctors accept it? o May require you to use network doctors or get referrals o Make sure that your doctors accept the plan! Nearly everyone must pay the Part B premium Some plans may also charge a monthly premium, or may have a $0 premium Can only join/leave plan during certain periods Plan does not work with Medigap policies 24 Should I join a Medicare Advantage plan?

25.  When you are first eligible for Medicare Initial Enrollment Period- usually 7 months surrounding your 65 th birthday  You may join, drop or change plans during the Open Enrollment Period Oct. 15 – Dec. 7 each year  May be able to join/drop/change at other times Special Enrollment Periods  Generally, can only leave the plan at the end of a calendar year  Contact the plan or Medicare to join 25 When can I enroll in an MA plan?

26. Do you need help paying for your plan?  Programs are available for people with lower income and assets  SHIBA can help you apply! OR  For Extra Help for Part D: www.ssa.gov/medicare/prescriptionhelp/ www.ssa.gov/medicare/prescriptionhelp/  For Medicare Savings Program: www.washingtonconnection.org www.washingtonconnection.org 26

27. Get help paying for Part D 27 Individual Monthly Income Limit Married Couple Monthly Income Limit Helps Pay Your Extra Help $1,471$1,991 Part D Premium, Deductibles and Co-pays Extra Help works with Stand-alone plans or Medicare Advantage Plans! Asset Limits: Individual $13,640 Couple $27,250

28. 28 What other help is there? If you qualify for Extra Help:  (MSP) You might also qualify for help to pay Part B premiums and other Medicare costs  This is called the Medicare Savings Program There are several levels of MSP: o QMB o SLMB o QI - 1

29. Who can qualify for MSP? 29 Individual Monthly Income Limit Married Couple Monthly Income Limit Helps Pay Your Medicare Savings Program $1,324$1,792 Part B premiums, and sometimes Part A premiums, Medicare A & B deductibles and co-insurance Asset Limits: Individual $ 7,280 Couple $10,930

30. 30 How do I choose a plan?  Step 1: Collect your information Medicare card, any insurance cards Current coverage, drugs and dosages Extra Help info (income/asset information)  Step 2: See if you qualify for Extra Help  Step 3: Compare plans for upcoming year It’s easy using the Medicare Plan Finder on www.Medicare.gov www.Medicare.gov SHIBA can help with the Plan Finder

31. 31 How do I join a plan? After choosing the plan you are interested in:  Step 1: Call plan with any questions Confirm any rules, coverage and exceptions  Step 2: Enroll in plan www.medicare.gov Call: 1-800-MEDICARE Call plan directly  At any time: Call SHIBA for help at 1-800-562-6900

32. 32 Tips to help when you change to a new plan  Plan ahead at the end of this year- fill all of your Rx before 12/31 Ask your doctor about a 60 or 90 day supply  If your new plan denies your drugs : Ask about a “transitional supply” If you have to pay out of pocket, save receipts and ask your plan to reimburse you Ask your pharmacist, doctor or SHIBA for help

33. Need help with other insurance questions? The Office of the Insurance Commissioner can also help you with questions, information, and complaints about all types of insurance, such as: Call our Insurance Consumer Hotline 1-800-562-6900 33 Homeowner Auto Life Annuities Health And more!