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Published bySharleen Dean Modified over 9 years ago
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The Health Care Law: What it Means for People with Medicare
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Welcome 2
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Agenda What’s changing What’s not changing When changes take place Q & A 3
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How The Law Improves Medicare Protects guaranteed Medicare benefits Improves Medicare benefits Lowers prescription drug costs Adds more preventive benefits 4
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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
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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
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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 www.aarp.org/doughnuthole 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 1-800-633-4227 www.medicare.gov 9
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Improves Access To Primary Care Doctors Primary care doctors get bonus payments Medicare gives extra payments where shortage of providers 10
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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
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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
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Changes To Medicare Advantage Plans Guaranteed Medicare benefits are protected Choose either a Medicare Advantage plan or Original Medicare 13
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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
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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
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What Lower Subsidies Could Mean May drop extra services May raise premiums and co-payments May leave the Medicare program 16
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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 1-800-633-4227 www.medicare.gov 17
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Part D Income-Related Premiums Income levels for higher premiums start $85,000 -- single person $170,000 -- married couple 18
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Reduces Waste, Fraud & Abuse Cuts inefficient care Identifies fraudulent providers Reduces overpayments to insurance companies Protects personal information Call Medicare at 1-800-633-4227 www.aarp.org/fightfraud 19
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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
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www.HealthLawAnswers.org
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For More Information The Health Care Law HealthLawAnswers.org HealthLawAnswers.org MiLeydeSalud.org MiLeydeSalud.org Medicare www.Medicare.gov1-800-633-4227 www.Medicare.gov SHIP www.SHIPtalk.org1-800-677-1116 www.SHIPtalk.org 22
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23 www.aarp.org/ShareYourThoughts Has the Health Care Law helped you? Share your personal story
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24 Upcoming Web Events www.aarp.org/HealthWebinars
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