1. A Social Innovator for Healthcare, Economic Security, and Personal Dignity. Update on Medicare for Youth & Adults with Disabilities Health & Disability Advocates October 20, 2015

2. A Social Innovator for Healthcare, Economic Security, and Personal Dignity. Objectives of this Presentation: Brief review of Medicare Overview of how Medicare works for young adults and people with disabilities Update on how Affordable Care Act impacts Medicare

3. A Social Innovator for Healthcare, Economic Security, and Personal Dignity. What is Medicare? A federal health insurance program Run by the Centers for Medicare and Medicaid Services (CMS) Benefit decisions controlled by the U.S. Congress and President (state has no role) Social Security Administration (SSA) handles enrollment and eligibility

4. A Social Innovator for Healthcare, Economic Security, and Personal Dignity. Medicare has 4 Parts – A, B, C, D Original Medicare Part A – Hospital Insurance Part B – Medical Insurance Provided through private companies that have contracts with Medicare Part C – Medicare Advantage Plans Part D – Prescription Drug Plans Medicare Puzzle Pieces Part A Part B Part D Part C

5. A Social Innovator for Healthcare, Economic Security, and Personal Dignity. Who is Eligible for Medicare? Age and work history People age 65+ – eligible for benefits under Social Security Railroad Retirement, federal, state or local employee – Have 40+ quarters of Social Security covered (FICA) employment (10 years full time) Eligible for Social Security AND premium free Medicare Part A. You pay a monthly premium for Part B. – If married, may receive benefits under a spouse’s work record – Married at least 10 years to receive benefits under a former spouse

6. A Social Innovator for Healthcare, Economic Security, and Personal Dignity. Others Eligible for Medicare Persons with disabilities under age 65 – Receiving disability benefits under Social Security (SSDI) or Railroad Retirements for 24 months or more At any age – including children – Receiving regular kidney dialysis or a kidney transplant – Amyotrophic Lateral Sclerosis (ALS) – Lou Gehrig’s disease (waiting periods apply, go to SSA.gov for details)

7. A Social Innovator for Healthcare, Economic Security, and Personal Dignity. Youth with Disabilities Eligible for Medicare (Disabled Adult Child or DAC) Young adults can receive Social Security Disability Insurance and Medicare if the following: – Onset of disability is prior to age 22; – Parent is receiving Social Security retirement or disability benefits (SSDI); OR – Parent is deceased and worked enough quarters to qualify for Social Security There is still a 24 month waiting period for Medicare after found eligible for SSDI.

8. A Social Innovator for Healthcare, Economic Security, and Personal Dignity. Paths to Coverage During Waiting Period “Regular”/AABD Medicaid or Health Benefits for Workers with Disabilities (if earning wages) Medicaid Between 100- 139% fpl, no asset test or Health Benefits for Workers with Disabilities (if earning wages) ACA Medicaid Up to Age 26 on Parent’s plan Private Health Plan Purchase a plan in the Marketplace ACA Marketplace Plan

9. A Social Innovator for Healthcare, Economic Security, and Personal Dignity. Enrolling in Medicare Initial Enrollment Period – – Age 65: 7 months (3-1-3 rule) 3 months, before, month of, and 3 months after 65 th birthday – SSDI : 25 th month of SSA disability Special Enrollment Period (SEP) – May be able to delay enrollment if you (or a spouse ) are still working and covered under an employer group health plan. Check with your employer. – Must enroll in Part B within 8 months after you stop working or employer coverage ends – whichever happens first General Enrollment Period – if you don’t enroll when you are first eligible or miss SEP – January 1 – March 31 of each year – Coverage begins July 1 st – Penalties may apply (10% for each 12 months missed)

10. A Social Innovator for Healthcare, Economic Security, and Personal Dignity. The ACA and Medicare 10

11. A Social Innovator for Healthcare, Economic Security, and Personal Dignity. ACA Changes to Medicare 11 Medicare Part D donut hole will close by 2020

12. A Social Innovator for Healthcare, Economic Security, and Personal Dignity. ACA Changes to Medicare 12 More plan options for individuals with Extra Help People with higher annual incomes pay higher Part D premiums https://www.medicare.gov/find-a-plan/questions/home.aspx

13. A Social Innovator for Healthcare, Economic Security, and Personal Dignity. ACA Changes to Medicare 13 Annual Medicare Enrollment Period: Oct. 15- Dec. 7 New Medicare Advantage Disenrollment Period: Jan. 1- Feb. 14

14. A Social Innovator for Healthcare, Economic Security, and Personal Dignity. ACA Changes to Medicare 14 No out of pocket costs for most preventative services New Annual Wellness Visit

15. A Social Innovator for Healthcare, Economic Security, and Personal Dignity. ACA Changes to Medicare 15 New demonstration programs to improve quality of care Reduced payments to Medicare Advantage plans

16. A Social Innovator for Healthcare, Economic Security, and Personal Dignity. ACA Changes to Medicare 16

17. A Social Innovator for Healthcare, Economic Security, and Personal Dignity. Transitioning onto Medicare

18. A Social Innovator for Healthcare, Economic Security, and Personal Dignity. Already on AABD Medicaid Need to enroll in Medicare when first eligible (Medicaid is secondary to Medicare) Will be automatically enrolled in Extra Help program If currently enrolled in a managed care plan as part of the Integrated Care Program, you will be automatically enrolled into a managed care plan for “dual eligibles” with the same company as their Integrated Care Program plan

19. A Social Innovator for Healthcare, Economic Security, and Personal Dignity. Currently on ACA Adult Medicaid Need to enroll in Medicare when first eligible (Medicaid is secondary to Medicare) Will likely not be automatically enrolled in Extra Help program or AABD Medicaid – should apply if the person qualifies

20. A Social Innovator for Healthcare, Economic Security, and Personal Dignity. Currently enrolled in a Marketplace plan Need to enroll in Medicare when first eligible – will face penalties otherwise – Individuals who have not paid into Social Security 40 quarters and therefore must buy into Medicare Part A are allowed to remain in Marketplace instead of buying Medicare Enroll in Medicare first, then contact Marketplace plan to drop coverage when Medicare begins (should use 3 months before birthday to enroll in Medicare so that Medicare coverage will begin when first eligible)

21. A Social Innovator for Healthcare, Economic Security, and Personal Dignity. Enrollment: Medicare, Medicare Supplement Etc. 21 Local SSA office www.medicare.gov 1-800-MEDICARE SHIP (Senior Health Insurance Program) 1- 800-548-9034 or SHAP (Senior Health Assistance Programs) listed at http://www.state.il.us/aging/1directory/SH AP.pdf. http://www.state.il.us/aging/1directory/SH AP.pdf

22. A Social Innovator for Healthcare, Economic Security, and Personal Dignity. Questions or Comments