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Medicare Annual Enrollment Important Medicare Updates for 2015. SHINE Overview. SHINE stands for S erving the H ealth I nsurance N eeds of E veryone Provides free and unbiased insurance information and counseling to Medicare beneficiaries - PowerPoint PPT Presentation
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Medicare Annual Enrollment
Important Medicare Updates for 2015
SHINE Overview SHINE stands for Serving the Health Insurance Needs of
Everyone Provides free and unbiased insurance information and
counseling to Medicare beneficiaries Over 600 SHINE counselors available throughout
Massachusetts to help SHINE Counselors are available at many Senior Centers,
Councils on Aging (COA), Community hospitals and many other community-based sites
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2014–2015 Important Dates October 15th 2014: Open Enrollment begins
• Medicare beneficiaries can change health and prescription coverage
December 7th 2014: Open Enrollment ends• Enrollment requests must be received by the 7th
January 1st 2015: Coverage begins
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Your Medicare Coverage Choices
Step 1: Decide how you want to get your coverage
PART AHospital
Insurance
PART BMedical
Insurance
PART CCombines Part A, Part B
and usually Part D
ORIGINAL MEDICARE MEDICARE ADVANTAGE PLAN
OR
PART D Stand Alone PDP
PART DIncluded in Part C
Step 3: Decide if you need to add supplemental medical coverage
MEDIGAPSupplement Core or Supplement 1 plan
ENDIf you join a Medicare Advantage
Plan with drug coverage (MAPD), you cannot join another drug plan and
you don’t need and cannot be sold a Medigap policy
Step 2: Decide if you need a Prescription Drug Plan
&
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Part B Preventive Benefits ACA provides access to many free preventive benefits
• Mammograms• Some pap smear and pelvic exams• Colorectal Screenings• Diabetes Self-Management Training/Tests• Bone Mass Measurements• Prostate Cancer Screening• Obesity screening/counseling• Depression screening/counseling• Annual Wellness Visit
Update individual’s medical & family history Record height, weight, body mass index, blood pressure and other routine measurements Provide personal health advice and coordinate appropriate referrals and health education
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Open Enrollment Options If in a Medicare Advantage (MA) plan:
• Can change to a different MA plan• Can change to Original Medicare and enroll in a Part D (along with a
Medigap, if desired)Members of MA plans must have Medicare Parts A & B and must
continue to pay the Part B premium If in Original Medicare:
• Can enroll in an MA plan If in a Part D plan:
• Can drop or switch Part D plans
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Medicare Supplement Plans 2015
Supplement Plans (Medigaps)• Sold by private insurance companies• Coverage varies for deductibles and co-insurance• No network restrictions• Drug coverage is NOT included
2015 updates• Continuous open enrollment• If changing plans, cancel enrollment in old plan
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Medicare Advantage Plans 2015
MA plans (HMO’s, PPO’s)• Coverage provided through private plans within
networks• Prescription drug coverage usually included
2015 Updates• Plan changes will be announced to members on
September 30th
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Medicare Supplement vs.Medicare Advantage
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Medicare Prescription Drug Coverage
Also called Part D Provides outpatient prescription drugs All Medicare beneficiaries are eligible
• Can have Part A and/or Part B Coverage for Part D is provided by:
• Prescription Drug plans (PDP’s), also known as stand alone plans
• Medicare Advantage Prescription Drug Plans (MAPD’s)
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Anatomy of a Drug Plan Cost components
• Premiums: Monthly cost• Deductibles: Annual cost• Co-pays and co-insurance: Paid at pharmacy• Formularies: List of medications covered• Drug tiers: Pricing ladder• Restrictions: Quantity limits, prior authorization, or step
therapy Amounts change periodically, therefore it is important to review
coverage during Open Enrollment
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Part D Coverage2014 vs. 2015
Standard Coverage Levels 2014 2015
Deductible $310 $320
Initial Coverage Limit $2,850 $2,960
“Out-of-pocket” Threshold $4,550* $4,700*
Catastrophic Cost-sharing 5% or$2.55/$6.35
5% or$2.65/$6.60
* In 2015, after $2,960 in retail costs, the beneficiary pays 45% of brand name drug costs and 65% of generic drug costs until total out-of-pocket costs equal $4,700
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Part D Changes for 2015 Plan changes announced September 30th
Important to compare plans every year
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Assistance Programs May Help There are several assistance programs to help pay
Medicare cost-sharing including:• Extra Help (Low Income Subsidy/LIS)• Prescription Advantage• Patient Access Programs• See handout “Concerned about Medicare Costs?”
These programs are based on income and/or assets A SHINE Counselor can help you determine which
programs you may qualify for and assist you in applying
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Resources
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SHINE: 1-800-AGE-INFO (1-800-243-4636), press 3
Medicare: 1-800-MEDICARE (1-800-633-4227)
MCPHS Pharmacy Outreach Program: 1-800-633-1617
Prescription Advantage: 1-800-AGE-INFO, press 2
Medicare Advocacy Project (MAP): 1-866-778-0939
Senior Medicare Patrol: 1-800-892-0890
Remember! This is the time of year to make changes to your
Medicare Advantage or Prescription Drug Plan
Ask yourself: Will my plan cover the drugs I take? How much will my plan cost? Will my doctor/hospital take my Medicare Advantage
Plan?
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