Medicare Open Enrollment MEDICARE

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Objectives

 Following this session you should be able to

• Provide an overview of key dates

• Know how to compare Medicare plans

• Describe how to join a new plan

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2014 Overview

 Medicare Advantage (MA) premiums are

projected to remain stable

•

Average weighted premium will increase by $1.64

•

The average MA premium is projected to be $32.60

•

MA premiums are down 9.8 percent

o

Since passage of Affordable Care Act (ACA)

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2014 Overview

 Part D estimated average basic premium and

estimated total premium will slightly increase

• Average premium projected to be $32.42 in 2014

 People who reach the “donut hole”

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Open Enrollment for People

with Medicare

 From October 15 to December 7 you can

• Join or switch a Medicare Prescription Drug Plan

• Join or switch a Medicare Advantage Plan

 Take time to review health and drug plan

choices

• Choose the plan that fits your needs

 Coverage begins on January 1, 2014

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Key Dates

September 16 CMS began mailing 2014 Medicare & You

handbook

30 Most plans must provide Annual Notice of Change (ANOC)/Evidence of Coverage (EOC) to members*

October 1 Plans may begin marketing

2014 plan data to be displayed on the Medicare Plan Finder (MPF)

8 Plan star ratings updated on MPF

15 Medicare’s Open Enrollment Period begins

December 7 Open Enrollment ends

January 1 CY 2014 plan benefit period begins

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Comparing Plans

 Each year

• Medicare Plans can change costs and coverage

• Plans mail Evidence of Coverage/Annual Notice of

Change



Gives details about plan coverage, costs, etc.

– For the next year

 Some plans may choose to leave Medicare

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Things to Consider

 Coverage

• Are the services or drugs you need covered?

• Do you have or are you eligible for other health and drug coverage?

 Costs

• Premiums, coinsurance, copays, and deductibles • What is the out-of-pocket limit for medical care?  Are your doctors/hospitals part of the plan?

 Are your prescription drugs covered?  What are the plan’s quality ratings?

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Where to Get Plan Information

1. Medicare Plan Finder on

Medicare.gov

2. The plan’s website

3. Medicare & You handbook

4. 1-800-MEDICARE (1-800-633-4227)

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1. Medicare Plan Finder

 More detailed comparison using Medicare Plan Finder

•

Medicare.gov, select “Find Health and Drug Plans”

•

Check the plan’s quality summary rating

 5-Star and low-performing plan icons

•

See which drugs are on the plan’s formulary

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5-Star Special Enrollment Period

 Enroll one time any time during the year in a

• 5-Star Medicare Advantage Plan

• 5-Star Medicare Advantage with Prescription Drug

Plan

• 5-Star Prescription Drug Plan

• Even if already in a 5-Star Plan

 New plan starts first of month after enrolled

 Star ratings on Plan Finder October 8

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Low-Performing Medicare Plans

 Plans that receive a summary rating of less than

3-Stars for at least 3 years in a row

• Ratings are on Medicare Plan Finder

• Medicare & You doesn’t have full, updated ratings

 Low-performing plans

• No online enrollment for low-performing plans

• No enrollment through 1-800-MEDICARE

• Must contact plan directly to enroll

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2. Contact the Plan

 Plan sites have the most comprehensive

information

• Unlike Medicare Plan Finder, you can’t compare

other plans

 Call plan or check their website

• On Medicare Plan Finder

• Contact information in Medicare & You handbook

 Phone number

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3. Medicare & You Handbook

 Has basic plan information

• Mailed each fall to beneficiary households

• Good for quick comparison

• Plan information not comprehensive

 Only one quality rating

 Mailed September 16

 CMS Product No. 10050

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4. 1-800-MEDICARE

 1-800-MEDICARE (1-800-633-4227)

• Say “Medicare Number” if available

• Say “Agent” if it is not

 Available 24 hours a day, 7 days a week

 Support is offered in 150 languages

• Tell customer service representative preferred

language

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5. State Health Insurance

Assistance Programs (SHIPs)

 Program for people with Medicare

• And their families

 Free personalized counseling and assistance

• Funded through Federal grants to states

 Find your local SHIP contact

• Look at the back of your Medicare & You

handbook

• Check the web at Medicare.gov/contacts

• Call 1-800-MEDICARE

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How to Join a New Plan

 May be able to enroll in Medicare Health Plan or

Medicare Prescription Drug Plan by

•

Paper Application

•

Calling the Plan

•

Enrolling on the plan’s website or on Medicare.gov

•

Calling 1-800-MEDICARE (1-800-633-4227)

 TTY users call 1-877-486-2048

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If You Have Other Coverage

IMPORTANT

 If you have other coverage, like from an employer or union

•

Check with your plan’s benefits administrator before making any changes to your coverage

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Your Medicare Choices

1. Original Medicare

• May add Medigap (Medicare supplement insurance)

• May add Medicare prescription drug coverage

2. Medicare Advantage Plans

• With or without Medicare Prescription Drug Coverage

3. Other Medicare Health Plans

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Medigap and Open Enrollment

 If you drop a Medicare Advantage (MA) Plan and join

Original Medicare during the Open Enrollment Period

• There is no guarantee that an insurance company

will sell you a Medigap policy

• You may have to meet medical underwriting

requirements

 Unless you have a guaranteed issue right

 Example: If your MA Plan leaves Medicare

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Medigap and Open Enrollment



You have a special right to buy a Medigap policy called a

guaranteed issue right

• If your Medicare Advantage Plan doesn’t renew

• If you join Original Medicare when this happens

• If you are 65 or older

• Lasts 60 days before to 63 days after your coverage ends

• If you’re under 65, you may not be able to buy a

Medigap policy until you turn 65.



Check with your State Health Insurance Assistance

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Medicare Advantage Plans and

Open Enrollment

 If you are in a Medicare Advantage (MA) Plan

• You can switch to another MA Plan by joining a new

MA plan

• You will be automatically disenrolled from your old plan

• You can switch back to Original Medicare by joining a

stand-alone Medicare drug plan



If you do you should consider/see if you can get a

Medigap policy

REMEMBER: If you have other health or drug coverage, like from an employer or union, check with your benefits

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Leaving a Medicare Advantage Plan

 Between January 1–February 14

• You can leave an MA plan and switch to Original

Medicare

• If you make this change, you may also join a

Medicare Prescription Drug Plan to add drug

coverage

• Coverage begins the first of the month after the

plan gets enrollment form

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Medicare Open Enrollment 2013 October 2013

Need a Rx Before Getting Your

Membership Materials

 Take as much information to the

pharmacy/provider as possible, including

• Red, white, and blue Medicare card

• A photo ID

• An acknowledgement or confirmation letter, or an

enrollment confirmation number from the plan

• If enrollment can’t be confirmed, can pay

out-of-pocket and work with the plan to be reimbursed

• Medicaid card or letter showing eligibility for

Extra Help

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Reassignment Process

 Each Fall, CMS reassigns Low Income Subsidy (LIS)

(Extra Help) beneficiaries with 100% premium

subsidy to a new Medicare plan if

•

Plan is terminating

•

Plan premium increases

 Over regional LIS premium subsidy amount or  Converting to enhanced benefit

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Non-Renewing Medicare Plans

 Sometimes plans don’t renew all of their plans

•

Usually based on the plans’ business decisions

•

Or on CMS sanctions or contract terminations

 You may join another Medicare Advantage or Medicare

Prescription Drug Plan

 Plans must notify members affected

•

No later than the beginning of October (90 days before the end of the year)

•

Those affected get Special Enrollment Period

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Beneficiary Notices

 Terminating Medicare Prescription Drug Plans

 Medicare Advantage Plan Termination

 Prescription Drug Plan Premium Increase

 “Choosers”

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Prescription Drug Plan Premium Increase

 CMS sends letter in late October on

•

BLUE PAPER version 2

•

Current plan’s premiums increasing over LIS benchmark, or converting to enhanced plan

•

Reassigned to new plan effective January 1, 2014

 Unless they join a new plan by December 31, 2013

 Action

•

Keep the notice

•

Compare new 2014 plan with others

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Medicare Advantage Plan Termination

 CMS sends letter in late October/early November

•

Current plan is leaving Medicare Program

•

Health coverage will revert back to Original Medicare

•

If LIS, reassigned to a PDP plan effective January 1, 2014

 Action

•

Keep the notice

•

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Terminating Medicare Prescription Drug Plans

 CMS sends letter in late October

•

Current plan is leaving Medicare Program

•

Reassigned to new plan effective January 1, 2014

 Action

•

Keep the notice

•

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“Choosers”

 People who have Low Income Subsidy (LIS) with

100% premium subsidy

•

Chose current plan

AND

•

Have premium liability in 2014 >$0

 Does not include

•

Choosers in benchmark plans that remain below benchmark

•

LIS people with partial subsidies (75%, 50%, or 25%)

 CMS conducts outreach instead of reassignment

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“Choosers” Outreach Notices

 In the Spring (April)

•

New this year, but will be sent out from now on

•

Reminder that there are $0 premium plans available

•

Printed on TAN paper

 In the Fall (October)

•

Informs of the premium liability

•

Responsible for paying a portion unless they join a new plan

•

Printed on TAN paper

 Action

•

May want to look for a new plan

•

Compare current plan with others

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Reassignment Formulary Notice

 CMS sends letter in December

•

Sent to people affected by reassignment

•

Summarizes which Part D-covered drugs they took in 2013 will or will not be covered by their new Medicare drug plan for 2014

 Action

•

Keep the notice

•

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Medicare and the

Health Insurance Marketplace

 Messages in the media are increasing about

the new Health Insurance Marketplace

 People with Medicare may become confused

and think they need to enroll in a Marketplace

plan

 People with Medicare are covered and the

Marketplace will not require them to do

anything different with their Medicare

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Medicare and Marketplace Key Messages

 Your Medicare benefits aren’t changing

 Marketplace does not affect your Medicare

coverage

 Medicare is not part of the Marketplace

 Medicare Open Enrollment is the time to

review your health/drug plans

 Protect your personal information

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Resources

 Landscape of plans

CMS.HHS.gov/PrescriptionDrugCovGenIn/

 Plan Finder

Medicare.gov/find-a-plan/questions/home.aspx

 Medicare & You handbook

Medicare.gov/Publications/Pubs/pdf/10050.pdf

 State Health Insurance Assistance Program

Medicare.gov/contacts

 1-800-MEDICARE (1-800-633-4227)

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Resources (Continued)

 Open Enrollment Center on cms.gov at

CMS.gov/Center/Special-Topic/Open-Enrollment-Center.html

• Download poster, drop-in articles, publications

• View public service announcement scripts

 Product ordering website at

Productordering.cms.hhs.gov/

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Additional Medicare Publications

CMS Product Number

Things to Think About When You Compare Medicare Drug Coverage

11163

Choose Higher Quality for Better Health Care 11226

Have You Done Your Yearly Medicare Plan Review? 11220

Understanding Medicare Enrollment Periods 11219

Withholding Medicare Rx Premium from your Social Security Payment

11400

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Appendix A

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Appendix A

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INFORMATION PARTNERS SHOULD KNOW

People with Medicare and the Health Insurance Marketplace

Frequently Asked Questions

How will the Health Insurance Marketplace that starts in 2014 affect my Medicare coverage?

The Health Insurance Marketplace is designed to help people who don’t have any health insurance. You have health insurance through Medicare. The Marketplace won’t have any effect on your Medicare coverage.

Your Medicare benefits aren’t changing. No matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan, you’ll still have the same benefits and security you have now, and you won’t have to make any changes.

The Marketplace provides new health insurance options for many Americans. If you have family and friends who don’t have health insurance, tell them to visit www.HealthCare.gov to learn more about their options.

How will the Health Insurance Marketplace that starts in 2014 affect my Medicare coverage?

The Health Insurance Marketplace is designed to help people who don’t have any health insurance. You have health insurance through Medicare. The Marketplace won’t have any effect on your Medicare coverage.

Your Medicare benefits aren’t changing. No matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan, you’ll still have the same benefits and security you have now, and you won’t have to make any changes.

The Marketplace provides new health insurance options for many Americans. If you have family and

friends who don’t have health insurance, tell them to visit www.HealthCare.gov to learn more about

their options.

People with Medicare and the Health Insurance Marketplace

Frequently Asked Questions

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Appendix B

Do I need to do anything with Marketplace plans during Medicare Open Enrollment (October 15 – December 7, 2013)?

Medicare’s Open Enrollment isn’t part of the new Health Insurance Marketplace. It’s against the law for someone who knows that you have Medicare to sell you a Marketplace plan.

Medicare Open Enrollment (October 15 – December 7, 2013) is the time when all people with Medicare are encouraged to review their current health and prescription drug coverage, including any changes in costs, coverage and benefits that will take effect next year. If you want to change your coverage for next year, this is the time to do it. If you’re satisfied that your current coverage will continue to meet your needs for next year, you don’t need to do anything. For more information on Medicare Open

Enrollment, visit www.medicare.gov or call 1-800-MEDICARE.

Note: The Health Insurance Marketplace Open Enrollment period (October 1, 2013 to March 31, 2014)

overlaps with the Medicare Open Enrollment period (October 15 – December 7, 2013). Therefore,

people with Medicare who are looking to make Medicare coverage changes should make sure that they

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Appendix B

What should I do if I’m contacted about signing up for a health plan?

The Medicare open enrollment period is a time when there’s a higher risk for fraudulent activities. It’s against the law for someone who knows that you have Medicare to sell you a Marketplace plan. DO NOT share your Medicare number or other personal information with anyone who knocks on your door or contacts you uninvited to sell you a health plan.

Senior Medicare Patrol programs are teaching people with Medicare how to detect and report fraud, and protect themselves from fraudulent activity and identity theft.

To learn more about health care fraud and ways to protect against it, visit

www.stopmedicarefraud.gov or the Senior Medicare Patrol (SMP) program in your area (locate your SMP at www.smpresource.org).

This information is provided by the United States Department of Health and Human Services.