Medicare Open Enrollment Period (OEP) 2020: Overview, Costs, and Updates

1. The Medicare Open Enrollment Period (OEP) Getting Ready for 2020

2. Contents Lesson 1—Original Medicare & Part D Overview and Costs…… Lesson 2—Medicare Open Enrollment Period (OEP) Overview……………………………………………………………… Lesson 3—2020 Updates………………………………………………………. Lesson 4—Medicare Communications & Marketing Guidelines (MCMG) Updates………………................... Lesson 5—Notices to People with Medicare………..……………….. Resources………..……………………………………………………………………. Appendix A—Comparison Chart of Original Medicare and Medicare Advantage..………………………………………. Appendix B—Guide to Consumer Mailings……………………………. Appendix C—Enrollment Periods…………………………………………… 3–12 13–28 29–53 53–54 55–65 66–70 71–75 76–80 81–82 Getting Ready for OEP

3. Lesson 1—Original Medicare & Part D Overview and Costs • Part A (Hospital Insurance) • Part B (Medical Insurance) • Medicare Prescription Drug Coverage (Part D) Getting Ready for OEP

4. Paying for Medicare Part A • Most people don’t pay a premium for Part A • If you paid Federal Insurance Contributions Act (FICA) taxes for at least 10 years • If you paid FICA taxes less than 10 years, you can pay a monthly premium to get Part A • May have a penalty if you don’t enroll when first eligible for Part A (if you have to buy it) • Your monthly premium may go up 10% • You’ll have to pay the higher premium for twice the number of years you could’ve had Part A, but didn’t sign up Getting Ready for OEP

5. Part A—What You Pay in Original Medicare 2019 Getting Ready for OEP

6. What You Pay—Part B Premiums 2019 Monthly Premium • Standard premium is $135.50 (may have to pay a higher amount depending on your income; see next slide) • 2020 IRMAA- coming soon • Some people who get Social Security benefits pay less than this amount Part B Medical Insurance Getting Ready for OEP

7. Part B—What You Pay in Original Medicare 2019 Getting Ready for OEP

8. Monthly Part B Standard Premium—Income-Related Monthly Adjustment Amount (IRMAA) for 2019 Chart is based on your yearly income in 2017 (for what you pay in 2019) NOTE: You may pay more if you have a Part B late enrollment penalty (LEP). Getting Ready for OEP

9. Prescription Drug 2020—Overview • The Part D estimated average basic premium • Projected to be $30 in 2020 ($32.50 in 2019) • Press Release announced on July 30, 2019 • CMS.gov/newsroom/press-releases/trump-administration-drives-down-drug-costs-seniors • People who reach the coverage gap or “donut hole” in 2020 pay • 25% of covered brand-name drugs • 25% of covered generic drugs • 2020 Landscape files available at • CMS.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/index.html Getting Ready for OEP

10. Prescription Drug 2020—Overview (continued) • The 2020 Part D base beneficiary premium is $32.74 • De minimis amount is $2 • For regional benchmark amounts and Extra Help (also called low income premium subsidy) amounts, visit • CMS.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/RegionalRatesBenchmarks2020.pdf • 2020 IRMAA—coming soon Getting Ready for OEP

11. Monthly Part D Standard Premium—Income-Related Monthly Adjustment Amount (IRMAA) for 2020 Chart is based on your yearly income in 2018 (for what you pay in 2020) *IRMAA is adjusted each year. It is calculated on the annual beneficiary base premium. Getting Ready for OEP

12. Regional Low-income Subsidy Benchmark and De Minimis Amount • Those that qualify for full Extra Help won’t have to pay a monthly plan premium if they select a plan at or below the regional low-income subsidy benchmark • If they enroll in a plan that has a premium above the benchmark amount, they may have to pay a portion of the monthly premium • Plans can choose to waive a “de minimis” premium amount above the regional benchmark • 2020 de minimis amount is $2 • Regional benchmark amounts and de minimis amounts are updated each year Getting Ready for OEP

13. Lesson 2—Medicare Open Enrollment Period (OEP) Overview • What is the Open Enrollment Period (OEP)? • Comparing Plans • Things to Consider • Where to Get Plan Information and How to Enroll • If You Have Other Coverage • Calendar Highlights Getting Ready for OEP

14. What is the Open Enrollment Period (OEP)? • During the Open Enrollment Period (OEP) you can • Join or switch a Medicare Prescription Drug Plan (PDP) • Join or switch a Medicare Advantage (MA) Plan • Leave an MA Plan and return to Original Medicare • The OEP lasts from October 15 to December 7 • Take time to review and compare health and drug plan choices • Choose and enroll in the plan that fits your needs • Coverage begins on January 1, 2020 • You should have membership card/materials in hand Getting Ready for OEP

15. Comparing Plans • Each year • Medicare plans can change costs and coverage • Plans mail or provide electronically • Annual Notice of Change (ANOC) explains changes from last years’ coverage, (electronically—if enrollee has opted into receiving electronic version) • Explanation of Coverage (EOC) explains coverage and costs for following year’s coverage • Some plans may choose to leave Medicare Getting Ready for OEP

16. Things to Consider • There are important differences between coverage options. Before making any changes to your coverage, consider things such as • Cost • Coverage • Supplemental coverage • Prescription drugs • Doctor and hospital choice • Quality of care • Travel • See Appendix A for comparison chart (Original Medicare vs. Medicare Advantage) Getting Ready for OEP

17. Research, Compare, and Choose • 2020 “Medicare & You” Handbook • Plan’s Annual Notice of Change (ANOC) and/or Evidence of Coverage (EOC) • State Health Insurance Assistance Program (SHIP) • 1-800-MEDICARE (1-800-633-4227); TTY: 1-877-486-2048 • New Medicare Plan Finder • Medicare.gov/plan-compare • Plans’ websites Getting Ready for OEP

18. The “Medicare & You” Handbook • Has basic plan information • Mailed each fall to beneficiary households • Good for quick comparison • Plan information isn’t comprehensive • Only one quality rating • Mailing started in September • CMS Product No. 10050 CMS Product No. 10050 NOTE: The quality rating in the handbook is the “Members’ Rating of Plan” (how plan members rated the plan from the 2018 Consumer Assessment of Healthcare Providers and Systems [CAHPS] survey). Getting Ready for OEP

19. State Health Insurance Assistance Programs (SHIPs) • Free health insurance counseling program for people with Medicare and their families • Funded through federal grants to states • Find your local SHIP contact • Look at the back of your “Medicare & You” handbook • Visit shiptacenter.org • Call 1-800-MEDICARE (1-800-633-4227); TTY: 1‑877-486-2048 Getting Ready for OEP

20. 1-800-MEDICARE • 1-800-MEDICARE (1-800-633-4227) • Say “Medicare number” if available • You can say “Agent” at any time to talk to a customer service representative; TTY: 1-877-486-2048 • Available 24 hours a day, 7 days a week • Closed on Memorial Day, Independence Day, Labor Day, Thanksgiving Day, and Christmas Day • Support is offered in over 250 languages • Tell customer service representative preferred language Getting Ready for OEP

21. Medicare Plan Finder • For a more detailed comparison • Visit Medicare.gov/plan-compare • Log in for a personalized experience • Search anonymously • Qualify for a SEP if looking for 2019 coverage • Learn more about Medicare • Find Medigap plans Getting Ready for OEP

22. The Plan’s Website • Plan websites have the most comprehensive information • Unlike Medicare Plan Finder, you can’t compare other plans • Find the plan phone number and website information • On Medicare Plan Finder • Contact information in the “Medicare & You” handbook • Plans send a plan “ANOC” each fall showing changes in coverage, costs, or service area • Changes are effective January 1 Getting Ready for OEP

23. 5-Star Special Enrollment Period (SEP) • Use Medicare Plan Finder at Medicare.gov/find-a-plan to see quality and performance ratings • Star ratings are given once a year in October for the past year • Use 5-star SEP to switch to any plan with a 5-star overall rating one time • December 8–November 30 of following year • Coverage starts 1st day of month after enrolled • Be careful not to switch from an MA Plan with drug coverage to an MA Plan without Part D coverage • You’d have to wait until the next enrollment period to get drug coverage and may have to pay a penalty Getting Ready for OEP

24. Consistently Low Performing Plans • Low performing star rating status • You may have a one-time option to switch to another Medicare drug plan with a rating of 3, 4, or 5 stars if your plan’s summary rating was less than 3 stars for 3 years • Low Performing Icon (LPI) appears on Plan Finder • Plans may not attempt to discredit their LPI status by showcasing a separate higher rating Getting Ready for OEP

25. How to Join a New Plan During Open or Special Enrollment Periods (OEP or SEP) • May be able to enroll in a Medicare health or drug plan by • Calling the plan • Enrolling on the plan’s website or on Medicare.gov/plan-compare • Call 1-800-MEDICARE (1-800-633-4227); TTY: 1-877-486-2048 • Paper application • Enrolling in a new plan will disenroll you from your previous plan Getting Ready for OEP

26. 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 • Otherwise, you could lose coverage for you and your dependents Getting Ready for OEP

27. Need a Prescription 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 • Medicaid card or letter showing eligibility for Extra Help • If enrollment can’t be confirmed, can pay out-of-pocket and work with the plan to get reimbursed Getting Ready for OEP

28. Calendar Highlights— Medicare Health and Drug Plans Getting Ready for OEP

29. Lesson 3—2020 Updates • Medicare Advantage (MA) Plans • Medicare Prescription Drug Plans • Medicare Supplement Insurance (Medigap) Policies Getting Ready for OEP

30. Medicare Advantage (MA)—2020 • CMS Press Release from September 24, 2019 • CMS.gov/newsroom/press-releases/trump-administration-drives-down-medicare-advantage-and-part-d-premiums-seniors • Medicare Advantage (MA) average monthly premium expected to decline 23% from 2018 • Estimated average monthly plan premium is $23 in 2020 ($26.87 in 2019) • More than 24 million people with Medicare are projected to enroll in a MA Plan for 2020 • People with Medicare have more plan choices with about 1,200 more MA Plans operating in 2020 than in 2018 • Average number of MA Plan choices per county will increase from about 33 plans in 2019 to 39 plans in 2020 (49% increase since 2017) • Enrollment in MA projected to an all-time high of 24.4 million out of approximately 60 million people currently enrolled in Medicare Getting Ready for OEP

31. NEW-2020 Non-Opioid Pain Management Extra Benefits • CMS encourages MA Plans to consider extra benefits that address medically-approved non-opioid pain management and complementary and integrative treatments • Peer support services to facilitate recovery and assist in navigating health care resources as part of pain management treatment • Psychosocial services/cognitive behavioral therapy can be included in counseling services • Non-Medicare covered chiropractic services • Acupuncture • Therapeutic massage Getting Ready for OEP

32. NEW-2020 Special Benefits for the Chronically Ill • MA Plans may offer additional benefits that aren’t “primarily health-related” benefits only to enrollees who are “chronically ill enrollees” as defined by Medicare statute and only when the additional benefits have a reasonable expectation of improving or maintaining the health or overall function of the chronically ill enrollee • CMS won’t require extra benefits to be primarily health related when they are provided to chronically ill Getting Ready for OEP

33. Non-Primarily Health Related Items or Services Examples “Non-primarily health related” item or service examples that may meet the criteria if the statute requirements are met Getting Ready for OEP

34. NEW-2020 Physical Exam Extra Benefit for Special Needs Plans (SNPs) • Beginning CY 2020, SNPs may offer the Physical Exam extra benefit • Currently available to Non-SNP MA Plans • Provide services beyond those services required to be provided in the Annual Wellness Visit • Provide services beyond what is required as part of the SNP’s regular care coordination and disease management responsibilities • The exam would be provided by a qualified physician or qualified non-physician practitioner Getting Ready for OEP

35. NEW Elimination of Gag Clauses • Know the Lowest Price Act of 2018 • Prohibits Medicare drug plans from restricting or penalizing a pharmacy for disclosing price information to an enrollee • Allows pharmacies to disclose difference between the negotiated price and a lower price without using any health insurance coverage • CMS already instructed plans to eliminate gag clauses, but legal requirement applies to plan years beginning on or after January 1, 2020 • Enrollees can choose to pay cash at the pharmacy and submit claim to plan for reimbursement and True Out of Pocket (TrOOP)counting Getting Ready for OEP

36. Medicare Advantage Plans with Low Enrollment • Plans with low enrollment can’t renew for 2020 • Non-SNPs that had fewer than 500 enrollees • SNPs that had fewer than 100 enrollees • In existence for 3 or more years as of March 2019 • Excludes plans • With low enrollment operating in service areas that don’t have a sufficient number of competing options • Section 1876 Cost Plans, employer plans, or MSA plans • Upon receipt of CMS notification, organizations • Confirm each of the low enrollment plans identified by CMS will be eliminated or consolidated with another of the organization’s plans for CY 2020, or • Provide a justification to CMS for renewal Getting Ready for OEP

37. Expansion of Telehealth Benefits • Starting in 2020, MA Plans can include “additional telehealth benefits” in their bids for basic benefits • Beyond what Original Medicare allows • MA enrollees may get Part B healthcare services from places like their homes • Rather than a healthcare facility • MA Plans have broader flexibility in how they pay and expand telehealth services Getting Ready for OEP

38. CY 2020 Voluntary and Mandatory Maximum Out-of-Pocket (MOOP) Range Amounts by Plan Type Getting Ready for OEP

39. End-Stage Renal Disease (ESRD) and Enrollment • Currently, most people with ESRD can’t join an MA Plan • Effective January 1, 2021, people with ESRD will no longer be prohibited from enrolling in an MA Plan • Cost of acquiring organs shift from the MA Plans to Original Medicare Getting Ready for OEP

40. Default Enrollment • Default enrollment is only permitted from Medicaid Managed Care plans into Dual Eligible Special Needs Plans (D-SNPs) under same organization when enrollee is first eligible for Medicare • Plan must request and get CMS approval before implementing default enrollment; approvals last for 5 years • State(s) determines if MA Plan can use default enrollment • Advance notification with 60-day opt-out • Coverage in MA Plan starts the same day as Part A/B Getting Ready for OEP

41. Simplified Enrollment Mechanism • Simplified enrollment mechanism • Optional enrollment mechanism for all MA organizations that offer MA Plans and non-Medicare coverage (can be used in place of default enrollment) • Generally permits plans to collect only the information they don’t already have for the MA enrollment • Available only to those in their Initial Coverage Election Period (ICEP)/IEP based on their initial enrollment in Medicare • No break in coverage between non-Medicare plan and MA Plan • Can use MA OEP to change after enrollment starts Getting Ready for OEP

42. Passive Enrollment • Passive enrollment can occur for dually-eligible beneficiaries currently enrolled in a non-renewing integrated D-SNP to be passively enrolled into another integrated D-SNP • To be conducted in consultation with a state’s Medicaid agency • The D-SNP getting the new beneficiary must have: • High level of integration • Quality standards • Premium and cost sharing limits • Similar benefits and provider network • Person with Medicare gets • 60 day and 30 day notice of passive enrollment • Special Enrollment Period (SEP) in addition to other SEPs Getting Ready for OEP

43. Enrollment Changes • Regulation CMS-4182-F, published April 16, 2018, included new enrollment provisions • Impacts MA and Part D Plans • Effective January 1, 2019 • Subregulatory guidance issued July 31, 2018 Getting Ready for OEP

44. NEW Formulary Changes • A Medicare drug plan may • Remove a brand-name drug from its Part D formulary, or • Change the brand-name drug's preferred or tiered cost-sharing, so long as a plan • Adds a therapeutically equivalent generic drug to its formulary • Couldn’t have previously included such drug on its formulary because such generic drug wasn’t yet available on the market • Provides general notice to all current and prospective enrollees • Provides advance general notice to CMS Getting Ready for OEP

45. NEWThe Preclusion List • List of individuals and entities currently revoked from Medicare, are under reenrollment bar, or could be revoked if they had been enrolled in Medicare because of OIG exclusions, felony convictions, and other misconduct, and if CMS determines that the underlying conduct that led to the revocation is detrimental to the best interest of the Medicare Program • Individuals and entities are notified of their potential inclusion on the list and their applicable appeal rights • One Preclusion List with subsequent updates - Initial list available January 1, 2019 • Updates made every 30 days (first business day of each month) • Visit CMS.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/PreclusionList.html for Preclusion List resources • Medicare Advantage Plans and Part D plans must • Reject claims or deny payments for Part D drugs and Medicare Advantage services and items prescribed or furnished by an individual or entity on the preclusion list • Notify enrollees who got care in the last 12 months from a contracted provider or a prescription from a provider who’s included on the list Getting Ready for OEP

46. NEWThe Preclusion List—Beneficiary Notice • Medicare enrollees get 60-day advance notice before payment is denied or pharmacy claims are rejected • Plans could begin payment denials and claims rejections on April 1, 2019, for the January 1, 2019, Preclusion List • Allowing 30 days for plans to review the list and notify Medicare enrollees, but no later than 30 days from the posting of the list and an additional 60 days for enrollees to prepare • Follow the same process for monthly updates to the Preclusion List as they did for the initial list Getting Ready for OEP

47. 2020 Specialty Tiers Threshold • Part D sponsors may exempt a formulary tier from its tiering exceptions process • Sponsor-negotiated price must exceed a dollar-per-month threshold established by CMS • 2020 specialty tier threshold is $670 for the full cost of a 30-day supply Getting Ready for OEP

48. Low Enrollment Plans (Stand-alone PDPs only) • CMS will terminate low enrollment plans for 2020 • Below 1,000 enrollees • In the lowest 5th of enrollment within the specific PDP region • For 3 consecutive years • CMS notified affected low enrollment plans in the Spring of 2019 • Option to consolidate or non-renew the plan • May alternatively submit a strategic plan that describes how enrollment will be increased Getting Ready for OEP

49. Medigap and Open Enrollment Period • If you drop an MA Plan and join Original Medicare during the OEP • There’s no guarantee that an insurance company will sell you a Medigap policy unless you’re in a Trial Right period • You may have to meet medical underwriting requirements • Unless you have a guaranteed issue right • Example: If your MA Plan leaves Medicare • States have different rules and protections • Contact Medigap insurers in your area to see what policies might be available to you Getting Ready for OEP

50. Medigap Rights Open Enrollment Period • You would have a right to buy a Medigap policy called a guaranteed issue right if • Your MA Plan doesn’t renew, and • You return to Original Medicare when this happens, and • You’re 65 or older, or • You’re in a Trial Right period—limited times when you’re allowed to buy a Medigap policy • 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 SHIP or State Insurance Department Getting Ready for OEP