CHOICES Counselor Update Training 2013

1. CHOICES Counselor Update Training2013 Southwestern CT Agency on Aging October 5, 2012

2. What we will cover… • Annual Enrollment Period • Part D Plans in 2013 • Medicare Advantage Plans • Medigap / Medicare Supplement Plans • The Plan Finder on Medicare.gov • Disenrollment Periods

3. Annual Enrollment Period • Starts on October 15 thand ends December 7th • The AEP applies to Part D drug plans and Medicare Advantage Plans (MA, MAPD) • During the AEP someone can : • Enroll in a PDP or MA/MAPD plan • Switch from one PDP to another • Switch from a PDP to an MAPD • Switch from a MAPD back to Original Medicare with a PDP • Effective date of coverage is January 1, 2013

4. Five Special Enrollment Period • Begins December 8, 2012 and goes throughout the 2013 plan year. • During the 5-star SEP you can join or switch from any PDP or MA plan to a 5 PDP or Medicare Advantage Plan. • You can only use this SEP to make one change each year. • Remember, this SEP can only be used to get into a 5 star plan. • Don’t know if we have any 5 plans in CT yet.

5. Other Special Enrollment Periods If you qualify for any of the following, you can qualify for a SEP, which allows you to change plans throughout the year. • If you move out of your plan’s service area • If you lose other “creditable” Rx coverage • If you live in an institution • If you are on Medicare & Medicaid • If you are on a Medicare Savings Program • If you are on the Low Income Subsidy

6. Part D Plans in 2013 • In 2013, there will be 30 plans available in CT. • Least expensive plan is AARP’s Saver Plus Plan at $15.00 / month • Most expensive plan is Humana’s Complete Plan at $114.00/ month • Six benchmark plans with $0 premium for anyone on the full low income subsidy • Seven benchmark plans from 2012 will not be benchmarks in 2013

7. 2013 Benchmark Plans • Aetna CVS Pharmacy Plan • Humana Walmart Preferred Plan • Silverscript Basic Plan • SmartD Rx Plan • AARP Saver Plus Plan • Wellcare Classic

8. 2012 Benchmark plans that are not benchmarks in 2013 • Cigna Medicare Plan One • Community CCRx Basic • First Health Premier • Healthspring Region 2 • Health Net Orange Option 1 • Silverscript CVS Caremark Value • United American Select

9. The Standard Part D Benefit in 2013

10. The Donut Hole in 2013 • Brand name “formulary” drugs will continue to be discounted by 47.5% at pharmacy counter • Generic “formulary” drug subsidy will increase to 21% so beneficiary will pay 79% of the cost of drug. • Some Plans are offering generic drug coverage during donut hole.

11. Cost Sharing for Brand Name Drugs in the Donut Hole 2010-2020

12. Cost sharing for Generic Drugs in the Donut Hole from 2010-2020

13. Excluded Drugs • In 2013 benzodiazepines will now be covered by Medicare Part D • Certain Barbiturates will be covered for the following diagnosis: • Cancer • Epilepsy • Certain Mental Illness

14. The Low Income Subsidy • LIS co –pays for formulary drugs will not exceed • $6.60 for brand name formulary drugs • $2.65 for generic formulary drugs • Those on: • Any of the Medicare Savings Programs • Medicaid • SSI Automatically are enrolled in the Low Income Subsidy

15. Part D Income Related Premiums

16. Medicare Advantage Plans • 16 plans available in 2013 • Aetna is offering three MA plans (premiums range $0 - $94) • Anthem Blue Cross offering one plan ($18 premium) • ConnectiCare offering six plans (premiums range $0 - $204) • United Healthcare has four plans (premiums range $0- $96) • WellCare has two plans (premiums range $0 - $49) • 2 Special Needs Plans • Wellcare Access - SNP for dual eligibles on Medicare & Medicaid • United Nursing Home Plan – for individual in a skilled nursing facility

17. Medicare Advantage Enrollment Periods • Annual Enrollment Period - Oct. 15 – Dec. 7th with effective date of coverage being Jan. 1, 2013 • Initial Enrollment Period for anyone new to Medicare. • Special Enrollment Periods • Annual Disenrollment Period – Jan. 1 – Feb. 14th • 12 month Trial Disenrollment Period

18. Things to remember when doing plan comparisons • Preferred pharmacy of client • Drug Restrictions • Prior authorization • Step therapy • Quantity limits • Provide consumer with the top two or three plans that cover their drugs and best meet their needs • Find out if their medical providers (Doctors, labs, hospitals) are in the plan’s network (if looking for a MA plan)

19. Medigap or Medicare Supplement Plans • Most current Medigap rate sheet is 7/2012 • Currently 13 approved companies in CT • CT has a continuous open enrollment for Medigap • Someone on QMB cannot purchase a Medigap policy however if they have one prior to getting QMB, they can keep it.

20. Dates to remember…. • Oct. 15 – Dec 7, 2012 is the period that most Medicare beneficiaries must make a change or enroll in a MA/MAPD or Part D plan. • One time SEP for individuals to enroll or switch from one plan into a 5 star plan. • January 1 – February 14, 2013 is the MA disenrollment period where someone in an MA plan can disenroll and return to Medicare and buy a Part D plan .

21. As a CHOICES Counselor you must remember… • The decision needs to ultimately be made by the consumer. • Our job is to provide unbiased, comprehensive and accurate information and education. • We do NOT tell consumers what plan they should choose.

22. Medicare.gov The Plan Finder Medicare Part D Plans Compare Medicare Advantage Plans Medigap Plans