Medicare and Benefits Update 2014

1. Medicare and Benefits Update2014 Legal Aid of the Bluegrass SHIP PROGRAM

2. Medicare & Benefits Updates- 2014 • ACA • Medicare Part A & B • Medicare Part C & D • Money Saving Benefits

3. THE ACA

4. The ACA and Health Insurance Marketplaces • ACA created marketplaces for uninsured individuals and insured individuals with high premiums to purchase health insurance • Insurance sold under the marketplace offered by private companies • Kentucky’s marketplace is called kynect (kynect.ky.gov) • Over 600,000 Kentuckians are uninsured

5. The ACA and Health Insurance Marketplaces • Insurance plans will be placed into categories based on level of coverage • Bronze, silver, gold and platinum • Individuals can compare the coverage and determine which type is best for them • Assistance in the way of tax credits and cost sharing reductions are available to people to reduce the cost of premiums • To determine approximate credit and premium amounts visit, http://kff.org/interactive/subsidy-calculator/

6. The ACA and Medicaid • Governor Beshear expanded Medicaid to include anyone with income of 138% fpl or below • Over 300,000 Kentuckians will be eligible for Medicaid benefits under the expansion

7. The ACA and health care marketplaces • Enrollment begins October 1 and ends March 31 for the first year • October 15 to December 7 in 2014 and beyond • Coverage is effective January 1 if enrollment happens prior to December 15 • People on Medicare are not allowed to participate in the marketplace

8. Medicare Part A & Part B

9. Outpatient Mental Health Care After Part B deductible For visits to diagnose condition Beneficiaries pay 20% of Medicare-approved amount For outpatient treatment (such as psychotherapy)

10. National Mail Order Program for Diabetic Testing Supplies Effective July 1, 2013 Includes all parts of the United States including US Territories To find a supplier, visit http://www.medicare.gov/supplierdirectory/search.html

11. Outpatient vs Inpatient • Must be formally admitted to be considered inpatient • Outpatient services include • Emergency Room visits • Observation services at a hospital- including over night stays at the hospital • Outpatient surgery • Lab tests and X-rays

12. Outpatient vs Inpatient • Always ask for inpatient or outpatient status if in the hospital for more than a few hours • Outpatient status will affect admission to a skilled nursing facility

13. Medicare Part C & D

14. Standard Part D Benefit Parameters

15. Part D Coverage Gap Discount Program If beneficiaries reach the coverage gap in 2014 52.5% discount on covered brand-name drugs 50% paid by drug manufacturer will still apply to getting out of the donut hole 2.5% paid by Part D plan will not count toward TrOOP 28% discount on covered generic drugs Dispensing fees are not subject to the 52.5% discount Additional savings in coverage gap each year Until 2020

16. Improved Coverage in the Coverage Gap

17. Landscape of Plans • 100% of people with Medicare have access to a Medicare Advantage plan • 100% of people with Part D have access to a plan with lower premium than what they paid in 2013 • 38% of people with Medicare Part D get Extra Help (also called the low-income subsidy, or LIS) • $12.60 is the lowest monthly premium for a prescription drug plan • 13 PDPs have a premium of $0 for people who qualify for Extra Help • 340,165 people in Kentucky with Original Medicare took advantage of at least one free preventive service through August 2013 • People with Medicare in Kentucky have saved $141,019,279 on prescription drugs in the Medicare Part D donut hole as a result of the Affordable Care Act.

18. Landscape of Plans (PDP) • New Plans • Transamerica MedicareRx • Choice • Classic • Symphonix • Rite Aid Value Rx • Value Rx • Humana Walmart Rx • Cigna Secure-Xtra • Plans That Are Leaving • EnvisionRxPlus Gold • Humana Complete • Name Changes • 2013 Humana Walmart-Preferred Rx plan will be called Humana Preferred Rx Plan • Cigna Plan One now Cigna Secure • Cigna Plan Two now Cigna Secure-Max • Cigna has purchased HealthSpring and will rename the HealthSpring plan to Cigna-HealthSpring Rx • Reader’s Digest plan will change to HealthMarkets Value Rx • SmartD Rx (purchased by Express Scripts) and SilverScript are still under CMS sanction and were not included in Medicare Part D landscape data

19. Landscape of Plans (PDP), cont’d *Lowest Premium PDP for 2014: Humana Walmart Rx Plan **Lowest Premium $0 Deductible PDP for 2014: WellCare Classic

20. Premium Changes for Persons Staying in their Current PDP

21. Landscape of Plans (MA) • New Plans • Anthem Senior Advantage Complete HMO • HumanaChoice H6609-(078-081) • Plans That Are Leaving • Anthem Medicare Preferred Select PPO • 2013 non-regional HumanaChoice plans • Today’s Options plans

22. Landscape of Plans (SNP) • Minimal changes • WellCare Access HMO-SNP for dual eligible individuals has expanded its covered counties

23. 2013 Calendar Highlights Late September- CMS mails the Medicare & You handbook September 30- Plans must provide Annual Notice of Change/Evidence of Coverage to members October 1- Plans begin marketing October 1- 2014 plan data to be displayed on the Medicare Plan Finder Mid-October- plan ratings updated on MPF October 15-Open Enrollment beings December 7- Open Enrollment ends January 1- 2014 plan benefit period begins

24. Low-Performing Medicare Advantage and Drug Plans Plans that receive average Part C or D summary rating of less than 3-stars for 3 years in a row Indicates organization’s substantial failure to comply with its Medicare contract Ratings are on Medicare Plan Finder Tool Medicare & You does not have full, updated ratings

25. Low-Performing Medicare Advantage Plans Changes for low-performing plans in 2013 No online enrollment for low-performing plans Must contact plan directly to enroll Enrolled beneficiaries may use Special Enrollment Period to move to a higher quality plan Will receive mailing from CMS CMS has option to terminate low-performing contracts starting in 2015

26. High Performing Medicare Drug Plans 5 Star Special Enrollment Period Plans rated 5 Stars are indicated with a yellow triangle with a star and the number 5 located in the center SEP begins December 8 each year Beneficiaries can enroll into a 5 Star rated plan up until Nov. 30 of the following year Only allowed one enrollment during the SEP SEP is extended to individuals currently enrolled into a 5 Star plan

27. Marketing Guidelines During Medicare Open Enrollment • Plans must disclose plan information, including changes at least twice a year • At time of enrollment • Annual Notice of Change

28. Marketing Guidelines During Medicare Open Enrollment • Plans can • Offer gifts costing no more than $15 to potential enrollees (could include light snack) • Call existing members regarding enrollment into a plan • Call beneficiaries that requested a phone call • Schedule in home appointments with beneficiaries during a sales event • Sell non-health related products if the beneficiary contacts the plan and requests that information

29. Marketing Guidelines During Medicare Open Enrollment • Plans CANNOT • Conduct door-to-door solicitation • Make outbound marketing calls (cold calling) • Call beneficiaries to confirm receipt of mailed information • Approach beneficiaries in common areas (parking lots, hallways, lobbies, sidewalks, etc.) • Call or visit beneficiaries that attended sales events unless express permission is given by the beneficiary

30. Marketing Guidelines During Medicare Open Enrollment • Plans CANNOT • Cross sell other non-health related insurance products during a MA or Part D sales activity/presentation (annuities, life insurance, etc.)

31. Notices from CMS and SSA September Social Security Notice to Review Eligibility for LIS Plan Annual Notice of Change/Evidence of Coverage Plan LIS Rider-from plan telling how much they get in 2014 towards Part D premium, deductibles and co-payments Creditable Coverage letters from Employer/Union plans Loss of Deemed Status Notice-from SSA stating they are no longer eligible for LIS Medicare & You handbooks

32. Notices from CMS and SSA October Plan Non-Renewal Notices Change in Extra Help Co-Payment Notice- from SSA on orange paper explaining copayments levels will change in 2014 Reassignment Notices-Plan Termination-on blue paper explaining that plan is terminating and they will be reassigned to a new plan Reassignment Notice-Premium Increase-on blue paper explaining that will be re-assigned to a new plan due to the increase in their current plan premium which is above the benchmark

33. Notices from CMS and SSA October MA Reassignment Notice-on blue paper explaining that the MA plan is terminating and they will be re-assigned to a Medicare drug plan for 2014 November LIS Choosers Notice-on tan paper explaining if they chose a Plan on their own that the plan’s premium has increased above the benchmark and they will pay a portion of the premium

34. Notices from CMS and SSA November Non-Renewal Reminder Notice- reminds people who do not get LIS that the plan is terminating Social Security Income Related Adjustment Amount Notice- tell higher income beneficiaries about the higher Part B and Part D premium adjustments Social Security LIS Redetermination Decision Notice-informing beneficiaries of their LIS award for 2014 Social Security LIS and MSP Outreach Notice-informs individuals of these two benefits

35. Notices from CMS and SSA December Social Security Benefit Rate Change Notice- tells people about benefit payment changes due to cost of living increases, premium withholdings, etc. Reassign Formulary Notice- on blue paper informing individuals who get LIS and were affected by reassignment which of the Part D drugs they took in 2013 will be covered in their new 2014 Medicare plan January CMS Non-Renewal Action Notice- reminds people who do not get LIS and whose plan terminated to join a new drug plan February Consistent Poor Performer Notice- Informs people that they’re enrolled in a plan that has been identified as a consistent poor performer and encourages them to explore other plan options in their area

36. Changes to Plan Finder Tool • Session timeout redirects to Medicare.gov • Estimated annual costs rounded to nearest $10 instead of $50 • 30, 60, 90 day supply info on drug benefit summary pop-up • Medication Therapy Management tab instead of link • Show estimated full cost the plan charges Medicare • January 2014 – Will show costs for the rest of the year ONLY

37. Money Saving Benefits

38. Extra Help With Drug Costs • Sometimes called Low Income Subsidy (LIS) • People with lowest income and resources • Pay no premiums or deductibles • Have small or no copayments • Those with slightly higher income and resources • Have a reduced deductible • Pay a little more out of pocket • No coverage gap for people who qualify for LIS

39. Extra Help in 2013

40. Medicare Savings Programs • Help from Medicaid to pay Medicare premiums • For people with limited income and resources • May also pay Medicare deductibles and coinsurance • Programs include • Qualified Medicare Beneficiary (QMB) • Specified Low-income Medicare Beneficiary (SLMB) • Qualifying Individual (QI)

41. Medicare Savings Programs • Provides payment for Part A and Part B premiums and deductibles and co-insurance • QMB • SLMB • QI

42. Eligibility for QMB • Provides assistance with Part B premium and offers additional insurance • Income not exceeding 100% FPL • $978 individual • $1313 couple • Resources • $7,080 for an individual • $10,620 for married couple

43. Eligibility for SLMB • Benefit is limited to payment of Part B premiums only • Income not higher than 120% FPL • $1169 individual • $1571 couple • Resources • $7,080 for an individual • $10,620 for married couple

44. Eligibility for QI • Benefit limited payment of Part B premiums • Cannot be otherwise eligible for Medicaid • Income not higher than 135% FPL • $1313 Individual • $1765 couple • Resources • $7,080 for an individual • $10,620 for married couple

45. SNAP Benefits • Supplemental Nutrition Assistance Program (SNAP) • Federally funded program to assist with purchasing food • Must have resources (assets) below $3250 if age 65 or older or disabled (some exclusions including the home and its contents, personal property and vehicles) • Income requirements based on household size • Deductions to income such as medical expenses are allowed

46. SNAP- Income Guidelines