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SHINE Counselor Fall Training Preparing for Open Enrollment

SHINE Counselor Fall Training Preparing for Open Enrollment. Save Time Remember to Pre-Screen!. Ask beneficiaries if they have: GIC Retiree Federal Blue Cross Ask beneficiary what insurance coverage they already have: Do they have Part A and Part B Ask to see their cards

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SHINE Counselor Fall Training Preparing for Open Enrollment

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  1. SHINE Counselor Fall TrainingPreparing for Open Enrollment

  2. Save TimeRemember to Pre-Screen! • Ask beneficiaries if they have: • GIC • Retiree • Federal Blue Cross • Ask beneficiary what insurance coverage they already have: • Do they have Part A and Part B • Ask to see their cards • It is very important to know the current coverage: • Enrolling in Part D may dis-enroll beneficiary from retiree plan

  3. GIC and Part D • All GIC retirees with a UniCareState Indemnity Plan will be auto-enrolled into SilverScript for 2016 • Early November SilverScript is required by Medicare to send opt out letters to all being auto-enrolled • DO NOT OPT OUT-Will lose GIC coverage • DO NOT CHANGE PART D PLANS-Will lose GIC coverage • Refer all GIC retirees back to GIC • GIC Phone Number: (617) 727-2310

  4. Federal Employees Health Benefits • Open Enrollment period: Nov 9th- Dec 14th • New enrollment type: • Self + 1: Retiree plus another individual • Lower cost option • Must select this option (no automatic enrollment) • Self and Self + Family types still available

  5. Reporting Issues with Part C and/or Part D • What should be reported (actual examples of complaints) • PDPs- when medication cost rises a lot or when beneficiaries are running out of meds and can’t get them at pharmacy • When plan member is having billing issues with MA or PDP • Plan changed formulary/cost of meds differed from Plan Finder • Plan mailed wrong meds and member can’t get ones she ordered and needs • MA plan is reducing services that are needed

  6. Where To Send Complaints • Complaint Process: • Fill out Complaint Entry Form (found on Common Resources) • Send to RD who will either enter it in computer or send to state staff to enter • CMS follows and action is taken quickly • Where Complaints go: Complaints Tracking Module System (CTM) • Repository of Part C and Part D complaints that is used to detect patterns of problems and obtain RAPID resolution by plans

  7. 2016 Medicare Plans

  8. Choosing a Medigap No change in number of plans offering Medigaps New premiums BC/BS lowest cost for CORE and Supplement 1

  9. Choosing a Medicare Advantage Plan • Check if doctors take plan and if drugs covered (use plan finder) • Compare premiums, co-pays, deductibles, and annual out-of-pocket maximums • Cannot enroll in an MA plan (HMO, PPO) and a stand-alone PDP • Selection of PDP will result in disenrollment from MA plan • New MA enrollment will result in automatic disenrollment from prior MA or PDP plan

  10. Blue Cross/Blue Shield MA Plans • New Plan • Medicare HMO Blue FlexRx (HMO-POS) • Existing Plans • Premiumincreases in all plans except SaverRx which remains a $0 premium plan • Increase in Part B Meds in all plans but PlusRx HMO ] • Increase in hospital co-pays and high tech imaging in all but PlusRx plans

  11. Fallon Senior Plans • Existing Plans • Super Saver Rx premium staying at $0 • Premium increase for plans in Franklin, Hampden, Hampshire & Worcester counties • Preferred pharmacies: CVS, Target, Walmart, Big Y, Shaws/Star Market, Stop & Shop • Inpatient hospital & skilled nursing costs staying the same • Not all services covered out-of-network

  12. Harvard Pilgrim • Existing Plans: Stride HMO Value Rx Stride HMO Value Rx Plus • Both plans now available in Essex, Middlesex and Plymouth counties • Open network, Maine, New Hampshire, Massachusetts • Cost Changes • $2 Premium increase in both plans • DME now 20% • Tier 1 $0 co-pays in both plans

  13. Health New England • Freedom (HMO-POS) Plan discontinued • Members will be auto-enrolled into Premium HMO • Existing Plans • $8 premium increase in all plans • Increase in some DME and diagnostic x-ray costs • Service area remains Berkshire, Franklin, Hampden, and Hampshire counties • Hartford County Connecticut in network • Baystate Medical Center in network

  14. Tufts Medicare Preferred • Existing Plans • No premium changes for all HMO plans • SaverRx remains a $0 premium plan • Some increases and decreases in medical costs • Primary Care office visits now $10

  15. UnitedHealthCare • Existing Plans • AARP Complete Choice Regional PPO • Still available in every county • $10 premium increase in all counties • Plan 1 and 2 no premium change • Expanded to additional counties • Hampden County: Medicare Complete plan replaced by Plan 1 and 2 (members must choose new plan, no auto-enrollment) • Open network in New England

  16. Part D Standard Benefit * In 2016, after $3,310 in retail costs, the beneficiary pays 45% of brand name drug costs and 58% of generic drug costs until total out-of-pocket costs equal $4,850

  17. Health Safety Net Reminders • Income 0-200% FPL – extensive benefits • Income at 200-400% FPL partial assistance • Could provide additional hospital coverage for individuals enrolled in Original Medicare, Core Medigap, or Medicare Advantage • May pay for medical services or drugs at a hospital or Community Health Center • HSN drug coverage is NOT creditable coverage • Does NOT pay for SNF costs

  18. Prescription Advantage • Prescription Advantage Categories • S1: Most beneficial for those in it • S2-S4: Helps when beneficiaries hit the donut hole; provides fixed low co-pays • Under 65 must meet S2 income category • S5: $200 enrollment fee; may be worth it for some • 1x yearly SEP available to ALLcategories • MassHealth beneficiaries not eligible for PA • Online application available • www.prescriptionadvantagema.org

  19. Extra Help (LIS) • 6 PDP plans with $0 premium for LIS members: • Aetna Medicare Rx Saver • AARP MedicareRx Saver Plus • Humana Preferred Rx Plan • WellCare Classic • Silverscript Choice • Symphonix Value Rx

  20. LIS Member Reassignment • CMS will first attempt to transfer to other plans below benchmark within same organization as member’s current plan • If none available, CMS will randomly reassign to plan offered by another organization • CMS will start making reassignments in mid-October • Affected members will be sent a BLUE letter in late Oct/early Nov • Second BLUE letter sent in December identifying which of members drugs are on formulary of 2016 reassigned plan • Info on how to appeal, request exception, file grievance included

  21. LIS Choosers • Members who chose to be in their current plan (not auto-enrolled): • Will be notified if the plan’s premium goes above the benchmark • Will be given a list of plans available for $0 premium • Will not be automatically reassigned • CMS will mail out TAN lettersin early November

  22. Discontinued PDP Plans • Members of discontinued plans received notification by October 2nd • Notification explains options: • List of alternative Medicare Advantage or Prescription Drug Plans and phone numbers • Information on Original Medicare, Medigap, Extra Help, and Medicaid • Contact information for Medicare & SHINE

  23. Discontinued PDP Plans • Terminated plans offering NO auto-assignment, SEP available until end of February: • Smart D Rx Saver • Plans auto-assigning members to new plans: • Aetna Rx Premiere  Aetna Rx Saver • Transamerica Rx Choice  Transamerica Rx Classic • Cigna Healthspring Secure Max  Cigna Healthspring Secure-Xtra

  24. Auto-Assignment for Discontinued PDP Plans

  25. New PDPs in 2016 • New Company: Symphonix Health • 3 new plans • SymphonixPrimeSaver Rx • Symphonix Value Rx • EnvisionRx Plus Clear Choice • 26 plans in 2016 • Down from 27 in 2015

  26. Sanctioned Plans • United American (S5755) • Plan remains under CMS sanction • Beneficiaries currently enrolled should not be affected by the sanctions • Plan will not appear on Plan Finder

  27. 2016 PDP Premiums • Average premiums remain stable at about $53 • Transamerica Medicare Rx Classic premium change • 2015 premium: $34.70 • 2016 premium: $118.80 • 242% premium increase

  28. Preferred Pharmacy Pricing • Many PDPs continue to offer preferred cost sharing at select pharmacies in 2016 • Refer to updated Preferred Pharmacy Chart • Pricing can vary dramatically between pharmacies • Important for beneficiaries to do 2 pharmacy comparisons for preferred pharmacy pricing options

  29. SEPs Available After December 7th • Plan is terminating • Special Enrollment Period (SEP): Dec 8th – Feb 28th • Prescription Advantage members • One SEP each calendar year • If used in December, counted for 2015 SEP • Extra Help beneficiaries and dual-eligibles • Continuous SEP • Loss of Extra Help on 1/1/2016 • SEP Until March 31st • 5 Star Plan SEP • Low Performing Medicare Plan • Call 1-800-Medicare • Medicare Advantage Disenrollment Period • Jan 1st – Feb 14th

  30. 5 Star SEP • 2016 plan star ratings will be available on Medicare.gov in October • Ratings based on: • Customer service, complaints & member experience • Drug pricing and patient safety • Health screenings and management of chronic conditions • SEP December 8th– November 30th • Allows beneficiary to enroll or switch into 5 star plan • One time each year • If Medicare Advantage plan, must meet eligibility criteria to enroll

  31. Medicare Advantage Disenrollment Period (MADP) Beneficiaries can disenroll from Medicare Advantage plan and return to Original Medicare from January 1st - February 14th Does not allow beneficiaries to switch to another MA Plan or switch from Original Medicare to a MA Plan Beneficiaries who switch to Original Medicare will have a SEP to join a PDP from Jan 1st – Feb 14th

  32. Medicare Plan FinderUpdates and Tipsfor Open Enrollment

  33. Choosing a PDP or MA-PD • Do a personalized search • If alerted that website is not secure when attempting personalized search; • Ask beneficiary if they feel comfortable to continue despite alert • If not, consider doing a general search • Enter drugs accurately- check with beneficiary or pharmacy if unclear whether brand or generic • Pharmacy selection is important • Check for Prescription Advantage eligibility

  34. Suppressed vs. Sanctioned Plans • Suppressed drug plans • Have submitted inaccurate drug pricing to CMS • These plans appear at the bottom of the Results Page of the Plan Finder and do not display accurate costs • Sanctioned drug plans • Have failed to remain in compliance with CMS standards and practices • These plans WON’T appear in the Plan Finder

  35. My Current Profile Box Displays dates for Current Coverage and Current Subsidy. If possible, always do a Personalized Search.

  36. Add/Edit Drugs Add or edit drugs here rather than going back to the beginning In Drug Costs & Coverage tab Under Drug List section

  37. Add/Remove Pharmacy Click on highlighted network pharmacies link In same Drug Costs & Coverage tab Under Pharmacy & Mail Order Information section

  38. Add/Remove Pharmacy Cont. Hit Add or Remove Pharmacy Hit Close window when finished (automatically saves) • A new Medicare.gov page opens

  39. Add/Remove Pharmacy Cont. Refresh page to see updated pharmacy Look inside browser toolbar for the refresh button, an icon similar to these

  40. Retail or Mail Order Enter month quantity at retail pharmacy (default) when possible

  41. Printable Plan Report

  42. Don’t forget you can customize your report when printing

  43. Remember to Click on Watermark When Enrolling Beneficiaries Click here on Watermark Enter your SHINE office phone number here

  44. Remember! Always use Plan Finder unless beneficiary takes no drugs! Write down Drug ID and Password after entering first drug (in case system goes down) Check plans for Restrictions (Prior Authorization, Quantity Limits, Step Therapy) Use Medicare Plan Finder Guide in your folder to ensure you are following all the necessary steps when performing drug plan searches Print Enrollment Confirmation page on Plan Finder with “Ctrl P” keys

  45. Medicare Improvements for Patients and Providers Act (MIPPA) • Screen beneficiaries for: • Extra Help • Medicare Savings Programs (Buy-In Programs) • Prescription Advantage • Remind beneficiaries about: • Preventive benefits offered by Medicare Part B MIPPA Brochure available on SHINE counselor website

  46. One Care Updates

  47. One Care Updates • Fallon Total Care left One Care as of Sept. 30th • Most members returned to fee for service Medicare & Medicaid • Some accepted into Tufts, CCA, PACE, SCO • 2 providers remaining • Commonwealth Care Alliance • Temporary moratorium on enrollment • Tufts Health Plan • Network Health will accept 500 from Worcester County and open to Suffolk County

  48. Medicare and the Marketplace

  49. What is the Marketplace? • The Marketplace is a state price comparison website for subsidized health insurance where individuals, families, and small businesses can shop for health insurance plans • Designed to help people who don’t have any health coverage • Medicare is NOT part of the Health Insurance Marketplace • The Health Connector is Massachusetts' health insurance Marketplace • Connector Open Enrollment: Nov 1st 2015 -Jan 31st 2016

  50. Message to Medicare Beneficiaries Who Have Questions About How the Marketplace Affects Them • Medicare isn’tpart of the Health Insurance Marketplace • No one can sell a Medicare beneficiary a Marketplace plan • Even if they only have Medicare Part A or Part B • Except plans through an employer sold through the Small Business Health Options Program (SHOP) if they’re an active worker/ dependent of an active worker • Medicare beneficiariesDO NOT NEED TO DO ANYTHING about the Marketplace

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