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Medicare Annual Enrollment Important Medicare Updates for 2015.

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Medicare Annual Enrollment Important Medicare Updates for 2015
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Page 1: Medicare Annual Enrollment Important Medicare Updates for 2015.

Medicare Annual Enrollment

Important Medicare Updates for 2015

Page 2: Medicare Annual Enrollment Important Medicare Updates for 2015.

SHINE Overview SHINE stands for Serving the Health Insurance Needs of

Everyone Provides free and unbiased insurance information and

counseling to Medicare beneficiaries Over 600 SHINE counselors available throughout

Massachusetts to help SHINE Counselors are available at many Senior Centers,

Councils on Aging (COA), Community hospitals and many other community-based sites

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Page 3: Medicare Annual Enrollment Important Medicare Updates for 2015.

2014–2015 Important Dates

October 15th 2014: Open Enrollment begins• Medicare beneficiaries can change health and

prescription coverage

December 7th 2014: Open Enrollment ends• Enrollment requests must be received by the 7th

January 1st 2015: Coverage begins

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Page 4: Medicare Annual Enrollment Important Medicare Updates for 2015.

Your Medicare Coverage Choices

Step 1: Decide how you want to get your coverage

PART AHospital

Insurance

PART BMedical

Insurance

PART CCombines Part A, Part B

and usually Part D

ORIGINAL MEDICARE MEDICARE ADVANTAGE PLAN

OR

PART D Stand Alone PDP

PART DIncluded in Part C

Step 3: Decide if you need to add supplemental medical coverage

MEDIGAPSupplement Core or Supplement 1 plan

ENDIf you join a Medicare Advantage

Plan with drug coverage (MAPD), you cannot join another drug plan and

you don’t need and cannot be sold a Medigap policy

Step 2: Decide if you need a Prescription Drug Plan

&

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Page 5: Medicare Annual Enrollment Important Medicare Updates for 2015.

Part B Preventive Benefits ACA provides access to many free preventive benefits

• Mammograms• Some pap smear and pelvic exams• Colorectal Screenings• Diabetes Self-Management Training/Tests• Bone Mass Measurements• Prostate Cancer Screening• Obesity screening/counseling• Depression screening/counseling• Annual Wellness Visit

Update individual’s medical & family history Record height, weight, body mass index, blood pressure and other routine measurements Provide personal health advice and coordinate appropriate referrals and health education

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Page 6: Medicare Annual Enrollment Important Medicare Updates for 2015.

Open Enrollment Options If in a Medicare Advantage (MA) plan:

• Can change to a different MA plan• Can change to Original Medicare and enroll in a Part D (along with

a Medigap, if desired)Members of MA plans must have Medicare Parts A & B and must

continue to pay the Part B premium If in Original Medicare:

• Can enroll in an MA plan If in a Part D plan:

• Can drop or switch Part D plans

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Page 7: Medicare Annual Enrollment Important Medicare Updates for 2015.

Medicare Supplement Plans 2015

Supplement Plans (Medigaps)• Sold by private insurance companies• Coverage varies for deductibles and co-insurance• No network restrictions• Drug coverage is NOT included

2015 updates• Continuous open enrollment• If changing plans, cancel enrollment in old plan

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Page 8: Medicare Annual Enrollment Important Medicare Updates for 2015.

Medicare Advantage Plans 2015

MA plans (HMO’s, PPO’s)• Coverage provided through private plans within

networks• Prescription drug coverage usually included

2015 Updates• Plan changes will be announced to members on

September 30th

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Page 9: Medicare Annual Enrollment Important Medicare Updates for 2015.

Medicare Supplement vs.Medicare Advantage

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Page 10: Medicare Annual Enrollment Important Medicare Updates for 2015.

Medicare Prescription Drug Coverage

Also called Part D Provides outpatient prescription drugs All Medicare beneficiaries are eligible

• Can have Part A and/or Part B Coverage for Part D is provided by:

• Prescription Drug plans (PDP’s), also known as stand alone plans

• Medicare Advantage Prescription Drug Plans (MAPD’s)

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Page 11: Medicare Annual Enrollment Important Medicare Updates for 2015.

Anatomy of a Drug Plan Cost components

• Premiums: Monthly cost• Deductibles: Annual cost• Co-pays and co-insurance: Paid at pharmacy• Formularies: List of medications covered• Drug tiers: Pricing ladder• Restrictions: Quantity limits, prior authorization, or step

therapy Amounts change periodically, therefore it is important to review

coverage during Open Enrollment

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Page 12: Medicare Annual Enrollment Important Medicare Updates for 2015.

Part D Coverage2014 vs. 2015

Standard Coverage Levels 2014 2015

Deductible $310 $320

Initial Coverage Limit $2,850 $2,960

“Out-of-pocket” Threshold $4,550* $4,700*

Catastrophic Cost-sharing 5% or$2.55/$6.35

5% or$2.65/$6.60

* In 2015, after $2,960 in retail costs, the beneficiary pays 45% of brand name drug costs and 65% of generic drug costs until total out-of-pocket costs equal $4,700

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Page 13: Medicare Annual Enrollment Important Medicare Updates for 2015.

Part D Changes for 2015

Plan changes announced September 30th

Important to compare plans every year

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Page 14: Medicare Annual Enrollment Important Medicare Updates for 2015.

Assistance Programs May Help There are several assistance programs to help pay

Medicare cost-sharing including:• Extra Help (Low Income Subsidy/LIS)• Prescription Advantage• Patient Access Programs• See handout “Concerned about Medicare Costs?”

These programs are based on income and/or assets A SHINE Counselor can help you determine which

programs you may qualify for and assist you in applying

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Page 15: Medicare Annual Enrollment Important Medicare Updates for 2015.

Resources

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SHINE: 1-800-AGE-INFO (1-800-243-4636), press 3

Medicare: 1-800-MEDICARE (1-800-633-4227)

MCPHS Pharmacy Outreach Program: 1-800-633-1617

Prescription Advantage: 1-800-AGE-INFO, press 2

Medicare Advocacy Project (MAP): 1-866-778-0939

Senior Medicare Patrol: 1-800-892-0890

Page 16: Medicare Annual Enrollment Important Medicare Updates for 2015.

Remember! This is the time of year to make changes to your

Medicare Advantage or Prescription Drug Plan

Ask yourself: Will my plan cover the drugs I take? How much will my plan cost? Will my doctor/hospital take my Medicare Advantage

Plan?

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