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Medicare Part D

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Can start looking at formulary finder now. ... Many people who have LIS will automatically be eligible for LIS the following year. ... – PowerPoint PPT presentation

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Title: Medicare Part D


1
Medicare Part D      
  • Eva Shiffrin
  • Fall 2008

2
Topics covered
  • Introduction to Medicare Part D
  • Costs for 2009
  • Formulary/ Cost Control
  • Enrollment
  • Choosing a Plan
  • The Low Income Subsidy
  • Eligibility
  • Enrollment in Low-Cost Plans
  • Cost-Sharing
  • Late Enrollment Penalties

3
Troubleshooting
  • Drugs Not Covered
  • Enrollment Problems
  • Formulary Problems
  • Billing Problems
  • Coordination of Benefits
  • Appeals

4
Medicaid vs. Medicare
  • need based (SSI or low income/assets)
  • Comprehensive coverage
  • State and Federal program Apply with county
  • based on work history (SSDI, title II)
  • not comprehensive coverage
  • Federal program Apply with SSA for Medicare A/B

Dual eligible person has Medicare and Medicaid
5
What is Part D?
  • Part D is Medicares prescription drug program.
  • To get this benefit, you have to sign up for a
    prescription drug plan. There are usually about
    60 different plans per year in Wisconsin to
    choose from.
  • These plans are private companies that contract
    with Medicare to provide this benefit.
  • Medicare requires that all plans follow basic
    cost-sharing structures and include a certain
    level of coverage in their formularies.

6
Part D
  • In 2009, 53 plans (57 in 2008)
  • 16 low cost plans (last year there were also 16
    low cost plans)
  • No longer low cost in 2009
  • DeanCare Classic
  • Humana PDP standard
  • Medicare Rx Rewards Value
  • Prescription Pathways Bronze Reg 16
  • Sterling Rx
  • All plans cover Wisconsin residents, statewide
  • Plans have three main parts
  • Cost
  • List of covered drugs Formulary
  • Pharmacy Network
  • The only way to choose a plan www.medicare.gov

7
Part D
  • Plans change each year.
  • Low-income beneficiaries can qualify for help
    with costs and must choose from a smaller group
    of these WI plans to maximize savings.
  • Most of the WI plans are national plans that a
    beneficiary can use in another state.
  • Premiums in 2009 range
  • from 13.70 to 102.70,
  • average of 47.13

8
Part D types
  • Stand alone prescription drug plans
  • Prescription drug coverage included as a part of
    a Medicare Advantage plan or a special needs
    plan.
  • The basic concepts of cost-sharing are the same
    whether the plan is a Part D plan or within a
    Medicare Advantage plan.

9
Medicare Part D costs- Medicare-only- People
with Extra Help

10
Basic Principles of D Cost-Sharing
  • Premium
  • Deductible
  • Initial Coverage Period
  • Donut Hole or Coverage Gap
  • Catastrophic Period
  • Total Drug Expenses
  • True Out-of-Pocket Expenses
  • Co-pays

11
Medicare Eligible (No Extra Help)STANDARD
BENEFIT - 2009
Plans can vary from this standard benefit
structure
12
Help with Costs the Low-Income Subsidy
  • 3 groups of people have LIS
  • Full dual eligibles (have both full MA card
    services and Medicare) automatically have full
    extra help.
  • MSP (Medicare Savings Program) eligibles have
    full extra help.
  • Extra help through Social Security. The SSA has a
    program to help with D costs. You can have full
    or partial extra help under 3.
  • Once you have LIS, it lasts until Dec. 31st of
    the calendar year with very few exceptions.

13
Full Subsidy 2009
Approx. 6,155 total drug costs
1.10 to 6.00 co-pays
100 Coverage


  • No premium in low-cost plans
  • No deductible
  • No cap on co-pays
  • If beneficiary is institutionalized, no co-pays
    apply.
  • Full subsidy individuals include
  • Individuals with both Medicare and Medicaid
  • Individuals with full extra help from Social
    Security
  • Individuals in a Medicare Savings Program



co-pay amounts depend on income- 1.10/3.60 or
2.40/6.00
14
Partial Extra Help 2009
Reduced premium (depends on income)
Approx. 6,155 total drug costs
60 deductible, if any
2.40 to 6.00 co-pays
85 Coverage





Limits are 150 FPL and assets, in 2008 (figures
for 2009 wont be out until February of 2009,
asset limits will rise too ) Single 1,300 per
month 10,490 assets Married 1,750 per month
20,970 assets Limits above are countable
income limits. Regular Social Security income
counting rules apply (20 disregard for unearned
65 disregard and ½ of the remainder for
earned)

15
Strategies to get extra help
Medicaid!
16
Medicaid programs
  • SSI-related
  • Medicare Buy-ins (QMB or SLMB)
  • MAPP
  • BadgerCare
  • All these programs qualify a Medicare beneficiary
    for full extra help
  • BadgerCare and MAPP have income limits and asset
    limits more generous than the SSA Part D subsidy
    program

See separate handout
17
Extra Help through social security
  • Must have assets and income below certain
    amounts.
  • Full extra help Income at or below 135 of
    poverty
  • Income Single 1,170, Couple 1,575
  • Assets Single 6,290, Couple 9,440
  • SSI income and asset counting rules apply with a
    few exceptions. Also, these asset limits do not
    include an allowable 1,500 per person burial
    allowance.
  • Partial Extra Help Income at or below 150 of
    poverty
  • Income Single 1,300, Couple 1,750
  • Assets Single 10,490, Couple 20,970

18
What Part D Plans Cover Drug Lists /
Formularies
19
Part D Drugs are
  • Retail pharmacy prescription drugs
  • Except.
  • Medicare Part B drugs Outpatient drugs that
    require durable medical equipment
  • Benzodiazepines / Barbiturates
  • Off label prescriptions, drugs not approved by
    FDA
  • Prescription vitamins, weight control,
    over-the-counter drugs, cosmetic purposes (hair
    loss), erectile dysfunction drugs
  • Generally, Medicare Part B or Medicaid will cover
    excluded drugs.
  • (Prior authorization may be required)

20
Part B vs. Part D
  • The same medication can be Part B or D depending
    on circumstances of the patient.
  • The following are Part B drugs
  • Anti-cancer
  • Oral anti-emetics prescribed within 48 hours of
    chemo if full replacement for IV treatment
  • Oral anti-cancer
  • Immunosuppressants if transplant covered by
    Medicare
  • Durable medical equipment supply drugs (DME)
  • When used in patients home
  • If the DME was covered by Medicare
  • Parenteral nutrition for individual with
    non-functioning digestive tract
  • Infusion/injectable drugs if administered by a
    physician
  • Other Part B covered items
  • DME test strips, lancets, ostomy, etc.

21
Drug Plan Cost-Controls
  • Formulary
  • 2. Utilization management techniques
  • Prior authorization
  • Quantity limits
  • Step therapy
  • 3. Tiered cost-sharing
  • Most plans Tiers 1-4
  • Does not generally apply to low income subsidy
    co-payments (1.10/3.20 or
    2.40/6.00)

22
Exceptions /Coverage determinations
  • Contact the drug plan to request
  • Decision
  • 72 hours from receiving doctors supporting
    statement
  • expedited process 24 hours
  • Further appeals available.
  • Step 2 Redetermination
  • Step 3 Reconsideration
  • ALJ or federal court

23
Enrollment Periods

24
Part D Enrollment
  • Medicare-only - Not automatic
  • - Must choose and enroll in a plan during an
    enrollment period.
  • Dual eligibles/Extra Help - auto-enrollment
  • Random assignment to low cost plan.
  • Dual eligibles w/ full Medicaid benefits
    enrollment retroactive to 1st day of MC - do not
    expect timeliness.
  • For other extra help enrollment effective at
    least two months after 1st entitled to MC or
    extra help eligibility is determined.

25
Enrollment Periods
  • Three types
  • Initial enrollment period (when first eligible
    for Medicare)
  • 7 month window
  • 3 months before
  • The month first eligible (age 65 or 25th SSDI
    payment)
  • 3 months after
  • Retroactive Medicare
  • Month notice received
  • 2 months after
  • 2. Annual Enrollment period
  • Nov 15 Dec 31 every year
  • Everyone with Medicare Part D should check their
    plan to see if it still works for them.

26
Enrollment in LIS
  • If you are on Medicaid or you go onto Medicare
    with a MSP, you will be put into a low cost
    plan.
  • This assignment will be random!
  • You can decline this enrollment choice.
  • You can also choose a new plan. Once you choose a
    plan, you are considered a chooser. This will
    impact your future treatment under the Medicare
    part D program.
  • If you already had a Medicare Part D plan and
    then became eligible for LIS, you will stay in
    your old plan (with some premium relief and
    cost-sharing relief) unless you choose a new low
    cost plan.

27
What is a low cost plan?
  • A low cost plan, sometimes called a benchmark
    plan, is one with a premium that falls below the
    benchmark figure for your state and be a basic
    plan.
  • A basic plan is one that meets certain minimum
    criteria for coverage. Not an enhanced plan.
  • The benchmark amount in WI in 2009 is 38.15

28
What is an SEP?
  • In general, a special enrollment period gives you
    the ability to make one election or choice within
    a period of time. For example, some SEPs allow
    you one election choice within a three month
    period. Others allow this choice within a month
    long period, etc.
  • Disenrollment is an election
  • Enrollment is an election
  • Enrolling in a plan automatically disenrolls
  • you from your previous plan!

29
Special Enrollment Periods
  • Low Income Subsidy ongoing 1X/month SEP
  • Move in or out of Wisconsin
  • Enter/leave long term care facility
  • Maintain Creditable coverage or loss of coverage
  • Enroll in Part B during annual enrollment
    (JanMar) Part D SEP (April-June)
  • Those enrolled in an SPAP have one SEP per
    calendar year (HIRSP, Chronic Renal Disease and
    Cystic Fibrosis Program, Hemophilia Home Care,
    SeniorCare if gt200 FPL or levels 23, HIRSP)
  • Plan terminated
  • Other SEPs coordinate with Medicare Advantage
    (Part C) enrollment periods
  • Loss of LIS at end of year enrollment period
    between January 1 March 31st
  • Others on case-by-case basis

30
Plan transitions 2008-2009
31
2008 2009 Transition
  • Different set of plans available every year.
  • Plans change their list of covered drugs and cost
    structure.
  • Plans can add prior authorization requirements or
    quantity limits.
  • Plans can change drug tiers for particular drugs.
  • List of low-cost plans is different.
  • Even if you are happy w/ 2008 plan you still
    should evaluate whether it will work for you in
    2009.

32
Plan Transition 2008-2009
  • Every Part D and Medicare Advantage plan member
    gets an Annual Notice of Change letter
    (explaining changes to a plans benefits and
    costs for 2008) by October 31
  • Explains changes from 2008 to 2009
  • Remember a plan could have same name but
    different costs, formulary, rules

33
Medicare Only AEP
  • Can start looking at formulary finder now.
  • You can sign up for a new PD plan from Nov.
    15-Dec. 31.
  • The new plan is effective January 1st.
  • If you have a MAPD, you can switch to another
    MAPD.
  • If you have a MAPD, you can go to an MA and a
    stand alone PD
  • If you have an MAPD, you can go back to original
    Medicare and a stand alone prescription drug
    benefit.
  • There are other enrollment periods as well.

34
2008 2009 Transition for People with LIS
  • Many people who have LIS will automatically be
    eligible for LIS the following year.
  • Dual eligibles and MSPs CMS looks at Medicaid
    data from states SSA in July/ August and uses
    that data to determine who it thinks will remain
    eligible for MA in 2009 it will re-deem those
    people for LIS in 2009. These folks will not get
    a letter telling them that they will still be
    eligible in 2009.
  • Those not re-deemed will get a gray letter from
    CMS stating that the individual will LIS in 2009
    and will be given a form to fill out to apply for
    extra help.
  • Cont. on next slide

35
2008 2009 Transition for People with LIS
  • Those who lost eligibility and were not on the
    files in July/ August, but regain MA/MSP before
    the end of 2008 should receive the LIS for 2009
    and will be informed of this status on a purple
    letter.
  • This means that those who receive MA, even for
    one month, after the July/August window, will be
    deemed eligible for the subsidy the following
    year.

36
2008 2009 Transition for People with LIS
  • For those with extra help through social
    security
  • Social security periodically checks some of its
    extra help beneficiaries to determine whether
    they remain eligible.
  • This year, approximately 250,000 people
    nationwide were sent a letter and forms asking
    them to re-verify that they remain eligible for
    extra help.
  • If you did not get this letter, you will get
    extra help in 2009.
  • It is very important to fill out these forms.
    Doing nothing will result in the loss of extra
    help.

37
2008 2009 Transition for People with LIS
  • A beneficiary auto-enrolled into a plan in 2008
    that is no longer a low-cost plan in 2009 will
    get a letter stating that s/he was autoenrolled
    (randomly) in a new low-cost plan for 2009.
  • LIS beneficiaries who chose a plan in 2008 that
    is not a low-cost plan in 2009 will stay in that
    plan and have premiums in 2009 if they do nothing.

Both of these groups of people should decide what
plan they want to be in for 2009.
38
Plan Selection
39
Plan Selection
  • The only way to effectively choose a plan for
    most people is by using the computer.
  • 1-800-medicare will help people over the phone.
  • You can also use the plan finder and formulary
    finder on Medicare.gov to help individuals
    identify plan options.

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Formulary Finder
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52
Other insurance Part D
53
Coordination of Benefits
  • Medicaid Part D coordinate well.
  • Part D coordinates well with HIRSP. If you have
    HIRSP, you are required to take the HIRSP
    Medicare supplement plan, Plan 2.
  • Part D does coordinate with SeniorCare mostly.
  • Part D can coordinate with private insurance.

54
I have Medical Assistance. Do I have to take Part
D?
  • In Wisconsin, if you have Medical Assistance and
    dont sign up for Part D, MA will no longer
    include drug coverage.
  • Because you have MA, when you sign up for a Part
    D plan, you will maximize your Medicare
    prescription drug savings because you will be
    eligible for LIS.
  • Further, those drugs excluded by law from
    coverage under Part D but covered by MA will
    continue to be covered by MA once you sign up for
    a Part D plan.

55
SeniorCare
  • SeniorCare works as an alternative to Part D
    (creditable coverage)
  • SeniorCare coordinates with Part D
  • SeniorCare does NOT coordinate with Medicaid
  • This means a person on SeniorCare who becomes
    eligible for Medicaid needs a Part D plan to
    cover their drugs. Ideally, this plan should be
    selected at least the month before the person
    goes onto to Medicaid.

56
Senior Care Coordination of Benefits
  • Medicare Part D and SeniorCare coordinate.
  • Claim submitted to Part D plan first.
  • Any remaining charges are submitted to
    SeniorCare.
  • SeniorCare can provide some coverage during the
    coverage gap or donut hole.

57
HIRSP
  • HIRSP (Health Insurance Risk Sharing Plan)
  • See www.hirsp.org for more info on HIRSP
  • If you have Medicare and HIRSP, you are required
    to take the HIRSP Medicare Supplement Policy
    (this is not the same as a Medigap Supplement
    policy).
  • HIRSP and Medicare Part D are designed to
    coordinate.
  • Before making a decision to alter your current
    arrangements to take HIRSP, please contact HIRSP.
    It has enrollment periods and pre-existing
    coverage exclusions that you will want to factor
    into any decision-making re HIRSP.

58
I have other drug coverage. Do I need Part D?
  • If you have other creditable coverage for
    prescriptions, you can decline D with no risk of
    a penalty later.
  • You can get a certificate of creditable coverage
    from your employer each year to prove that the
    coverage you have is creditable.
  • SeniorCare is creditable coverage.
  • Careful!!! Rules are very different for
    Medicare Part B coverage. Part B enrollment
    penalty depends on coverage tied to current
    employment not creditable coverage.

59
Private Prescription Insurance and/or COBRA
  • Typically do not coordinate well with Part D
    (have one or the other)
  • Typically are creditable coverage (works as an
    alternative to Part D)
  • Must find out from insurer (get in writing)
  • Careful!!! Rules are very different for
    Medicare Part B coverage. Part B enrollment
    penalty depends on coverage tied to current
    employment not creditable coverage

60
Part Ds late enrollment penalty
  • similar to Part B but not the same

61
Late Penalties
  • If you decline Part D, you may have a penalty
    when you sign up later.
  • People who are LIS or who become LIS eligible
    will not have a penalty.
  • The penalty increases annually.

62
When is a Part D Penalty assessed?
  • If it has been 63 days or longer since either
    the individuals initial enrollment period ended,
    or since the individual was last enrolled in a
    Part D plan, and the individual
  • Was eligible for Part D,
  • Not enrolled in Part D,
  • Not enrolled in creditable coverage, and
  • No exception to the penalty applies

63
The last day of an individuals initial
enrollment period (IEP) will be
  • May 15, 2006 if eligible for MC Jan 2006 or
    earlier
  • 3 months after first month of MC eligibility
  • If Medicare was awarded retroactively, 2 months
    after the month the Medicare beneficiary receives
    notice of retroactive Medicare
  • 3 months after the month beneficiary becomes age
    65 (if eligible for Medicare before age 65) or
  • 3 months after the month the enrollee moved out
    of incarceration or moved into the US after
    living abroad.

64
Exceptions to the penalty
  • Awarded extra help (whether due to Medicaid
    entitlement or approval by SSA) through the end
    of 2008
  • Katrina Evacuees if qualified for FEMA assistance
    and enrolled in Part D before Dec 31, 2006.
  • Otherwise as determined by CMS.

65
Determining the penalty
Time between last day of IEP and Part D
enrollment or time since last Part D enrollment
lt 63 days
gt 63 days
No penalty
Creditable coverage to fill in gap in Part
D Coverage?
YES
NO
Exception to penalty?
YES
NO
Penalty applies full calendar months btw
IEP/last D enrollment and current Part D
enrollment

(
) X
)
(
national base beneficiary premium
66
Appeals Process
  • Step one Coverage determination LEP notice
  • Step two
  • 60 days to request reconsideration (form supplied
    w/ LEP notice)
  • Decided by IRE Maximus Decisions of IRE are
    final and not subject to appeal
  • Good cause extension available

67
Reminder
  • Part D penalty is different from Part B Penalty.
  • Part B penalty does not factor creditable
    coverage but insurance coverage tied to active
    employment instead.

68
Marketing
  • CMS recently released new marketing guidelines
    due to widespread reports of fraudulent and
    misleading marketing practices.
  • These practices often caused beneficiaries to
    join plans that werent right for them.
  • Marketing occurs whenever a beneficiary is
    encouraged to join a specific plan or is steered
    toward one of several plans offered by a company.

69
Marketing is regulated in terms of
  • Unsolicited marketing contacts
  • Scope of sales appointments
  • Nominal gifts limitation
  • Meals prohibition
  • Marketing limitations in health care settings
  • Co-branding limitations
  • Agent/broker requirements
  • Training and testing
  • State appointment rules
  • Reporting terminated agents/brokers
  • Agent/broker compensation limitations

70
Marketing Violations
  • Misrepresenting benefits available under a plan
  • Providing meals as part of marketing activities
  • Telemarketing, door-to-door solicitation or other
    cold calling
  • Cross-selling non-health related products during
    marketing or sales of Medicare plans
  • Selling, marketing, or accepting applications in
    locations where health care is delivered
  • Selling, marketing, or accepting applications at
    an educational event
  • SEPs may be available for beneficiaries enrolled
    through marketing violations.

71
  • Troubleshooting

72
Drug not Covered
  • If it is a Part D drug, but is not on your
    formulary, try to use a transition policy, then
    ask for a coverage determination.
  • If it is a Part D drug and on your formulary, but
    denied because it is an off-label use, these are
    never successful, except for anti-cancer drugs.
  • If it is a Part D drug, but it exceeds the
    quantity limit or requires PA, ask for an
    emergency fill under the transition policy and
    ask for a coverage determination.
  • If it is not a Part D drug, see if
  • Covered by Forward Card?
  • Is there a therapeutically appropriate
    alternative?
  • Is there a prescription assistance program?
  • If you are LIS, you can always change plans,
    effective the month after the month you enroll.

73
Exceptions /Coverage Determinations
  • Contact the drug plan to request
  • Decision
  • 72 hours from receiving doctors supporting
    statement
  • expedited process 24 hours
  • Further appeals available.
  • Step 2 Redetermination
  • Step 3 Reconsideration
  • ALJ or federal court

74
Coverage Gaps
  • Occur because of the lag when the individual gets
    LIS and when it is updated in Medicare and/or the
    plans computer.
  • Occur because the effective date for an
    individuals LIS or Medicare Part D is wrong.
  • Occur because an individual doesnt know about
    prior authorization requirements, formulary
    restrictions, or formulary changes.
  • Occur because an individual with LIS is being
    assessed a higher cost-share s/he cant afford.

75
Tools to resolve coverage gaps
  • Coverage Determination
  • Transition Policies
  • Formulary change protections
  • B v. D issue
  • Wellpoint
  • Best Available Evidence
  • Regional Office

76
Transition Policies
  • Each plan is required to have a transition policy
    that
  • Provides a 30-day fill for individuals new to a
    plan who didnt know about plan restrictions of
    non-formulary Part D drugs or who need the fill
    in order to comply with PA requirements.
  • This policy should be in effect for individuals
    90 days into the plan year or 90 days after
    enrollment.

77
Formulary Changes
  • Plan changes formulary during the year
  • It can immediately stop refilling if the change
    is change is for a safety reason.
  • If change is for maintenance reason (generic
    substitution, e.g.), it must provide a 60-day
    notice, and if no notice is provided, a 60-day
    supply.
  • If the change is for any other reason, the plan
    must fill the medication for the rest of the plan
    year.

78
Resolving Part B v. Part D Issues
  • Try billing both and see what works.
  • Determine which you think it is and ask for an
    expedited coverage determination.
  • Contact one of the helplines.
  • These can be complex.

79
Point-of-Sale Facilitated Enrollment
  • Works when Medicare recognizes the individual as
    dual and individual is not enrolled in a plan.
  • Wellpoint (Anthem) is the provider.
  • Works for a one month fill while the person
    enrolls in a plan.
  • http//www.cms.hhs.gov/Pharmacy/Downloads/POSFEFou
    rSteps041808.pdf
  • Doesnt always work.

80
Best Available Evidence
  • If a person is enrolled in a plan, but the plan
    doesnt know that the person is dually eligible,
    the plan is required to take the best available
    evidence that the person receives Medicaid, and
    to structure cost-sharing payment accordingly.
  • This could include award letters, emails from ES
    workers, Cares Notice, etc, showing the MA status
    during relevant time.
  • The plan is now required to affirmatively
    investigate the individuals status if the
    individual states they have Medical Assistance or
    the low income subsidy.
  • Experience on the helplines shows that few of the
    front-line workers know about the best available
    evidence policy you may have to ask for a
    supervisor.

81
Resolving Coverage Gaps
  • POS Facilitated Enrollment Process
  • Finding the right person with the right
    information/ Best Available Evidence
  • Transition Policies
  • Formulary Change Protections
  • Creativity
  • Retroactive Enrollment you must demonstrate that
    you have tried other options.
  • Complaint Process
  • Change plans

82
Creativity
  • Some individuals can afford a one or two day
    supply while the glitch is worked out and can
    either wait for the reimbursement for the plan or
    ask the pharmacist to rerun the claim and refund
    the difference.
  • Id love to hear what else has worked for you!
  • Sometimes the pharmacist trusts the patient or
    the DBS/EBS and will fill the medication and run
    the claim after the glitch is resolved.

83
Retroactive Enrollment
  • Only Medicares regional office can retroactively
    enroll a beneficiary. It can do so at the request
    of a plan or at the request of a beneficiary.
  • The regional office only wants to hear from the
    beneficiary or advocate if they have TRIED
    WELLPOINT and it failed AND they are out of
    necessary medications.

84
Change plans
  • Dont forget that individuals can change plans
    once a month who are LIS.
  • Sometimes, this is quicker and easier than other
    methods.

85
Billing Problems
  • Billing problems are involved and not easily
    solved.
  • Premium withholding is difficult and can take
    months to resolve.

86
Complaint Process
  • Complaints are lodged after coverage
    determinations, transition policies, and other
    mechanisms for resolving coverage gaps have
    failed.
  • Complaints can be made to the plan, but if there
    is an emergency, they can also be made directly
    to the regional office.
  • Complaints indicating emergency are supposed to
    receive expedited treatment.

87
Resources
  • Part D and Age 60 and older
  • Elderly Benefit Specialists
  • Prescription Drug Helpline (CWAG) (866)456-8211
    www.wismedrx.org
  • Part D and Under age 60
  • Disability Drug Benefit Helpline (DRW)
    (800)926-4862
  • Disabilityrightswi.org (click on Part D on the
    left)
  • DBSs, HEC, Independent Living Centers
  • Medicare Advantage / Medigap
  • Medigap Helpline 1(800)242-1060
  • http//oci.wi.gov/ for publications

88
Part C
  • (Medicare Choice Medicare Advantage Medicare
    health plans)
  • Approximately 52 private plans
  • Eligibility depends on county of residence
  • Combines all MC benefits (A D or A - B)
  • Opt out of Parts A and B
  • Provides same services as A and B but different
    cost sharing may apply
  • Large variation in premiums (still pay part B)
  • Large variation in coverage

89
Part C continued
  • Variety of plan types
  • HMOs,
  • PPOs,
  • private fee for service (PFFS) any willing
    provider, may reimburse at a different rate than
    Medicare
  • Special Needs Plans (SNP) usually restricted
    dual eligibles or dual eligibles in particular
    nursing homes

90
www.medicare.gov Medicare Advantage info
  • Go to www.medicare.gov and click on Compare
    Health Plans and Medigap Policies in Your Area
  • Search by zip code
  • Listed by annual cost estimates - very rough
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