Medicare Annual Enrollment Important Medicare Updates for 2015 - PowerPoint PPT Presentation


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Medicare Annual Enrollment Important Medicare Updates for 2015


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Title: Medicare Annual Enrollment Important Medicare Updates for 2015

Medicare Annual EnrollmentImportant 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

20142015 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

Your Medicare Coverage Choices
Step 1 Decide how you want to get your coverage
PART B Medical Insurance
PART A Hospital Insurance
PART C Combines Part A, Part B and usually Part D

Step 2 Decide if you need a Prescription Drug
PART D Stand Alone PDP
PART D Included in Part C
Step 3 Decide if you need to add supplemental
medical coverage
END If you join a Medicare Advantage Plan with
drug coverage (MAPD), you cannot join another
drug plan and you dont need and cannot be sold a
Medigap policy
MEDIGAP Supplement Core or Supplement 1 plan
Part B Preventive Benefits
  • ACA provides access to many free preventive
  • 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 individuals 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

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

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

Medicare Advantage Plans 2015
  • MA plans (HMOs, PPOs)
  • Coverage provided through private plans within
  • Prescription drug coverage usually included
  • 2015 Updates
  • Plan changes will be announced to members on
    September 30th

Medicare Supplement vs.Medicare Advantage
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 (PDPs), also known as
    stand alone plans
  • Medicare Advantage Prescription Drug Plans

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

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
Part D Changes for 2015
  • Plan changes announced September 30th
  • Important to compare plans every year

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

  • 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

  • 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?