THE ACA AND YOU AND MEDICARE TOO

1
THE ACAAND YOUAND MEDICARE TOO

• Angela Zeek
• Bluegrass SHIP Coordinator
• 2013

2
Affordable Care Act (ACA)
3
ACA

• Signed into law on March 23, 2010
• Created health insurance marketplaces for the
  uninsured to buy insurance
• Made a number of changes to Medicare

4
The ACA and Medicare

• Many believe that rate of spending on Medicare
  cannot be sustained
• The number of people with Medicare will grow
  rapidly as Boomers age
• 10,000 people turning 65 every day for the next
  20 years
• Medicare spending is increasing faster than the
  rest of the economy

5
ACA Changes to Medicare Finances

• Increased Revenues
• Higher payroll taxes for wealthy workers
  (200/250,000)
• Higher Part D premiums for 5 of wealthy Medicare
  beneficiaries (85/170,000)
• Reduced Spending
• Slower growth in payments to providers (not
  doctors)
• Reduction in over-payments to Medicare Advantage
  plans
• Average yearly Medicare spending increases down
  from 6.8 to 5.7
• NO CUTS in basic benefits

6
Reduced Payments to Medicare Advantage Plans

• MA plans were paid about 1,000 more per person
  than people in original Medicare (14 higher)
• Beginning in 2012, these overpayments started to
  be gradually reduced
• Exception- higher performing plans will receive
  bonuses

7
The ACA Financial Changes to Medicare

• Prior to the ACA, Medicare Trust Fund would be
  depleted by 2017.
• Trust Fund is projected to be solvent until
  roughly 2029 due to the changes
• Increased funding to improve some Medicare
  benefits

8
How These Changes Affect You

• Medicare Prescription Drug Improvements
• Better Preventive and Chronic Care
• Better quality of care

9
How These Changes Affect You

• Improvements in Medicare Prescription Drug
  Coverage
• Closing the Donut Hole (coverage gap)

10
Phase Out of Donut Hole for Brand Name Medications
Year Pharmaceutical Manufacturer Discount Government Subsidy (paid through plans) Consumer Responsibility
2013 50 2.50 47.50
2014 50 2.50 47.50
2015 50 5 45
2016 50 5 45
2017 50 10 40
2018 50 15 35
2019 50 20 30
2020 50 25 25
11
Phase Out for Donut Hole for Generic Medications
Year Government Subsidy (paid through plans) Consumer Responsibility
2013 21 79
2014 28 72
2015 35 65
2016 42 58
2017 49 51
2018 56 44
2019 63 37
2020 75 25
12
How These Changes Affect You

• Improvements in Medicare Prescription Drug
  Coverage
• Improved appeals for coverage denials
• More help for people with limited means
• For certain illnesses all medications
  manufactured to treat those conditions must be
  added to a plans formulary

13
How These Changes Affect You

• Better Preventive Care
• Free annual wellness visit and prevention plan
• No more cost sharing free preventive benefits
• More funding for prevention services

14
How These Changes Affect You

• Better Chronic Care
• New quality improvements
• Better coordination among doctors, specialists,
  other providers
• Services to reduce hospital readmissions
• Help so you can manage your own care

15
How These Changes Affect You

• Changes in Medicare Advantage (MA) Plans?
• New bonuses to reward high quality care
• New consumer protections to limit out-of-pocket
  costs

16
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
• Kentuckys marketplace is called Kynect
  (kynect.ky.gov)
• Over 600,000 Kentuckians are uninsured

17
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 are
  available to people to reduce the cost of
  premiums
• To determine approximate credit and premium
  amounts visit, http//kff.org/interactive/subsidy-
  calculator/

18
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

Family Size Monthly Income
1 1,321
2 1,784
3 2,247
4 2,710
19
The ACA and health care marketplaces

• Enrollment begins October 1 and ends March 31 for
  the first year
• October 1 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

20
Medicare Updates
21
Original Medicare (Part A Part B)
22
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)

In this Year Beneficiaries Pay
2013 35
2014 20
23
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

24
Medicare Part C D
25
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 organizations substantial failure to
  comply with its Medicare contract
• Ratings are on Medicare Plan Finder Tool
• Medicare You does not have full, updated ratings

26
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

27
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

28
Standard Part D Benefit Parameters
Benefit Parameters 2013 2014
Deductible 325 310
Initial Coverage Limit 2970 2850
Out-of-Pocket Threshold 4750 3605
Total Covered Drug Spending at OOP Threshold 6954.52 6455
Minimum Cost Sharing in Catastrophic Coverage 2.65/6.60 2.55/6.35
Extra Help Copayments 2013 2014
Institutionalized 0 0
Receiving Home Community Based Ser. 0 0
Up to or at 100 FPL 1.15/3.50 1.20/3.60
Full Extra Help 2.65/6.60 2.55/6.35
Partial Extra Help (deductible/cost-sharing) 66/15 63/15
29
Part D Coverage Gap Discount Program

• If beneficiaries reach the coverage gap in 2013
• 52.5 discount on covered brand-name drugs
• Counts toward TrOOP
• 21 discount on covered generic drugs
• Total cost paid by beneficiary (plus the 52.5
  discount) counts toward catastrophic coverage
• Dispensing fees are not subject to the 52.5
  discount
• Additional savings in coverage gap each year
• Until 2020

30
Improved Coverage in the Coverage Gap
Year What Beneficiaries Pay for Brand Name Drugs in the Coverage Gap What Beneficiaries Pay for Generic Drugs in the Coverage Gap
2013 47.5 79
2014 47.5 72
2015 45 65
2016 45 58
2017 40 51
2018 35 44
2019 30 37
2020 25 25
31
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

32
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

33
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

34
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 plans
  premium has increased above the benchmark and
  they will pay a portion of the premium

35
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

36
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 theyre enrolled in a plan that has been
  identified as a consistent poor performer and
  encourages them to explore other plan options in
  their area

37
THINGS TO REMEMBER

• Medicare Open Enrollment begins October 15 and
  ends December 7
• Must compare your prescription drug and/or
  Medicare Advantage plan
• Kynect, Kentuckys health care marketplace is for
  uninsured individuals and enrollment dates are
  different from Medicare Open Enrollment
• Review all information received from Social
  Security or Medicare

38
(No Transcript)