Medicare ABCD Presentation to the San Juan Rotary

Medicare ABCD Presentation to the San Juan Rotary Club May 12, 2020 Marina Diaz, MHSA Centers for Medicare & Medicaid Services Puerto Rico & Virgin Islands

Presentation Structure § Background: A Little Bit Of History § Parts ABCD § Medicare Then / Now § Puerto Rico By The Numbers § The Medicare Advantage Program § New Technologies – Blue Bottom § My Medicare § Plan Compare § Puerto Rico State Insurance Assistance § Appendix – Detailed History

Historical Background 1965 - Titles XVIII and XIX of the Social Security Act Signed into law by President Lyndon B Johnson Coverage for people 65 and older- MEDICARE Coverage for people at certain poverty level - Medicaid 1972 - Extended to individuals under 65 with dissabilities 1977 - Health Care Financing Administration(HCFA) 1982 - Agency delegates payments of hospitals and creates the Quality Oversight

Medicare Milestones • 2000 - Benefits improvement Protection Act Increased Medicare payments to managed Health Care organizations • 2001 - Secretary Tommy Thompson change name from HCFA to Centers for Medicare and Medicaid Services • 2003 - Prescription Drug benefit: Foster competition among Health plan Impulse innovation Covered prevention services • 2007 - Beneficiaries with higher income were asked to pay greater share of part B

Then and Now • Number of Beneficiaries % of Federal Expenditure Ø 1965 - 19 million 2. 3% Ø 2019 - 61 million 23. 5%

ABCD of Medicare • A – HOSPITAL SERVICES • B – OUTPATIENT SERVICES ( Not automatic in Puerto Rico) • C – MEDICARE ADVANTAGE • D – PHARMACY SERVICES

Puerto Rico 2019 • Medicare Beneficiaries - 745, 471 • Medicare Advantage (79. 6%) - 593, 337 • New Beneficiaries Monthly - 1, 000

Medicare – Traditional and Medicare Advantage o There are two options to elect in Medicare: 1. Traditional Medicare – An open network accepted by all providers who accept Medicare, OR 2. Medicare Advantage Organizations (MAO) which is a managed care plan through a specific carrier: o In Puerto Rico, there are 4 options of MAO carriers: a) Humana, b) MMM c) MCS d) Triple-S Categorized by a star rating (1 -5) Open Enrollment - Oct 15 -Dec 7 Jan 1 -March 31 st, -you can change plans or return to Traditional Medicare

Medicare Advantage VS. Traditional Medicare MA Traditional You should use the physicians in their network You go to any provider that accepts Medicare May need a referal from a primary physician to go to a specialist You go directly to any specialist Reduces out of pocket costs because it bundles pharmacy. , Dental and Vision It covers 80% of costs, you need to buy supplemetary coverage and pharmacy coverage

e. Medicare Efffort to improve the relationship between the beneficiary and Medicare with “user friendly” technology My Medicare-provides access to your information, re-print card, get your utilization report What is Covered; you know if a procedure or service is covered Plan Compare: tool designed to assist in decision making – comparing the different Health plans benefit packages

State Health Insurance Assistance Program • Staff is trained to provide coaching on comparing plans and deciding between traditional Medicare and Advantage • San Juan Office is in Bus Stop 18 - Santurce (Marshall’s Blg) • SHIP • 1 -877 -725 -4300

Puerto Rico/USVI Office Local Engagement and Administration: • Obtain and Provide clarity on CMS Rules and Regulations • Disseminate Information • Bridge Conversations between PR Stakeholders and Subject Matter Experts • Outreach and Education to providers and beneficiaries

Questions prfo@cms. hhs. gov – Local Contact marina. diaz@cms. hhs. gov Medicare. gov 1 -800 -633 -4227

Thank you!

Historical Background 1965 - Titles XVIII and XIX of the Social Security Act Signed into law by President Lyndon B Johnson Coverage for people 65 and older- MEDICARE Coverage for people at certain poverty level - Medicaid 1972 - Extended to individuals under 65 with dissabilities

Medicare Milestones • 1980’s Medigap (supplemental coverage) under federal oversight • Prospective payment system for hospitals • 1997 -Balanced Budget Act (BBA) • Established a new array of Managed care and other private Health plan choices • Need to slow rate of spending growth to extend life of trust fund • Testing innovative models of payment

Medicare Milestones • 2000 - Benefits improvement Protection Act Increased Medicare payments to managed Health Care organizations • 2001 - Secretary Tommy Thompson change name from HCFA to Centers for Medicare and Medicaid Services • 2003 - Prescription Drug benefit: Foster competition among Health plan Impulse innovation Covered prevention services • 2007 - Beneficiaries with higher income were asked to pay greater share of part B

Medicare Milestones • 2015 - Alternative payment models-encourage quality and efficiency • 2020 - In response to pandemic: Expand telemedicine Increase workforce Hospital without walls Expand testing