Medicare Annual Enrollment Important Medicare Updates for 2014

Medicare Annual Enrollment Important Medicare Updates for 2014 Regional Here] Info] [Insert Regional Office and Contact

SHINE Overview • SHINE stands for Serving the Health Insurance Needs of Everyone • Provides free and unbiased insurance information and counseling to Medicare beneficiaries • 650 volunteer 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 Regional Here] Info] [Insert Regional Office and Contact

2013 – 2014 Important Dates • October 15, 2013 - Open Enrollment begins – Medicare beneficiaries can change health and prescription coverage • December 7, 2013 - Open Enrollment ends – Enrollment requests must be received by the 7 th • January 1, 2014 – Coverage begins Regional Here] Info] [Insert Regional Office and Contact

Your Medicare Coverage Choices Step 1: Decide how you want to get your coverage ORIGINAL MEDICARE Part A Hospital Insurance OR MEDICARE ADVANTAGE PLAN (like an HMO or PPO) Part C Combines Part C A, Part B and usually Part D Step 2: Decide if you need a Prescription Drug Plan Part B Medical Insurance Part D Drug coverage is limited to plan offered by HMO or PPO. Part D Stand Alone PDP Step 3: Decide if you need to add supplemental medical coverage Medigap Supplement Core or Supplement 1 plan End If 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. [Insert Regional Office Here]

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 Regional Here] Info] [Insert Regional Office and Contact

Open Enrollment Options • If in a Medicare Advantage 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) • If in Original Medicare, can enroll in an MA plan • If needed, change your Prescription Drug Plan • Member of MA plans must have Medicare Parts A & B (must continue to pay Part B premium) Regional Here] Info] [Insert Regional Office and Contact

Medicare Supplement Plans 2014 • Supplement Plans (a. k. a. , Medigaps) – Sold by private insurance companies – Coverage varies for deductibles and co-insurance – No network restrictions – Drug coverage is NOT included • 2014 updates – More plans available (see handout) – Continuous open enrollment – If changing plans, cancel enrollment in old plan Regional Here] Info] [Insert Regional Office and Contact

Medicare Advantage Plans 2014 • MA plans are HMO’s and PPO’s – Coverage provided through private plans within networks – Prescription drug coverage usually included • 2014 Updates – Plan changes will be announced to members on September 19 th Regional Here] Info] [Insert Regional Office and Contact

Medicare Supplement vs. Medicare Advantage Original Medicare + Medigap Supplement 1 Medicare Advantage Plan Higher monthly premium but no co-pays/co-insurance Generally lower premiums but has co-pays Freedom to choose doctors Generally restricted to network No referrals necessary May need referrals for specialists Some routine services not covered (vision, hearing) May include extra benefits (vision, hearing, fitness) Covered anywhere in U. S. Only urgent and emergency services Provided outside certain area Regional Here] Info] [Insert Regional Office and Contact

Medicare Prescription Drug Coverage • Also called Part D • Provides outpatient prescription drugs • All Medicare beneficiaries are eligible – Can have Part A and/or 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) Regional Here] Info] [Insert Regional Office and Contact

Anatomy of a Drug Plan • Cost components – Premiums – monthly – Deductibles – annual – 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, important to review coverage during Open Enrollment Regional Here] Info] [Insert Regional Office and Contact

Part D Coverage 2013 vs. 2014 Standard Coverage Levels 2013 2014 Deductible $325 $310 Initial Coverage Limit $2, 970 $2, 850 “Out-of-pocket” Threshold $4, 750* $4, 550* Catastrophic Cost-sharing 5% or $2. 65/$6. 60 5% or $2. 55/$6. 35 * In 2014, after $2, 850 in retail costs, the beneficiary pays 47. 5% of brand name drug costs and 72% of generic drug costs until total outof-pocket costs equal $4, 550. Regional Here] Info] [Insert Regional Office and Contact

Part D Changes for 2014 • Plan changes announced September 19 th • Plans will now cover barbiturates regardless of your medical condition. Restrictions had applied in past years. • Important to compare plans every year Regional Here] Info] [Insert Regional Office and Contact

Assistance Programs May Help • There are several assistance programs to help pay Medicare cost-sharing – – “Extra Help” 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 assit you in applying Regional Here] Info] [Insert Regional Office and Contact

Resources SHINE 1 -800 -AGE-INFO, press 3 (1 -800 -243 -4636) Medicare 1 -800 -MEDICARE (1 -800 -633 -4227) MCPHS Pharmacy Outreach Program 1 -800 -633 -1617 Prescription Advantage 1 -800 -AGE-INFO, press 2 (1 -800 -243 -4636) Medicare Advocacy Project 1 -866 -778 -0939 Senior Medicare Patrol 1 -800 -892 -0890 Regional Here] Info] [Insert Regional Office and Contact

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? Regional Here] Info] [Insert Regional Office and Contact