SHIPState Health Insurance Assistance Program Barbara Albert SHIP

SHIP/State Health Insurance Assistance Program Barbara Albert, SHIP Coordinator Howard County Office on Aging COGS February 24, 2016 1

What is SHIP? �SHIP/State Health Insurance Assistance Program ◦ Local help with Medicare �Medicare has no customer service offices � 1 -800 -MEDICARE open 24/7 provides significant help but does not go into detailed explanations �SHIP was created to use a volunteer cadre to provide local assistance �In every county in US; may go by different name (such as SHINE, VICAP) ◦ No cost, confidential and unbiased ◦ Available to all Medicare beneficiaries, COGS February 24, 2016 regardless of age or financial situation 2

SHIP Activities �Public Education ◦ Medicare 101 and Medicare 102 �Aimed at New to Medicare, whether new beneficiaries, family and friends starting to help, or community partners learning about Medicare ◦ Using Medicare Plan Finder �Aimed at anyone wanting to learn how to use the Plan Finder tool on www. medicare. gov to compare Medicare Prescription Drug Plans (Part D) �Targeted presentations as appropriate ◦ Community partners, large employers, faithbased groups, disease management groups, etc. COGS February 24, 2016 3

SHIP Activities �One-on-One counseling ◦ Certified counselors who receive continual update training ◦ By appointment ◦ Various locations around county ◦ Cover range of topics/issues: �New to Medicare �Benefit Program Review and Application Assistance �Plan reviews �Problems/Issues �Fraud, Error, Waste and Abuse (SMP) �Outreach ◦ Wide variety of activities, such as health and community fairs, employee/retiree events, etc. COGS February 24, 2016 4

SMP – Senior Medicare Patrol � SMP – Senior Medicare Patrol: ◦ Helps with fight against fraud, waste, abuse and error ◦ Throughout Maryland the rest of the country � Medicare fraud, waste, abuse and error impacts everyone: ◦ Beneficiaries may incur inappropriate expenses, lose benefits or receive incorrect treatment/substandard equipment �Could create or worsen medical conditions ◦ Taxpayer dollars are being lost which could otherwise reduce expenses or improve services COGS February 24, 2016 5

Medicare �A health insurance program for ◦ People 65 years of age and older ◦ People under 65 with certain disabilities �After receiving Social Security cash benefits for 24 months (except for ALS which begins first month) ◦ People any age with End Stage Renal Disease (permanent kidney failure) �Must be a U. S. Citizen or have 5 years legal residence in the U. S. �Administered by the Centers for Medicare and Medicaid Services (CMS) �Over 55 million beneficiaries and growing rapidly with the Baby Boomers aging in COGS February 24, 2016 6

Medicare Overview Insert graphic of parts of Medicare COGS February 24, 2016 7

Medicare Considerations �Complex program in an ever changing health insurance environment �Other health insurance options may be available, through retiree benefits or other sources (very important to understanding options and coordination) �Coverage choices, cost-sharing variations, enrollment periods/time frames, penalties and other important factors can be very confusing for many beneficiaries �Timing is Important ◦ Enrollment Periods �Different for Parts A & B vs Parts C & D vs Medigaps �Late Enrollment Penalties: time and financial COGS February 24, 2016 8

Medicare Beneficiaries -Howard County �‘Landscape’ of choices in Howard County ◦ Increased number of MA plan sponsors �Aetna Medicare: 1 HMO �Cigna Healthspring (current under sanctions): 2 HMOs and 3 SNPs (Special Needs Plans) �Johns Hopkins (new in 2016): 2 PPOs �Kaiser Permanente (only 5 -star plans in MD in 2016): 6 Cost Plans �Medstar (new in 2015): 1 HMO and 2 SNPs �United. Healthcare: 1 SNP �University of Maryland (new in 2016): 1 HMO and 1 SNPs ◦ Stand-alone Prescription Drug Plans (PDPs) � 21 plans (2 Cigna plans under sanctions) COGS February 24, 2016 9

Medicare Beneficiaries -Howard County COGS February 24, 2016 10

Assistance Programs �QMB/Qualified ◦ ◦ Medicare Beneficiary Federal/State Income and Resource Limits (see handout) State pays Part A and/or Part B premium Deductible and Cost Sharing eliminated for Medicare Part A and Part B services (must go to providers who accept dual eligibles) �SLMB/Specified Beneficiary Low-Income Medicare ◦ Federal/State ◦ Income and Resource Limits (see handout) ◦ State pays for Part B premium COGS February 24, 2016 11

Assistance Programs �Extra Help/LIS (Low Income Subsidy) ◦ Federal ◦ Income and Resource Limits (see handout) ◦ Reduces or eliminates monthly Part D premium ◦ Reduces or eliminates deductible ◦ Reduces cost-sharing (limited situations in which cost-sharing is eliminated) ◦ Can make changes to Medicare prescription drug coverage any month, as many times a year as needed (coverage starts the first of the month after enrollment) ◦ Approximately 5, 125 Medicare beneficiaries in Howard County had Extra Help in 2015 COGS February 24, 2016 12

Assistance Programs � SPDAP/ Program Senior Prescription Drug Assistance ◦ State ◦ Available to Medicare beneficiaries of any age with 6 months residency in Maryland ◦ Income limits only/No resource test (see handout) ◦ Provides up to $40/month subsidy for Medicare prescription drug coverage ◦ Limited number of plans provide SPDAP ‘donut hole’ assistance ◦ Member can change Medicare prescription drug coverage one time a year, any month, to start the first of the following month ◦ As of January 2016 there were 845 SPDAP members in Howard County COGS February 24, 2016 13

Medicare - Other Topics � Medicare Goals ◦ Paying Providers for Value, not Volume �Moving from fee-for-service based on volume to fee-for-service based on quality to alternative payment models and populationbased payments ◦ Medicare Shared Savings Program �Building on earlier successes, such Accountable Care Organizations ◦ Open Payments �more transparency regarding financial ties and relationships ◦ Health Care Payment Learning and Action Network �Fostering collaboration between HHS and private payers, large employers, providers, consumers and state and federal partners �Innovation. cms. gov/initiatives/Health-Care-Payment-Learning-and. Action-Network 14

Medicare - Other Topics � Initiatives ◦ Independence at Home Demonstration �Provides chronically ill people with Medicare primary care services in a home setting � 3 year demonstration ◦ Oncology Initiative �Supports better care coordination for cancer patients ◦ Medicare Choices Model �Provides greater flexibility in deciding between hospice care and curative treatment when faced with life-limiting illness �Specific criteria and requirements for participating � 2016 to 2020 timeframe for model ◦ Million Hearts �National initiative to prevent 1 million heart attacks and strokes by 2017 ◦ 5 -star Rating System for Additional CMS Compare Websites �Medicare Part C and Part D plans, Nursing Homes, Doctor, Hospital, Dialysis Facility and Home Health 15

Medicare - Other Topics � Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ◦ ‘Doc Fix’ – replaces ‘Sustainable Growth Rate’ formula ◦ New publicly available information on providers ◦ Extensions �Increased payments for certain low-volume and rural providers �Therapy cap exceptions process �Special Needs Plans �Qualified Individual (QI) program – permanent extension (part of SLMB in Maryland) ◦ Income thresholds for Part B and Part D income adjustments ◦ Payment rate adjustments ◦ Fighting Fraud �Taking Social Security Number off of Medicare cards: in 4 years for new beneficiaries, 8 years for all beneficiaries �New prescriber requirement – must be enrolled in Medicare or have an ‘opt-out’ request on file with Medicare in order to have prescriptions covered by Medicare prescription drug plan 16

Medicare - Other Topics � Preventive Services ◦ Important to stay current ◦ Medicare & You 2016 �List on pages 69 and 70 �Brief explanations pages 43 through 68 ◦ New services for 2016 �Multi-target stool DNA test (colorectal cancer screening): every 3 years if meet certain conditions �Other colorectal cancer screenings still in place �Hepatitis C screening: subject to certain conditions �Lung Cancer screening: once a year if meet certain conditions �Pneumococcal vaccine update 17

Resources � www. medicare. gov ◦ Helpful information on Medicare and related programs: Medicare services and costs, claims and appeals, publications, etc. ◦ “Compare Drug and Health Plans”: Plan Finder ◦ Help finding providers, including nursing homes, hospitals, home health services, dialysis facilities, equipment and supplies, etc. ◦ Comparative information on several categories of providers � 1 -800 -MEDICARE ◦ Open 24 hours/7 days a week other than some federal holidays � Medicare & You Handbook � State Health Insurance Assistance Program (SHIP) ◦ Local help with Medicare � Additional COGS February 24, 2016 information available at www. cms. hhs. gov 18