for 2019 1 APPRISE is Pennsylvanias State Health Insurance - PowerPoint PPT Presentation

Changes to Medicare 
 for 2019 1

APPRISE is Pennsylvania’s State Health Insurance Assistance Program (SHIP) 2

APPRISE provides free counseling to help individuals understand their health care options 3

Two ways for consumers to access APPRISE services: ▪ State-wide Hot Line 800-783-7067 ▪ Local Program’s direct line (Allegheny County) 412-661-1438 ▪ William.McKendree@wfspa.org 4

Medicare 
 Basics 5

Medicare is a federal government program that provides health care coverage for qualified individuals � 6 6

Medicare Eligibility ▪ 65 years of age and older OR ▪ Under 65 years and receiving disability benefits from SSA or RRB Must receive these benefits for 24 months before eligibility for Medicare (ALS exception) OR ▪ Under 65 years and diagnosed with End Stage Renal Disease ▪ End Stage Renal Disease or ▪ Kidney Transplant � 7 7

Medicare has multiple parts, each of which covers different parts of health care � 8 8

Current Parts of the Medicare System Part A: Hospital Care •Covers in-patient care/services Part B: Medical Care •Covers out-patient care/services Parts A and B are usually referred to as “Traditional” or “Original” Medicare � 9 9

Cost Sharing was intentionally built into the Medicare system Beneficiaries are expected to share the cost of coverage through payments of: • Deductibles • Co-payments � 10 10

As a Result: A key characteristic of the Medicare system is the utilization of private insurance to help with the costs that “Basic” Medicare does not cover � 11 11

Medicare Coverage Options MEDICARE MEDICARE MEDICARE PARTS A & PARTS A & PARTS A & B B B EMPLOYE MEDICAID PRIVATE R BENEFITS INSURANC BENEFITS (through E private (through (directly insurance private obtained by coverage) insurance beneficiary) coverage) 12

Private Insurance Parts of 
 the Medicare System Medigap: Supplemental Insurance for Medicare Parts A and B Part C: Alternative Private Insurance Coverage Part D: Prescription Drug Coverage � 13 13

Medicare Coverage Options Using Private Insurance Products Option 1 Option 2 Medicare Part C Basic Medicare (Managed Care Plan) (Part A and B) is primary coverage is primary coverage Can include Part D coverage Access to Part C Part D Supplement requires enrollment in Drug Plan (Medigap) Basic Medicare (Part A and B) 14

Medicare Prescription Drug Plan (2019) Plan Pays 95% Catastrophic Beneficiary Pays Coverage 5% out of pocket limit $5,100 No Coverage Coverage Gap “DOUGHNUT Initial HOLE” coverage limit $3,820 Plan Pays 75% Beneficiary pays Partial 25% Coverage Plan Deductible (if any) 15

New for 2019 16

1. 
 Changes to Medicare’s 
 Annual Enrollment Period 17

▪ Medicare’s ▪ October 15 – December 7 Annual Enrollment Period ▪ Coverage begins January 1 04/28/2011 � 18 Understanding Medicare 18

Additional Enrollment Period ▪ Begins in 2019 ▪ January 1st - March 31st ▪ Must be in MA plan on January 1st ▪ Only one change during this period • Switch MA plans • Leave MA plan for Basic Medicare + Part D • Cannot switch from one stand alone Part D to another ▪ New selection in effect 1st day of following month � 19 19

2. 
 Non-Medical 
 Personal Care Service 
 through Advantage Plans 20

Expanded Benefits with Medicare Advantage Plans ▪ In April 2018 CMS expanded the capacity of Advantage Plans to offer additional non-Medicare covered benefits ▪ Effective January 1, 2019 ▪ Only applies to Medicare Advantage Plans (HMOs and PPOs) � 21 21

CMS’s language Supplemental benefits that will • Compensate for physical impairments • Diminish the impact of injuries or health conditions • Reduce avoidable emergency room utilization � 22 22

Expanded Benefits with Medicare Advantage Plans ▪ Adult Day Care Programs ▪ Non-medical In-home care – home aides providing help with activities of daily living ▪ Home Health Safety Devices – such as grab bars and wheelchair ramps ▪ Transportation to medical appointments ▪ Meal Deliveries � 23 23

3. 
 Elimination of Certain Medigaps 
 24

Elimination of F , F-HD, and C Medigaps • Effective: 1/1/2020 • Acquisitions before 1/1/2020 are grandfathered • Eligibility is also Grandfathered example: turns 65 in 2019 but postpones enrollment in Part B till after 2019 – Still eligible to purchase F, F-HD, or C gaps Significance • F and C are the only Medigaps that eliminate the Part B Deductible � 25 25