medicare in minnesota 2012 your medicare: making the best possible decisions october 2011 presented...
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Medicare in Minnesota 2012Your Medicare: Making the Best Possible Decisions
October 2011
Presented by Stephanie MinorSenior LinkAge Line® Program Consultant
Minnesota Board on Aging
Overview
• Open Enrollment Period Changes• 2012 Medicare Changes• Assistance with Medicare Out-of-Pocket Costs• Reminder of 2011 Medicare Changes• Resources
– Health Care Choices– Senior LinkAge Line® – Online Resources
Open Enrollment Period Change
• Open Enrollment Period – October 15, 2011- December 7, 2011 (54 days)
– Will need to make plan changes during this time period• Medicare Part D and Medicare Advantage• No changes from December 8 – December 31, 2011
– Plan effective date will be January 1, 2012• Not seeing huge increase in premiums
Medicare in Minnesota 2012• Medicare Advantage Options
– 4 Local HMO Plans– 9 Preferred Provider Organization Plans– 1 Private Fee-for-Services Plan– 3 Special Need Plans for Chronic Conditions– 8 Special Need Plans for Duals 65+– 3 Special Need Plans for Duals under age 65
• Other Medicare Plans– 21 Cost Plans
• Stand Alone Prescription Drug Plans– 33 Options
Reduced Medicare Prescription Drug Benefit (Part D) Donut Hole Beneficiary Costs
• 2011– 50% discount on brand
name drugs purchased while the beneficiary is in the donut hole
– 7% discount on co-insurance for generic drugs purchased while the beneficiary is in the donut hole. Beneficiary pays 93%
• 2012– 50% discount on brand
name drugs purchased while the beneficiary is in the donut hole
– 14% discount on co-insurance for generic drugs purchased while the beneficiary is in the donut hole. Beneficiary pays 86%
5%95% Catastrophic Benefit
100% with discounts
75%25%
$320 Deductible
Monthly Premium
$2,930.01 - $6,657.50
$320.01 - $2,930
$.01 - $320
Over $6,657.50 (copays of $2.60/$6.50 or 5%)
Drug Costs
Beneficiary CostsPart D Plan
2012Part D Standard Benefit
No Extra Help (LIS)
Donut Hole50% discount on Brand Name drugs
14% discount on co-insurance for generic drugs
Medicare Prescription Drug Benefit Changes
• Beginning 1/1/12– Full duals receiving home and community based services
• Those on Elderly Waiver, as well as CAC, CADI, BI or DD Waivers
• Part D cost sharing will be the same as it is for beneficiaries in a SNF or ICF/MR
– $0 cost sharing for full duals
» Waiver clients
Reminder: Medicare Advantage Disenrollment Period
• January 1, 2012 – February 14, 2012• During this Medicare Advantage Disenrollment period,
– Beneficiaries can dis-enroll from a Medicare Advantage plan and switch to Original Medicare
– Beneficiaries can enroll in a Stand Alone PDP plan for Part D coverage
– Beneficiaries enrolled in a Medicare Advantage plan cannot switch to another Medicare Advantage plan
– Beneficiaries in Original Medicare cannot enroll in a Medicare Advantage plan
Medicare Advantage Updates
• 5-Star Rating System: – Beginning January 2012, plans may receive higher
payment if demonstrate providing high-quality care to enrollees (must receive 5 stars)
– Plans receiving 5-star rating may enroll beneficiaries year round
• Minnesota has no 5-star plans in 2012
Extra Help with Prescription Drugs• Extra Help (Low-income Subsidy)
– Administered by the Social Security Administration– Helps lower the cost of the Medicare Part D premium, deductible and out-of-pocket drug
costs– Paper application or apply online at www.ssa.gov – Income and Asset Guidelines for 2011:
• Income: – Single: $1,225.13 - $1,361.25/mo. – Couple: $1,654.88 - $1,838.75/mo.
• Assets: – Single: $12,640– Couple: $25,260
Medicare Savings Programs (MSP)• Helps individuals under 135% of Federal Poverty Guidelines pay for medical and
prescription drug expenses
• Apply through county of residence
• Three types of MSPs– QMB: Covers Medicare Part A premium (if any), Part B premium, Parts A and B out-of-
pocket costs
– SLMB and QI: Covers Medicare Part B premium
– All MSPs reduce Medicare Part D prescription drug costs: • No deductible• No premium (if on a benchmark)• Lower copays
Medicare Reminders from 2011
• Annual Wellness Visit – Receive personalized prevention plan services (PPPS)
• Establish a screening schedule for the next 5 to 10 years
• Provide personal health advice and coordinate appropriate referrals and health education
• Preventive services– Eliminates cost-sharing for most Medicare-covered preventive
services
– This includes the flu shot – don’t forget to get yours!
Health Care Choices 2012• Available online at www.mnaging.org and www.MinnesotaHelp.info
– Mid-October (scheduled)
• Print copies provided to the Senior LinkAge Line® for local community distribution
• Call 1-800-333-2433 to request a copy by leaving your name, address and phone number
• Includes all Minnesota plan options
• Also includes information on:– Long-term Care– Medicare Supplements– Help paying for Medicare costs
The SHIP in MN (MNSHIP) = Senior LinkAge Line®• State Health Insurance Assistance Program• 300+ certified volunteers in Minnesota• Medicare and long-term care option experts located in your community• Unbiased, Comprehensive, Neutral source• State based program that provides
– One to one counseling and assistance to people with Medicare and their families
– Free service provided through phone, in person, online chat, community events and media activities
– Grants provided by CMS– MN Board on Aging is the grantee
• Senior LinkAge Line® 1-800-333-2433• Available in all 87 counties of Minnesota through the Area Agencies on Aging
Senior LinkAge Line®: Your Link to An Expert
• Senior LinkAge Line® 1-800-333-2433 – Statewide– Objective– Comprehensive– Individualized assistance by phone, by online chat, in
your community and in your home– There is no fee for assistance provided– Does not sell, endorse or promote any insurance, long-
term care or health care product
MinnesotaHelp Network™ is here to help you
• Senior LinkAge Line® 1-800-333-2433• Disability Linkage Line® 1-866-333-2466• Veterans Linkage Line™ 1-888-LinkVet• www.MinnesotaHelp.info® (including Live Chat)• http://longtermcarechoices.minnesotahelp.info/• Local community based sites throughout Minnesota• 2012 edition of Health Care Choices available October 2011
Questions?
Thank you!
Stephanie Minor
Stephanie.a.minor@state.mn.us
651-431-2602
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