1. Medicare and Benefits Update 2014 Legal Aid of the Bluegrass SHIP PROGRAM

2. Medicare & Benefits Updates- 2014 ACA ACA Medicare Part A & B Medicare Part A & B Medicare Part C & D Medicare Part C & D Money Saving Benefits Money Saving Benefits

3. THE ACA

4. The ACA and Health Insurance Marketplaces ACA created marketplaces for uninsured individuals and insured individuals with high premiums to purchase health insurance ACA created marketplaces for uninsured individuals and insured individuals with high premiums to purchase health insurance Insurance sold under the marketplace offered by private companies Insurance sold under the marketplace offered by private companies Kentucky’s marketplace is called kynect (kynect.ky.gov) Kentucky’s marketplace is called kynect (kynect.ky.gov) Over 600,000 Kentuckians are uninsured Over 600,000 Kentuckians are uninsured

5. The ACA and Health Insurance Marketplaces Insurance plans will be placed into categories based on level of coverage Insurance plans will be placed into categories based on level of coverage Bronze, silver, gold and platinum Bronze, silver, gold and platinum Individuals can compare the coverage and determine which type is best for them Individuals can compare the coverage and determine which type is best for them Assistance in the way of tax credits and cost sharing reductions are available to people to reduce the cost of premiums Assistance in the way of tax credits and cost sharing reductions are available to people to reduce the cost of premiums To determine approximate credit and premium amounts visit, http://kff.org/interactive/subsidy-calculator/ To determine approximate credit and premium amounts visit, http://kff.org/interactive/subsidy-calculator/http://kff.org/interactive/subsidy-calculator/

6. The ACA and Medicaid Governor Beshear expanded Medicaid to include anyone with income of 138% fpl or below Governor Beshear expanded Medicaid to include anyone with income of 138% fpl or below Over 300,000 Kentuckians will be eligible for Medicaid benefits under the expansion Over 300,000 Kentuckians will be eligible for Medicaid benefits under the expansion Family Size Monthly Income 1$1,321 2$1,784 3$2,247 4$2,710

7. The ACA and health care marketplaces Enrollment begins October 1 and ends March 31 for the first year Enrollment begins October 1 and ends March 31 for the first year October 15 to December 7 in 2014 and beyond October 15 to December 7 in 2014 and beyond Coverage is effective January 1 if enrollment happens prior to December 15 Coverage is effective January 1 if enrollment happens prior to December 15 People on Medicare are not allowed to participate in the marketplace People on Medicare are not allowed to participate in the marketplace

8. Medicare Part A & Part B

9. Outpatient Mental Health Care After Part B deductible After Part B deductible For visits to diagnose condition For visits to diagnose condition Beneficiaries pay 20% of Medicare-approved amount Beneficiaries pay 20% of Medicare-approved amount For outpatient treatment (such as psychotherapy) For outpatient treatment (such as psychotherapy) In this Year Beneficiaries Pay 201335% 201420%

10. National Mail Order Program for Diabetic Testing Supplies Effective July 1, 2013 Effective July 1, 2013 Includes all parts of the United States including US Territories Includes all parts of the United States including US Territories To find a supplier, visit http://www.medicare.gov/supplierdirectory/sea rch.html To find a supplier, visit http://www.medicare.gov/supplierdirectory/sea rch.html http://www.medicare.gov/supplierdirectory/sea rch.html http://www.medicare.gov/supplierdirectory/sea rch.html

11. Outpatient vs Inpatient Must be formally admitted to be considered inpatient Must be formally admitted to be considered inpatient Outpatient services include Outpatient services include Emergency Room visits Emergency Room visits Observation services at a hospital- including over night stays at the hospital Observation services at a hospital- including over night stays at the hospital Outpatient surgery Outpatient surgery Lab tests and X-rays Lab tests and X-rays

12. Outpatient vs Inpatient Always ask for inpatient or outpatient status if in the hospital for more than a few hours Always ask for inpatient or outpatient status if in the hospital for more than a few hours Outpatient status will affect admission to a skilled nursing facility Outpatient status will affect admission to a skilled nursing facility

13. Medicare Part C & D

14. Standard Part D Benefit Parameters Benefit Parameters 20132014 Deductible$325$310 Initial Coverage Limit $2970$2850 Out-of-Pocket Threshold $4750$3605 Total Covered Drug Spending at OOP Threshold $6954.52$6455 Minimum Cost Sharing in Catastrophic Coverage $2.65/$6.60$2.55/$6.35 Extra Help Copayments 20132014 Institutionalized$0$0 Receiving Home & Community Based Ser. $0$0 Up to or at 100% FPL $1.15/$3.50$1.20/$3.60 Full Extra Help $2.65/$6.60$2.55/$6.35 Partial Extra Help (deductible/cost-sharing) $66/15%$63/15%

15. Part D Coverage Gap Discount Program If beneficiaries reach the coverage gap in 2014 If beneficiaries reach the coverage gap in 2014 52.5% discount on covered brand-name drugs 52.5% discount on covered brand-name drugs 50% paid by drug manufacturer will still apply to getting out of the donut hole 50% paid by drug manufacturer will still apply to getting out of the donut hole 2.5% paid by Part D plan will not count toward TrOOP 2.5% paid by Part D plan will not count toward TrOOP 28% discount on covered generic drugs 28% discount on covered generic drugs Dispensing fees are not subject to the 52.5% discount Dispensing fees are not subject to the 52.5% discount Additional savings in coverage gap each year Additional savings in coverage gap each year Until 2020 Until 2020

16. Improved Coverage in the Coverage Gap Year What Beneficiaries Pay for Brand Name Drugs in the Coverage Gap What Beneficiaries Pay for Generic Drugs in the Coverage Gap 201347.5%79% 201447.5%72% 201545%65% 201645%58% 201740%51% 201835%44% 201930%37% 202025%25%

17. Landscape of Plans 100% of people with Medicare have access to a Medicare Advantage plan 100% of people with Medicare have access to a Medicare Advantage plan 100% of people with Part D have access to a plan with lower premium than what they paid in 2013 100% of people with Part D have access to a plan with lower premium than what they paid in 2013 38% of people with Medicare Part D get Extra Help (also called the low- income subsidy, or LIS) 38% of people with Medicare Part D get Extra Help (also called the low- income subsidy, or LIS) $12.60 is the lowest monthly premium for a prescription drug plan $12.60 is the lowest monthly premium for a prescription drug plan 13 PDPs have a premium of $0 for people who qualify for Extra Help 13 PDPs have a premium of $0 for people who qualify for Extra Help 340,165 people in Kentucky with Original Medicare took advantage of at least one free preventive service through August 2013 340,165 people in Kentucky with Original Medicare took advantage of at least one free preventive service through August 2013 People with Medicare in Kentucky have saved $141,019,279 on prescription drugs in the Medicare Part D donut hole as a result of the Affordable Care Act. People with Medicare in Kentucky have saved $141,019,279 on prescription drugs in the Medicare Part D donut hole as a result of the Affordable Care Act.

18. Landscape of Plans (PDP) New Plans New Plans Transamerica MedicareRx Transamerica MedicareRx Choice Choice Classic Classic Symphonix Symphonix Rite Aid Value Rx Rite Aid Value Rx Value Rx Value Rx Humana Walmart Rx Humana Walmart Rx Cigna Secure-Xtra Cigna Secure-Xtra Plans That Are Leaving Plans That Are Leaving EnvisionRxPlus Gold EnvisionRxPlus Gold Humana Complete Humana Complete Name Changes Name Changes 2013 Humana Walmart-Preferred Rx plan will be called Humana Preferred Rx Plan 2013 Humana Walmart-Preferred Rx plan will be called Humana Preferred Rx Plan Cigna Plan One now Cigna Secure Cigna Plan One now Cigna Secure Cigna Plan Two now Cigna Secure-Max Cigna Plan Two now Cigna Secure-Max Cigna has purchased HealthSpring and will rename the HealthSpring plan to Cigna- HealthSpring Rx Cigna has purchased HealthSpring and will rename the HealthSpring plan to Cigna- HealthSpring Rx Reader’s Digest plan will change to HealthMarkets Value Rx Reader’s Digest plan will change to HealthMarkets Value Rx SmartD Rx (purchased by Express Scripts) and SilverScript are still under CMS sanction and were not included in Medicare Part D landscape data SmartD Rx (purchased by Express Scripts) and SilverScript are still under CMS sanction and were not included in Medicare Part D landscape data

19. Landscape of Plans (PDP), cont’d Statistic2014 Change from 2013 to 2014 Total Number of Part D Drug Plans 30-2 # of Enhanced Plans 15-2 # of Basic Plans 150 # of $0 Deductible Plans 14 Lowest Cost PDP Plan $12.60*-$2.40 Lowest Premium for $0 Deductible Plan $20.90**-$8.20 Number of LIS $0 Premium Plans 132 *Lowest Premium PDP for 2014: Humana Walmart Rx Plan **Lowest Premium $0 Deductible PDP for 2014: WellCare Classic

20. Premium Changes for Persons Staying in their Current PDP Statistic2014 Change from 2013 to 2014 Number of Plans with Premium Decrease 100 Number of Plans with No Premium Change 00 Number of Plans with Premium Increase 14-7 % of People with Premium Increase 73%-9% Weighted Average Increase for People with a Premium Increase $5.26$1.55

21. Landscape of Plans (MA) New Plans New Plans Anthem Senior Advantage Complete HMO Anthem Senior Advantage Complete HMO HumanaChoice H6609-(078-081) HumanaChoice H6609-(078-081) Plans That Are Leaving Plans That Are Leaving Anthem Medicare Preferred Select PPO Anthem Medicare Preferred Select PPO 2013 non-regional HumanaChoice plans 2013 non-regional HumanaChoice plans Today’s Options plans Today’s Options plans

22. Landscape of Plans (SNP) Minimal changes Minimal changes WellCare Access HMO-SNP for dual eligible individuals has expanded its covered counties WellCare Access HMO-SNP for dual eligible individuals has expanded its covered counties

23. 2013 Calendar Highlights Late September- CMS mails the Medicare & You handbook Late September- CMS mails the Medicare & You handbook September 30- Plans must provide Annual Notice of Change/Evidence of Coverage to members September 30- Plans must provide Annual Notice of Change/Evidence of Coverage to members October 1- Plans begin marketing October 1- Plans begin marketing October 1- 2014 plan data to be displayed on the Medicare Plan Finder October 1- 2014 plan data to be displayed on the Medicare Plan Finder Mid-October- plan ratings updated on MPF Mid-October- plan ratings updated on MPF October 15-Open Enrollment beings October 15-Open Enrollment beings December 7- Open Enrollment ends December 7- Open Enrollment ends January 1- 2014 plan benefit period begins January 1- 2014 plan benefit period begins

24. Low-Performing Medicare Advantage and Drug Plans Plans that receive average Part C or D summary rating of less than 3-stars for 3 years in a row Plans that receive average Part C or D summary rating of less than 3-stars for 3 years in a row Indicates organization’s substantial failure to comply with its Medicare contract Indicates organization’s substantial failure to comply with its Medicare contract Ratings are on Medicare Plan Finder Tool Ratings are on Medicare Plan Finder Tool Medicare & You does not have full, updated ratings Medicare & You does not have full, updated ratings

25. Low-Performing Medicare Advantage Plans Changes for low-performing plans in 2013 Changes for low-performing plans in 2013 No online enrollment for low-performing plans No online enrollment for low-performing plans Must contact plan directly to enroll Must contact plan directly to enroll Enrolled beneficiaries may use Special Enrollment Period to move to a higher quality plan Enrolled beneficiaries may use Special Enrollment Period to move to a higher quality plan Will receive mailing from CMS Will receive mailing from CMS CMS has option to terminate low-performing contracts starting in 2015 CMS has option to terminate low-performing contracts starting in 2015

26. High Performing Medicare Drug Plans 5 Star Special Enrollment Period 5 Star Special Enrollment Period Plans rated 5 Stars are indicated with a yellow triangle with a star and the number 5 located in the center Plans rated 5 Stars are indicated with a yellow triangle with a star and the number 5 located in the center SEP begins December 8 each year SEP begins December 8 each year Beneficiaries can enroll into a 5 Star rated plan up until Nov. 30 of the following year Beneficiaries can enroll into a 5 Star rated plan up until Nov. 30 of the following year Only allowed one enrollment during the SEP Only allowed one enrollment during the SEP SEP is extended to individuals currently enrolled into a 5 Star plan SEP is extended to individuals currently enrolled into a 5 Star plan

27. Marketing Guidelines During Medicare Open Enrollment Plans must disclose plan information, including changes at least twice a year Plans must disclose plan information, including changes at least twice a year At time of enrollment At time of enrollment Annual Notice of Change Annual Notice of Change

28. Marketing Guidelines During Medicare Open Enrollment Plans can Plans can Offer gifts costing no more than $15 to potential enrollees (could include light snack) Offer gifts costing no more than $15 to potential enrollees (could include light snack) Call existing members regarding enrollment into a plan Call existing members regarding enrollment into a plan Call beneficiaries that requested a phone call Call beneficiaries that requested a phone call Schedule in home appointments with beneficiaries during a sales event Schedule in home appointments with beneficiaries during a sales event Sell non-health related products if the beneficiary contacts the plan and requests that information Sell non-health related products if the beneficiary contacts the plan and requests that information

29. Marketing Guidelines During Medicare Open Enrollment Plans CANNOT Plans CANNOT Conduct door-to-door solicitation Conduct door-to-door solicitation Make outbound marketing calls (cold calling) Make outbound marketing calls (cold calling) Call beneficiaries to confirm receipt of mailed information Call beneficiaries to confirm receipt of mailed information Approach beneficiaries in common areas (parking lots, hallways, lobbies, sidewalks, etc.) Approach beneficiaries in common areas (parking lots, hallways, lobbies, sidewalks, etc.) Call or visit beneficiaries that attended sales events unless express permission is given by the beneficiary Call or visit beneficiaries that attended sales events unless express permission is given by the beneficiary

30. Marketing Guidelines During Medicare Open Enrollment Plans CANNOT Plans CANNOT Cross sell other non-health related insurance products during a MA or Part D sales activity/presentation (annuities, life insurance, etc.) Cross sell other non-health related insurance products during a MA or Part D sales activity/presentation (annuities, life insurance, etc.)

31. Notices from CMS and SSA September September Social Security Notice to Review Eligibility for LIS Social Security Notice to Review Eligibility for LIS Plan Annual Notice of Change/Evidence of Coverage Plan Annual Notice of Change/Evidence of Coverage Plan LIS Rider-from plan telling how much they get in 2014 towards Part D premium, deductibles and co-payments Plan LIS Rider-from plan telling how much they get in 2014 towards Part D premium, deductibles and co-payments Creditable Coverage letters from Employer/Union plans Creditable Coverage letters from Employer/Union plans Loss of Deemed Status Notice-from SSA stating they are no longer eligible for LIS Loss of Deemed Status Notice-from SSA stating they are no longer eligible for LIS Medicare & You handbooks Medicare & You handbooks

32. Notices from CMS and SSA October October Plan Non-Renewal Notices Plan Non-Renewal Notices Change in Extra Help Co-Payment Notice- from SSA on orange paper explaining copayments levels will change in 2014 Change in Extra Help Co-Payment Notice- from SSA on orange paper explaining copayments levels will change in 2014 Reassignment Notices-Plan Termination-on blue paper explaining that plan is terminating and they will be reassigned to a new plan Reassignment Notices-Plan Termination-on blue paper explaining that plan is terminating and they will be reassigned to a new plan Reassignment Notice-Premium Increase-on blue paper explaining that will be re-assigned to a new plan due to the increase in their current plan premium which is above the benchmark Reassignment Notice-Premium Increase-on blue paper explaining that will be re-assigned to a new plan due to the increase in their current plan premium which is above the benchmark

33. Notices from CMS and SSA October October MA Reassignment Notice-on blue paper explaining that the MA plan is terminating and they will be re- assigned to a Medicare drug plan for 2014 MA Reassignment Notice-on blue paper explaining that the MA plan is terminating and they will be re- assigned to a Medicare drug plan for 2014 November November LIS Choosers Notice-on tan paper explaining if they chose a Plan on their own that the plan’s premium has increased above the benchmark and they will pay a portion of the premium LIS Choosers Notice-on tan paper explaining if they chose a Plan on their own that the plan’s premium has increased above the benchmark and they will pay a portion of the premium

34. Notices from CMS and SSA November November Non-Renewal Reminder Notice- reminds people who do not get LIS that the plan is terminating Non-Renewal Reminder Notice- reminds people who do not get LIS that the plan is terminating Social Security Income Related Adjustment Amount Notice- tell higher income beneficiaries about the higher Part B and Part D premium adjustments Social Security Income Related Adjustment Amount Notice- tell higher income beneficiaries about the higher Part B and Part D premium adjustments Social Security LIS Redetermination Decision Notice-informing beneficiaries of their LIS award for 2014 Social Security LIS Redetermination Decision Notice-informing beneficiaries of their LIS award for 2014 Social Security LIS and MSP Outreach Notice- informs individuals of these two benefits Social Security LIS and MSP Outreach Notice- informs individuals of these two benefits

35. Notices from CMS and SSA December December Social Security Benefit Rate Change Notice- tells people about benefit payment changes due to cost of living increases, premium withholdings, etc. Social Security Benefit Rate Change Notice- tells people about benefit payment changes due to cost of living increases, premium withholdings, etc. Reassign Formulary Notice- on blue paper informing individuals who get LIS and were affected by reassignment which of the Part D drugs they took in 2013 will be covered in their new 2014 Medicare plan Reassign Formulary Notice- on blue paper informing individuals who get LIS and were affected by reassignment which of the Part D drugs they took in 2013 will be covered in their new 2014 Medicare plan January January CMS Non-Renewal Action Notice- reminds people who do not get LIS and whose plan terminated to join a new drug plan CMS Non-Renewal Action Notice- reminds people who do not get LIS and whose plan terminated to join a new drug plan February February Consistent Poor Performer Notice- Informs people that they’re enrolled in a plan that has been identified as a consistent poor performer and encourages them to explore other plan options in their area Consistent Poor Performer Notice- Informs people that they’re enrolled in a plan that has been identified as a consistent poor performer and encourages them to explore other plan options in their area

36. Changes to Plan Finder Tool Session timeout redirects to Medicare.gov Session timeout redirects to Medicare.gov Estimated annual costs rounded to nearest $10 instead of $50 Estimated annual costs rounded to nearest $10 instead of $50 30, 60, 90 day supply info on drug benefit summary pop-up 30, 60, 90 day supply info on drug benefit summary pop-up Medication Therapy Management tab instead of link Medication Therapy Management tab instead of link Show estimated full cost the plan charges Medicare Show estimated full cost the plan charges Medicare January 2014 – Will show costs for the rest of the year ONLY January 2014 – Will show costs for the rest of the year ONLY

37. Money Saving Benefits

38. Extra Help With Drug Costs Sometimes called Low Income Subsidy (LIS) Sometimes called Low Income Subsidy (LIS) People with lowest income and resources People with lowest income and resources Pay no premiums or deductibles Pay no premiums or deductibles Have small or no copayments Have small or no copayments Those with slightly higher income and resources Those with slightly higher income and resources Have a reduced deductible Have a reduced deductible Pay a little more out of pocket Pay a little more out of pocket No coverage gap for people who qualify for LIS No coverage gap for people who qualify for LIS

39. Extra Help in 2013 Group 1 Group 2 Group 3 Premium$0$0 Sliding scale based on income Deductible $325/year $0$0$65 Coinsurance up to $4,750 out of pocket $1.15/$3.50 copay $2.65/$6.60 copay Up to 15% coinsurance Catastrophic coverage $0$0 $2.65/$6.60 copay

40. Medicare Savings Programs Help from Medicaid to pay Medicare premiums Help from Medicaid to pay Medicare premiums For people with limited income and resources For people with limited income and resources May also pay Medicare deductibles and coinsurance May also pay Medicare deductibles and coinsurance Programs include Programs include Qualified Medicare Beneficiary (QMB) Qualified Medicare Beneficiary (QMB) Specified Low-income Medicare Beneficiary (SLMB) Specified Low-income Medicare Beneficiary (SLMB) Qualifying Individual (QI) Qualifying Individual (QI)

41. Medicare Savings Programs Provides payment for Part A and Part B premiums and deductibles and co-insurance Provides payment for Part A and Part B premiums and deductibles and co-insurance QMB QMB SLMB SLMB QI QI

42. Eligibility for QMB Provides assistance with Part B premium and offers additional insurance Provides assistance with Part B premium and offers additional insurance Income not exceeding 100% FPL Income not exceeding 100% FPL $978 individual $978 individual $1313 couple $1313 couple Resources Resources $7,080 for an individual $7,080 for an individual $10,620 for married couple $10,620 for married couple

43. Eligibility for SLMB Benefit is limited to payment of Part B premiums only Benefit is limited to payment of Part B premiums only Income not higher than 120% FPL Income not higher than 120% FPL $1169 individual $1169 individual $1571 couple $1571 couple Resources Resources $7,080 for an individual $7,080 for an individual $10,620 for married couple $10,620 for married couple

44. Eligibility for QI Benefit limited payment of Part B premiums Benefit limited payment of Part B premiums Cannot be otherwise eligible for Medicaid Cannot be otherwise eligible for Medicaid Income not higher than 135% FPL Income not higher than 135% FPL $1313 Individual $1313 Individual $1765 couple $1765 couple Resources Resources $7,080 for an individual $7,080 for an individual $10,620 for married couple $10,620 for married couple

45. SNAP Benefits Supplemental Nutrition Assistance Program (SNAP) Supplemental Nutrition Assistance Program (SNAP) Federally funded program to assist with purchasing food Federally funded program to assist with purchasing food Must have resources (assets) below $3250 if age 65 or older or disabled (some exclusions including the home and its contents, personal property and vehicles) Must have resources (assets) below $3250 if age 65 or older or disabled (some exclusions including the home and its contents, personal property and vehicles) Income requirements based on household size Income requirements based on household size Deductions to income such as medical expenses are allowed Deductions to income such as medical expenses are allowed

46. SNAP- Income Guidelines Household Size Gross Income for Elder or Disabled Person 1$1498 2$2023 3$2548 4$3074 5$3599