1 Benefits update StateWide Senior Action Council annual convention East Greenbush, NY October 12, 2011 Presenter: Cathy Roberts, Senior Paralegal Empire Justice Center, Albany, NY

2 Today’s presentation  A review of changes affecting: Medicare Medicaid Food stamps HEAP (Home Energy Assistance Program)

3 Medicare update: what’s new in 2012

4 Medicare Part D  New open enrollment period: Oct 15 - Dec 7  Special enrollment period for 5 star plans  Higher Part D premiums for higher income beneficiaries  Gradual closing of coverage gap  14% discount for generics  50% discount for brand name drugs  $0 drug co-pays for HCBS Medicaid waiver participants

5 Medicare Advantage  Same change to open enrollment period: Oct 15 - Dec 7  Preventive services must be free  Other limitations on cost sharing:  Chemotherapy  Dialysis  Skilled nursing facility

6 Original Medicare  Mental health co-pays reduced to 40%  Were 45% in 2011  Coming soon: Info regarding Part A and B premiums, deductibles, etc.

7 Programs that help with Medicare cost-sharing PROGRAMMONTHLY INCOME LIMIT (after disregards) RESOURCE LIMIT Extra Help (Part D Low Income Subsidy) $1,362 single $1,839 couple $12,640 single $25,260 couple Medicare Savings Program: QI-1 $1,226 single $1,655 couple none Medicare Savings Program: SLIMB $1,089 single $1,471 couple none Medicare Savings Program: QMB $908 single $1,226 couple none Community Medicaid for 65+, disabled or blind $767 single $1,117 couple $13,800 single $20,100 couple

8 What’s new in Medicaid

9 No more Medicaid “wrap” for dual eligibles  Medicaid no longer pays for any Part D covered drugs (as of 10/1/2011)  Medicaid continues to cover:  Part B drugs (co-insurance)  Benzodiazepines  Barbiturates  Prescription vitamins  Certain OTC drugs

10 New limitations in Medicaid services  Affects access to:  Compression stockings  Prescription footwear  Enteral nutritional formula  Level 1 personal care services  Physical, occupational and speech therapy

11 Dramatic expansion of mandatory managed care  Does not affect most Medicare beneficiaries (yet), except for:  New requirements governing managed long term care (MLTC).  Beginning in NYC in May 2012:  Anyone needing personal care for more than 120 days will be required to enroll in an MLTC plan

12 Reduction in reimbursement rates to providers  Decreased reimbursement rates may affect access to care, especially:  Home care services  Adult dental care

13 Food Stamps (aka SNAP: Supplemental Nutrition Assistance Program)

14 Many eligible seniors are not participating  Estimated “take-up” rate for seniors: 34%  Recent changes have improved access  No asset test for most seniors  No in-person interview required  Can apply by mail or internet  Most seniors getting Part D Extra Help or EPIC premium assistance can qualify  For more info, go to

15 HEAP: Home Energy Assistance Program

16 Cuts on the federal level will drastically affect New York this winter  Shorter HEAP season:  Regular HEAP opens Nov 16, 2011  Emergency HEAP not expected to open until January 3, 2012  Significant reduction in benefit levels:  Most households will get 30-40% less than what they got last year  More info is available at

17 Where to go for help  Health Insurance Information Counseling and Assistance Program (HIICAP)  NYS toll-free helpline:  MEDICARE or  Social Security Administration (to enroll in Medicare): or  Food stamps and HEAP :

18 Questions? My contact information: Cathy Roberts, Senior Paralegal Empire Justice Center 119 Washington Avenue Albany, NY x 112