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

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

Mar 06, 2024 9 likes •260 views

Changes to Medicare for 2019 1 APPRISE is Pennsylvanias 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

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Changes to Medicare 


for 2019

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APPRISE

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

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APPRISE

provides free counseling to help individuals understand their health care options

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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

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Medicare
 Basics

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Medicare

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

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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

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Medicare

has multiple parts, each of which covers different parts of health care

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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

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Cost Sharing

was intentionally built into the Medicare system Beneficiaries are expected to share the cost of coverage through payments of:

  • Deductibles
  • Co-payments

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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

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MEDICARE PARTS A & B MEDICARE PARTS A & B EMPLOYE R BENEFITS

(through private insurance coverage)

MEDICAID BENEFITS

(through private insurance coverage)

MEDICARE PARTS A & B PRIVATE INSURANC E

(directly

  • btained by

beneficiary)

Medicare Coverage Options

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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

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Medicare Coverage Options Using Private Insurance Products

Basic Medicare

(Part A and B) is primary coverage Supplement (Medigap) Part D Drug Plan

Medicare Part C

(Managed Care Plan) is primary coverage Can include Part D coverage

Option 1 Option 2

Access to Part C requires enrollment in

Basic Medicare

(Part A and B)

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Medicare Prescription Drug Plan (2019)

Plan Pays 95% Beneficiary Pays 5% Plan Pays 75% Beneficiary pays 25%

No Coverage “DOUGHNUT HOLE” Catastrophic Coverage

  • ut of pocket

limit $5,100

Initial

coverage limit $3,820

Partial Coverage

Plan Deductible (if any)

Coverage Gap

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New for 2019

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1.


Changes to Medicare’s
 Annual Enrollment Period

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04/28/2011 18 Understanding Medicare

Medicare’s Annual Enrollment Period

▪

▪October 15 – December 7 ▪Coverage begins January 1

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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

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2.


Non-Medical
 Personal Care Service 
 through Advantage Plans

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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)

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CMS’s language

Supplemental benefits that will

  • Compensate for physical impairments
  • Diminish the impact of injuries or health conditions
  • Reduce avoidable emergency room utilization

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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

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3.


Elimination of Certain Medigaps


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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

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