MACRA MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT OF 2015 HISTORY - - PowerPoint PPT Presentation

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Nov 05, 2022 468 likes •657 views

MACRA MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT OF 2015 HISTORY OF MEDICARE Enacted with Social Security Act 1965 Omnibus Budget Reconciliation Act of 1990 (OBRA 90) Balanced Budget Act of 1997 2003 Medicare Prescription Drug

SLIDE 1

MACRA

MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT OF 2015

SLIDE 2

HISTORY OF MEDICARE

Enacted with Social Security Act

1965

Omnibus Budget Reconciliation

Act of 1990 (OBRA 90)

Balanced Budget Act of 1997
2003 Medicare Prescription Drug

Improvement and Modernization Act (MMA)

Medicare Modernization Act 2010
Medicare Access and Chip

Reauthorization Act of 2015 (MACRA)

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SLIDE 3

MACRA –MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT OF 2015

MACRA is a bipartisan legislation signed into law on April 16, 2015. Key impacts

Pay-for-performance program for providers that focuses on quality, value and

accountability

Extended the Children’s Health Insurance Program (CHIP)
Removes Social Security Numbers (SSNs) from all Medicare cards by April

2019.

Limits the availability of Medicare Cost Plans
Part D income tier adjustments and closing coverage gap
Prohibits the sale of Medigap policies that cover Part B deductibles to “newly

eligibles”

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PAY-FOR-PERFORMANCE

MACRA created the Quality Payment Program that:

Repeals the Sustainable Growth Rate formula
Changes the way that Medicare rewards

clinicians for value over volume

Streamlines multiple quality programs under

the new Merit Based Incentive Payments System (MIPS)

Gives bonus payments for participation in

eligible alternative payment models (APMs)

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SLIDE 5

CHIP

The Children’s Health Insurance Program (CHIP) - Enacted in 1997 to encourage states to expand access to affordable health coverage for uninsured children As an incentive, the federal government picks up a larger share of the costs compared to Medicaid MACRA extended the funding for this program through 2023

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MEDICARE BENEFICIARY IDENTIFICATION NUMBER

MACRA requires that Medicare remove Social Security numbers from the Medicare card and replace it with a Medicare Beneficiary Identification number or MBI. The MBI is required to be randomly generated with 11 characters and have no hidden or special meaning.

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MEDICARE COST PLANS

What is a Medicare Cost Plan?

Medicare cost plans are Medicare Health plans commonly known as a hybrid

between a Medicare Supplement and a Medicare Advantage plan

A Cost plans includes Part A and Part B services as well as some additional

coverage with a network defined by the carrier

Unlike a MA plan, if you see a non-network provider, your services are still

covered under Original Medicare

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In order to manage rising administrative cost, CMS is planning to sunset Cost Plans

ver the next few years

How are Cost Plans impacted by MACRA:

No Medicare contract for newly formed Cost Plans
Non-Renewal of Cost Plans in services areas where 2 or more MA plans meet

minimum enrollment thresholds

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SLIDE 9

MACRA AND MEDICARE PART D

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Accelerated the closing of the coverage gap Amended the ACA freeze on income thresholds for all income categories Reduced the threshold levels for two highest income tiers

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ELIGIBILITY FOR MEDIGAPCOVERAGE

Plans that cover Part B deductible will no longer be available to newly eligible Medicare beneficiaries Newly eligible Medicare beneficiaries are defined as those individuals who:

have attained age 65 on or after

January 1, 2020; or

first become eligible for Medicare

due to age, disability or end-stage renal disease, on or after January 1, 2020.

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SLIDE 11

PLANS IMPACTED

Plan C* Plan F High Deductible Plan F

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Wellmark currently offers Plan F and High Deductible Plan F. As of January 1, 2020, Wellmark will no longer offer High Deductible Plan F for new enrollments Plan F will remain open and available to those eligible for Medicare prior to 01/01/2020.

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WHY PLAN F IS STILL RELEVANT?

Plan F is the most comprehensive Medigap option providing first dollar coverage with no member cost share. What does that mean for our members:

Peace of Mind
No billing in the mail
No fear of the unknown (Part B deductible changes)

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SLIDE 14

Sam is age 67, has been enroll in Medicare Part A since 02/01/2017 and works full time with coverage through his employer Sam is retiring February 1, 2020 and enrolling in Part B Is Sam eligible for Plan F?

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Steve is 68 and was covered by his employer on a HDHP with an HSA. He continued to work past age 65 and chose not to enroll in Part A or Part B. He is set to retire March 1, 2020 and will enroll in Medicare Part A and Part B effective March 1st. Steve would like to enroll in Plan F. Is he eligible?

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Julie is age 49 and is eligible for Medicare due to a disability as of November 1, 2019. Julie is covered under her spouse’s health insurance and has met her deductible. She would like to come off his policy effective January 1, 2020. Julie would like to elect Plan F. Is she eligible?

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Penny is turning 65 on March 15, 2020 and becomes eligible for Medicare March 1, 2020. Both of her sisters have Plan F so she knows that she wants to enroll in Plan F as well. Is Penny eligible for Plan F?

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