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 Improvement and Modernization Act (MMA) • Medicare Modernization Act 2010 • Medicare Access and Chip Reauthorization Act of 2015 (MACRA) Confidential and Proprietary – Wellmark Blue Cross and Blue Shield 2
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” Confidential and Proprietary – Wellmark Blue Cross and Blue Shield 3
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) Confidential and Proprietary – Wellmark Blue Cross and Blue Shield 4
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 Confidential and Proprietary – Wellmark Blue Cross and Blue Shield 5
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. Confidential and Proprietary – Wellmark Blue Cross and Blue Shield 6
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 Confidential and Proprietary – Wellmark Blue Cross and Blue Shield 7
In order to manage rising administrative cost, CMS is planning to sunset Cost Plans over 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 Confidential and Proprietary – Wellmark Blue Cross and Blue Shield 8
MACRA AND MEDICARE PART D 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 Confidential and Proprietary – Wellmark Blue Cross and Blue Shield 9
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. Confidential and Proprietary – Wellmark Blue Cross and Blue Shield 10
PLANS IMPACTED Plan C* Plan F High Deductible Plan F Confidential and Proprietary – Wellmark Blue Cross and Blue Shield 11
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. Confidential and Proprietary – Wellmark Blue Cross and Blue Shield 12
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) Confidential and Proprietary – Wellmark Blue Cross and Blue Shield 13
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? Confidential and Proprietary – Wellmark Blue Cross and Blue Shield 14
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 1 st . Steve would like to enroll in Plan F. Is he eligible? Confidential and Proprietary – Wellmark Blue Cross and Blue Shield 15
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? Confidential and Proprietary – Wellmark Blue Cross and Blue Shield 16
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? Confidential and Proprietary – Wellmark Blue Cross and Blue Shield 17
Confidential and Proprietary – Wellmark Blue Cross and Blue Shield 18
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