SOUTHWESTERN CT AGENCY ON AGINGOCTOBER 5, 2012

CHOICES Counselor Update Training

2013

What we will cover…

Annual Enrollment Period

Part D Plans in 2013

Medicare Advantage Plans

Medigap / Medicare Supplement Plans

The Plan Finder on Medicare.gov

Disenrollment Periods

Annual Enrollment Period

Starts on October 15 th and ends December 7th

The AEP applies to Part D drug plans and Medicare Advantage Plans (MA, MAPD)

During the AEP someone can : Enroll in a PDP or MA/MAPD plan Switch from one PDP to another Switch from a PDP to an MAPD Switch from a MAPD back to Original Medicare with a

PDP

Effective date of coverage is January 1, 2013

Five Special Enrollment Period

Begins December 8, 2012 and goes throughout the 2013 plan year.

During the 5-star SEP you can join or switch from any PDP or MA plan to a 5 PDP or Medicare Advantage Plan.

You can only use this SEP to make one change each year.

Remember, this SEP can only be used to get into a 5 star plan.

Don’t know if we have any 5 plans in CT yet.

Other Special Enrollment Periods

If you qualify for any of the following, you can qualify for a SEP, which allows you to change plans throughout the year.

If you move out of your plan’s service area

If you lose other “creditable” Rx coverage

If you live in an institution

If you are on Medicare & Medicaid

If you are on a Medicare Savings Program

If you are on the Low Income Subsidy

Part D Plans in 2013

In 2013, there will be 30 plans available in CT.

Least expensive plan is AARP’s Saver Plus Plan at $15.00 / month

Most expensive plan is Humana’s Complete Plan at $114.00/ month

Six benchmark plans with $0 premium for anyone on the full low income subsidy

Seven benchmark plans from 2012 will not be benchmarks in 2013

2013 Benchmark Plans

Aetna CVS Pharmacy Plan

Humana Walmart Preferred Plan

Silverscript Basic Plan

SmartD Rx Plan

AARP Saver Plus Plan

Wellcare Classic

2012 Benchmark plans that are not benchmarks in 2013

Cigna Medicare Plan One

Community CCRx Basic

First Health Premier

Healthspring Region 2

Health Net Orange Option 1

Silverscript CVS Caremark Value

United American Select

The Standard Part D Benefit in 2013

Yearly Deductible

Initial Coverage Period

Coverage Gap a.k.a. “donut Hole”

Catastrophic Coverage

Ranges from $0 - $325 depending on plan

Beneficiary pays 100% of drug costs until they meet their deductible

Beneficiary pays roughly 25% of formulary drug costs and plan pays 75% till the total cost of formulary drugs reaches $2,970

Once the total cost of formulary drugs reach $2,970 beneficiary enters gap and pay 47.5% of brand name formulary drug costs and 79% of generic drugs until they spend $4,750 out of pocket

Once beneficiary spends $4,750 out of pocket, coverage gap ends and they now pay only 5% of formulary drug costs.

The Donut Hole in 2013

Brand name “formulary” drugs will continue to be discounted by 47.5% at pharmacy counter

Generic “formulary” drug subsidy will increase to 21% so beneficiary will pay 79% of the cost of drug.

Some Plans are offering generic drug coverage during donut hole.

Cost Sharing for Brand Name Drugs in the Donut Hole 2010-2020

0%10%20%30%40%50%60%70%80%90%

100%

Man. Discount

Plan cost

Enrollee cost

Cost sharing for Generic Drugs in the Donut Hole from 2010-2020

Excluded Drugs

In 2013 benzodiazepines will now be covered by Medicare Part D

Certain Barbiturates will be covered for the following diagnosis: Cancer Epilepsy Certain Mental Illness

The Low Income Subsidy

LIS co –pays for formulary drugs will not exceed

$6.60 for brand name formulary drugs $2.65 for generic formulary drugs

Those on: Any of the Medicare Savings Programs Medicaid SSI

Automatically are enrolled in the Low Income Subsidy

Part D Income Related Premiums

Beneficiaries who file single tax returns w/ income:

Beneficiaries who file joint tax returns with income:

Applicable Percentage

Part D monthly adjustment amount

Less than or equal to $85,000

Less than or equal to $170,000

N/A $0.00

Greater than $85,000 but less than $107,000

Greater than $170,000 but less than $214,000

35% $11.60

Greater than $107,000 but less than $160,000

Greater than $214,000 but less than $320,000

50% $29.90

Greater than $160,000 and less than $214,000

Greater than $320,000 and less than $428,000

65% $48.30

Greater than $214,000

Greater than $428,000

80% $66.00

Medicare Advantage Plans

16 plans available in 2013 Aetna is offering three MA plans (premiums range $0 - $94) Anthem Blue Cross offering one plan ($18 premium) ConnectiCare offering six plans (premiums range $0 -

$204) United Healthcare has four plans (premiums range $0-

$96) WellCare has two plans (premiums range $0 - $49)

2 Special Needs Plans Wellcare Access - SNP for dual eligibles on Medicare &

Medicaid United Nursing Home Plan – for individual in a skilled

nursing facility

Medicare Advantage Enrollment Periods

Annual Enrollment Period - Oct. 15 – Dec. 7th with effective date of coverage being Jan. 1, 2013

Initial Enrollment Period for anyone new to Medicare.

Special Enrollment Periods

Annual Disenrollment Period – Jan. 1 – Feb. 14th

12 month Trial Disenrollment Period

Things to remember when doing plan comparisons

Preferred pharmacy of client

Drug Restrictions Prior authorization Step therapy Quantity limits

Provide consumer with the top two or three plans that cover their drugs and best meet their needs

Find out if their medical providers (Doctors, labs, hospitals) are in the plan’s network (if looking for a MA plan)

Medigap or Medicare Supplement Plans

Most current Medigap rate sheet is 7/2012

Currently 13 approved companies in CT

CT has a continuous open enrollment for Medigap

Someone on QMB cannot purchase a Medigap policy however if they have one prior to getting QMB, they can keep it.

Dates to remember….

Oct. 15 – Dec 7, 2012 is the period that most Medicare beneficiaries must make a change or enroll in a MA/MAPD or Part D plan.

One time SEP for individuals to enroll or switch from one plan into a 5 star plan.

January 1 – February 14, 2013 is the MA disenrollment period where someone in an MA plan can disenroll and return to Medicare and buy a Part D plan .

As a CHOICES Counselor you must remember…

The decision needs to ultimately be made by the consumer.

Our job is to provide unbiased, comprehensive and accurate information and education.

We do NOT tell consumers what plan they should choose.

THE PLAN FINDER

MEDICARE PART D PLANSCOMPARE MEDICARE ADVANTAGE PLANS

MEDIGAP PLANS

Medicare.gov