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SHIBA | 800-562-6900 | September 2019 volunteer training | Page 1 of 50
Volunteer continuing education Statewide Health Insurance Benefits Advisors (SHIBA)
Open Enrollment and 2020 Medigap Changes (MACRA)
September 2019 Continuing Education Outline I. Job Aids and client publicationsII. Troubleshooting and sharing timeIII. Learning objectivesIV. Open EnrollmentV. Medicare Access and CHIP Reauthorization Act (MACRA)VI. Confidentiality and Unique IDsVII. DiscussionVIII. Advanced study resources
IX. Reminders and future trainingX. Continuing education evaluation
Note: Acronyms and Advanced study resources available on My SHIBA.
For training purposes only – do NOT share with consumers.
SHIBA | 800-562-6900 | September 2019 volunteer training | Page 2 of 50
Job Aids and Client Publications SHIBA Job Aids (formerly Quick Reference Cards or QRCs) are documents created by SHIBA, which will assist with your counseling. We’ll reference these documents in bold in this packet along with the corresponding page number, if applicable. We will also reference and make available job aids and client publications from other sources, such as OIC/SHIBA, CMS or SHIPTA in this packet and/or provide a web link when applicable. • SHIBA Job Aid: 2019-2020 Medicare Open Enrollment Period (OEP)
timeline .......................................................................................................................... P. 11 • Job Aids: September 2019 Medicare Minute (MM): Open
Enrollment Login required, Available at the end of August 2019......... shiptacenter.org
• Job aid: Guide to consumer mailings www.cms.gov/Medicare/Prescription-Drug-Coverage/LimitedIncomeandResources/Downloads/Consumer-Mailings.pdf ................................................................................................................. P. 13
• SHIBA Job Aid: SHIBA and PEBB: Counseling roles ............................ P. 19 • SHIBA client publication: Medicare Plan comparison form ............ P. 21 • SHIBA client publication: Your SHIBA Medicare Action plan
(provides help with Open Enrollment) SHIBA form SHP855-SHIBA-Medicare-action-plan-Rev.8-16: www.insurance.wa.gov/sites/default/files/documents/shiba-medicare-action-plan.pdf ............................................................................................................ P. 23
• SHIBA client publication: Your SHIBA Medicare problem-solving action plan: Help with determining next steps and referrals ......... P. 25
• SHIBA client publication: Medicare PlanFinder worksheet www.insurance.wa.gov/sites/default/files/2019-08/medicare-planfinder-worksheet.pdf ............................................................................................................. P. 27
• Job Aid: Medicare PlanFinder ........................................................ medicare.gov
SHIBA | 800-562-6900 | September 2019 volunteer training | Page 3 of 50
• SHIBA client publication: New Medigap changes take place in 2020 ............................................................................................................................................ P. 35
• Job Aids: August 2019 Medicare Minute: Medigaps, login required.................................................................................................................... shiptacenter.org
• CMS Module 03: Supplemental Insurance (Medigaps) Login required, see P. 33 of this packet for more information
• SHIBA Job Aid: SHIBA’s Confidentiality requirements ...................... P. 39 • Job Aids: Advanced study resources, this packet P. 44 ........... My SHIBA • Job Aid: Acronyms: Search My SHIBA for “acronym”
SHIBA | 800-562-6900 | September 2019 volunteer training | Page 4 of 50
Troubleshooting and sharing time Share with your group any questions or information you have about the July topics and any local topics:
• List the information you need when working on a fraud case.• List the action steps to take when you work on a fraud case.
o Example: Explain what to do when you get a call from a client whosays, “I’m the victim of some kind of fraud.”
o Example: Explain what to do and how to transform a panicked callinto a guided counseling session about an event that occurred.
• Explain the differences between fraud, errors and abuse.• Explain how, when working with SMP-related cases, to report fraud to
SHIBA staff so that SHIBA can refer and forward these cases to CMSand the Office of the Inspector General (OIG).
• Identify what our performance measure are for STARS. Explain howyour work helps to meet these performance measures.
• Describe ways to collect different types of data in STARS and how tobest deal with adding data rather than indicating “not collected.”
Local topics: __________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________
SHIBA | 800-562-6900 | September 2019 volunteer training | Page 5 of 50
Learning objectives After today’s training you should be able to:
• Open Enrollmento Describe the purpose of Open Enrollment.o Explain key dates for the upcoming Open Enrollment Period
(OEP).o Explain where to look for the changes to PlanFinder.o Demonstrate a basic understanding of the timeline during open
enrollment, including when information and mailings will comeout.
o Explain changes on the way to PlanFinder.o Explain the types of documents, tools and Job Aids (QRCs) that
SHIBA has available for counselors to assist clients with OE.• MACRA
o Describe the details included in OIC’s publication for MACRA.o Explain what changes to supplement plans are on the way in
2020.o Explain the exact date information associated with MACRA
changes.• Confidentiality and Unique IDs
o Explain what SHIBA means by confidentiality.o Explain the purpose of a Unique ID and who would use it.o List five types of personal protected information.
SHIBA | 800-562-6900 | September 2019 volunteer training | Page 6 of 50
Notes ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
SHIBA | 800-562-6900 | September 2019 volunteer training | Page 7 of 50
INSTRUCTIONAL NOTES: Open Enrollment SHIBA Job Aids are in bold with their corresponding page number in this packet.
I. Open Enrollment a. RTC and group time to review, basics, general information b. SHIBA Job Aid: Medicare Open Enrollment Period (OEP)
Timeline, see P. 11 c. Last year’s September 2018 training packet has some good info
(see Advanced Study Resources P. 47 in this packet for links) d. See September 2019 Medicare Minute (MM)
i. Available online at shiptacenter.org at end of August 2019 ii. Login is required iii. There are usually 3-4 documents
1. Script 2. Teaching Materials 3. Handout(s)
e. Job Aid: Guide to Medicare consumer mailings from CMS (colorful letters) see P. 13
i. Don’t expect many big changes except that dates could adjust by a year.
ii. Grey letters and Deeming 1. The Grey letter (Loss of Deemed status notice) is
important to know about. It should arrive in clients’ mail boxes in September 2019. What’s the purpose of this notice? It’s to inform some people with Medicare they no longer automatically qualify for Extra Help for the following year, and encourage them to apply for Extra Help to see if they’ll continue to qualify. An application for Extra Help is included with the notice.
SHIBA | 800-562-6900 | September 2019 volunteer training | Page 8 of 50
Remember that SHIBA volunteers can help clients complete an Extra Help Application online at https://secure.ssa.gov/i1020/start Deeming for Extra Help works like this: • A person who has Medicare and gets Medicaid,
MSP or is on SSI is automatically eligible (“deemed”) for Extra Help.
• This deeming period lasts for the complete calendar year, even if the person loses their Medicaid, MSP or SSI during the year.
o A person who loses this coverage before June of the calendar year, will be deemed for the rest of that calendar year, but no longer be deemed effective January of the new year.
o A person who loses this coverage between July and December of the calendar year will continue to be deemed for all of that year, and for the complete next calendar year.
iii. 2018-2019 Guide to consumer mailings, CMS version www.cms.gov/Medicare/Prescription-Drug-Coverage/LimitedIncomeandResources/Downloads/Consumer-Mailings.pdf
f. SHIBA Job Aid: SHIBA and PEBB: Counseling roles, see P. 19 g. SHIBA client publication: Medicare Plan comparison form,
see P. 21 h. Discussion, questions, scenarios, experiences from last OE,
questions about next OE i. Question for RTCs: What is the most important info or content
to get out to the volunteers for what they will need to use during OEP?
SHIBA | 800-562-6900 | September 2019 volunteer training | Page 9 of 50
II. SHIBA client publication: Your SHIBA Medicare Action plan (help with Open Enrollment), see P. 23
a. SHIBA form SHP855-SHIBA-Medicare-action-plan-Rev.8-16: www.insurance.wa.gov/sites/default/files/documents/shiba-medicare-action-plan.pdf
b. Can be ordered from Fulfillment III. SHIBA client publication: Your SHIBA Medicare problem-solving
action plan, see P. 25 a. Help with determining next steps and referrals b. Was included in the June 2019 training packet on P. 17 c. Available on My SHIBA as a part of September training
materials IV. Job Aid: PlanFinder at medicare.gov
a. Review of what it is and does, and where to find it b. Optional: Bring up website on computer and review c. PlanFinder updates
The PlanFinder tool is in the process of being updated. The goal is to make it more user-friendly and update the existing platform. The current PlanFinder is over 10 years old. As of 8/2/19, this is what we know:
• The updated version of the PlanFinder should be launched in late August or early September 2019.
• It offers better graphics and is expected to be less complicated to navigate.
• It will have 2019 plan information. • The new and “old” versions will both be available this fall
to allow for training and to work out any kinks in the system.
• When the 2020 plan information is loaded (most likely October 1, 2019), it will be available in the new version only.
SHIBA | 800-562-6900 | September 2019 volunteer training | Page 10 of 50
• As soon as the new version is available or we have more information, we will notify our network.
• We plan to offer training and record a webinar for team members to watch if they choose to this fall.
d. SHIBA client publication: Medicare PlanFinder worksheet, see P. 27
i. Includes a spot for sponsor to add a label with local SHIBA contact information.
ii. How to get help with Medicare options such as calling SHIBA, self-serve by going online or calling 1-800-MEDICARE
iii. www.insurance.wa.gov/sites/default/files/2019-08/medicare-planfinder-worksheet.pdf
iv. Search My SHIBA for “Medicare PlanFinder worksheet.” e. See Medicare & You OEP on pages 3, 56, 65, 74 and 90
For training purposes only – do NOT share with consumers.
SHIBA job aid
Contact: SHIBA | 800-562-6900 | [email protected]
2019 – 2020 Medicare Open Enrollment Period (OEP) Timeline
2019Early September
Social Security checks if some Extra Help (Low-Income Subsidy) clients can still qualify. They must reply or they’ll lose their coverage at the end of 2019.
Late September CMS mails the Medicare & You handbook.September 30 Current plan members must receive Annual Notice of
Change (ANOC). October 1 • Organizations may start marketing plans for 2020.
• TENTATIVE date Medicare posts 2020 plan and drugbenefit data on the Medicare Plan Finder.
October 2 People whose 2019 plan is leaving the Medicare program in 2020 must get notices from plans.
Early October • TENTATIVE timeframe for SHIBA to publish paper copiesof 2020 Part D plan lists.
• TENTATIVE timeframe for SHIBA to post online MedicareAdvantage plan lists for sale in Washington state bycounty.
October 15 • Last date employer/union and other group health plansmust tell enrollees whether or not their drug coverage iscreditable.
• 2019 Annual OEP starts.November 1 – 30
PEBB Open Enrollment, changes effective January 1, 2020.
December 7 2019 Annual OEP ends.December • Social Security Benefit Rate Change Notice – informs
people about benefit changes and Medicare premiumsdue to cost of living increases, etc.
Continued on back
2018 – 2019 Medicare Open Enrollment Period (OEP) Timeline
For training purpose only – do NOT share with consumers.
Contact: SHIBA | 800-562-6900 | [email protected] Page 2 of 2
SHIBA JOB AID – CREATED 7.19.19
2020January 1 Changes made during OEP take effect.January 1 MACRA changes take effect.January 1 – March 31
Medicare Advantage OEP occurs.
If client has: Clients have a one-time option to switch to:
A Medicare Advantage plan with or without drug coverage
A different Medicare Advantage plan with drug coverage OR A different Medicare Advantage plan without drug coverage OR Original Medicare and a Part D plan
OR Original Medicare without a Part D plan
Original Medicare with or without a Part D plan
Clients cannot switch their plan during this time.
Changes made take effect the first day of the month after the plan gets the client’s request.
Guide to consumer mailings from CMS, Social Security, & plans in 2018/2019
Mail date Sender Mailing/color Main message Consumer action
Mid-MaySocialSecurity
Social Security LIS and MSP Outreach Notice (SSA Pub. Forms L447 & L448)
Informs people who may be eligible for Medicare Savings Programs (MSPs) about MSPs and the Extra Help available for Medicare prescription drug coverage.
• If you think you qualify for ExtraHelp, you should apply.
• Apply for Extra Help throughSocial Security.
EarlySeptember
SocialSecurity
Social Security Notice to Review Eligibility for Extra Help (SSA Form No. 1026)
Informs people selected for review that they should see if they continue to qualify for Extra Help. Includes an “Income and Resources Summary” sheet.
If you get this notice, you must return the enclosed form in the enclosed postage-paid envelope within 30 days or your Extra Help may end.
September PlansPlan Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) Model ANOC
By September 30, people will get a notice from their current plan outlining 2019 formulary, benefit design, and/or premium changes.
Review changes to decide whether the plan will continue to meet your needs in 2019.
September Plans
Plan LIS RiderModel LIS Rider
By September 30, all people who qualify for Extra Help will get an LIS rider from their plan telling them how much help they’ll get in 2019 towards their Part D premium, deductible, and copayments.
Keep this with your plan’s “Evidence of Coverage” (EOC), so you can refer to it if you have questions about your costs.
September CMS
Loss of Deemed Status Notice(Product No. 11198) (GREY Notice)
Informs people that they no longer automatically qualify for Extra Help as of January 1, 2019.
Apply for Extra Help through Social Security (application and postage-paid envelope enclosed) or a State Medical Assistance (Medicaid) office.
Late September
CMS
“Medicare & You” Handbook Mailed to all Medicare households each fall. Includes a summary of Medicare benefits, rights, and protections; lists of available health and drug plans; and answers to frequently asked questions about Medicare.
Keep the handbook as a reference guide. You can also download a copy online at Medicare.gov.
Early OctoberEmployer/unionplans
Notice of Creditable Coverage By October 15, employer/union and other group health plans must tell all Medicare- eligible enrollees whether or not their drug coverage is creditable.
Keep the notice.
(All notices available online are hyperlinked, but note that current year versions for many notices aren’t posted until fall. You can also visit Medicare.gov/forms-help-resources/mail-you-get-about-medicare to view this information.)
As of June 2018. Available at: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/LimitedIncomeandResources/Downloads/Consumer-Mailings.pdf
Mail date Sender Mailing/color Main message Consumer action
October Plans Plan Marketing Materials On October 1, plans begin sending marketing materials for 2019.
Use this information to compare options for 2019.
October Plans Plan Non-Renewal Notice By October 2, people whose 2018 plan is leaving the Medicare Program in 2019 will get notices from plans.
You must look for a new plan for coverage in 2019.
October Plans
Change in Extra Help Co-payment Notice (Product No. 11199) (ORANGE Notice)
Informs people that they still automatically qualify for Extra Help, but their copayment levels will change starting January 1, 2019.
• Keep the notice.• No action, unless you believe an error
has occurred.
Late October*This notice won’tbe mailed if nopoor-performingplans are identifiedfor the upcomingplan year.
Plans
Consistent Poor Performer Notice (Product No. 11627)
Informs people that they’re enrolled in a plan that has been identified as a consistent poor performer (i.e. fewer than 3 stars for 3 or more consecutive years) and encourages them to explore other plan options in their area.
• Visit Medicare.gov/find-a-plan to findand compare plans in your area.
• You can change plans during theOpen Enrollment Period (October 15–December 7). Call 1-800-MEDICARE(1-800-633-4227) to change plansoutside of this period. TTY users cancall 1-877-486-2048.
Late October CMS
Reassignment Notice – Plan Termination (Product No. 11208) (BLUE Notice)
Informs people that their current Medicare drug plan is leaving the Medicare Program and they’ll be reassigned to a new Medicare drug plan effective January 1, 2019, unless they join a new plan on their own by December 31, 2018.
• Keep the notice.
• Compare plans to see which planmeets your needs.
• Change plans, if you choose, in earlyDecember.
• For more information, call1-800-MEDICARE, check “Medicare &You,” visit Medicare.gov, or contactthe State Health Insurance AssistanceProgram (SHIP) for free, personalizedhelp.
Reassignment Notice – Premium Increase(Product No. 11209) (BLUE Notice)
Informs non-chooser LIS members thatbecause their current Medicare drug plan premium is increasing above the regional LIS premium subsidy amount, they’ll be reassigned to a new Medicare drug plan effective January 1, 2019, unless they join a new plan on their own by December 31, 2018.
Late October/Early November
CMS
MA Reassignment Notice(Product No. 11443) (BLUE Notice)
Informs people who get Extra Help and whose current Medicare Advantage (MA) plan is leaving the Medicare Program that they’ll be reassigned to a Medicare drug plan effective January 1, 2019, if they don’t join a new MA or PDP plan on their own by December 31, 2018.
• Keep the notice.
• Compare plans to see which planmeets your needs.
• Change plans, if you choose, in earlyDecember.
• For more information, call1-800-MEDICARE, check “Medicare &You,” visit Medicare.gov, or contactthe SHIP for free, personalized help.
As of June 2018. Available at: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/LimitedIncomeandResources/Downloads/Consumer-Mailings.pdf
Mail date Sender Mailing/color Main message Consumer action
Early November
CMS
LIS Choosers Notice (Product No. 11267) (TAN Notice)
Informs people who get Extra Help and chose a Medicare dug plan on their own that their plan’s premium is changing, and they’ll have to pay a different premium in 2019 unless they join a new $0 premium plan.
• Keep the notice.
• You may want to look for a newplan for coverage for 2019 witha premium below the regionallow income subsidy benchmark.(Notice includes list of localplans with no premium liability.)
• Change plans in early Decemberif you choose.
November CMSCMS Non-Renewal Reminder Notice (Product No. 11433 & Product No.11438)
Reminds people who don’t get Extra Help and whose plan is leaving the Medicare Program that they need to choose a new plan for 2019.
You must look for a new plan for coverage in 2019
NovemberSocial Security
Social Security Part B & Part D Income- Related Adjustment Amount Notice
Tells higher-income consumers about income- related Part B and Part D premium adjustments. Includes the information in the December BRI notices (see below.)
Keep the notice.
NovemberSocial Security
Social Security LIS Redetermination Decision Notice Begins
Social Security begins mailing notices letting people know whether they still qualify for Extra Help in the coming year.
• Keep the notice
• If you believe the decision isincorrect, you have the right toappeal it. The notice explainshow to appeal.
• If you have questions, callSocial Security at1-800-772-1213. TTY users cancall1-800-325-0778.
Late November
Social Security
Social Security LIS and MSP Outreach Notice (Form SSA-L441)
Informs people who may be eligible for Qualified Disabled Working Individual (QDWI) about the Medicare Savings Programs and the Extra Help available for Medicare prescription drug coverage.
• If you think you qualify for ExtraHelp, you should apply.
• For more information aboutthe Extra Help or if you want toapply, call Social Security.
DecemberSocial Security
Social Security Benefit Rate Change (BRI) Notice
Tells people about benefit payment changes for the coming year due to cost of living increases, variations in the premiums that are withheld, etc
Keep the notice.
As of June 2018. Available at: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/LimitedIncomeandResources/Downloads/Consumer-Mailings.pdf
Mail date Sender Mailing/color Main message Consumer action
December CMS
Reassign Formulary Notice(Product No. 11475 & Product No. 11496) (BLUE Notice)
Informs people who get Extra Help and were affected by reassignment which of the Part D drugs they took in 2018 will be covered by their new 2019 Medicare drug plan.
• Consider whether this plan is right for you, orwhether another plan might cover more of yourdrugs.
• Compare this Medicare drug plan with others in yourarea.
• For more information, call 1-800-MEDICARE(1-800-633-4227), check “Medicare & You,” visitMedicare.gov, or contact the SHIP for free,personalized help. TTY users can call 1-877-486-2048.
December– January
CMS
Qualifying Health Coverage Initial Cover Notice (Product No. 11865)
This notice accompanies IRS Form 1095-B (Health Coverage). It informs people with Medicare Part A (Hospital Coverage) that their coverage is considered qualifying health coverage, which is required by the Affordable Care Act.
Keep this form 1095-B with your important tax information.
January CMS
CMS Non-Renewal Action Notice (Product No. 11452)
Reminds people who don’t get Extra Help and whose Medicare plan left the Medicare Program that they need to join a new Medicare drug plan if they want Medicare drug coverage for 2019.
You must join a Medicare drug plan by February 28 if you want Medicare drug coverage for 2019.
Daily– ongoing
CMS
Deemed Status Notice (Product No. 11166) (PURPLE Notice beginning in Sept/Oct)
Informs people that they’ll automatically get Extra Help, including people:
1. With Medicare and Medicaid
2. Who belong to a Medicare Savings Pro-gram
3. Who get Supplemental Security Income(SSI) benefits
• Keep the notice.
• No need to apply to get the Extra Help.
• Compare Medicare prescription drug plans withothers to meet your needs.
• For more information, call 1-800-MEDICARE, check“Medicare & You,” visit Medicare.gov, or contact theSHIP for free, personalized help.
Daily– ongoing
CMS
Auto-Enrollment Notice (Product No. 11154) (YELLOW Notice)
Sent to people who automatically qualify for Extra Help because they qualify for Medicare and Medicaid and currently get their benefits through Original Medicare. These people will be automatically enrolled in a drug plan unless they decline coverage or enroll in a plan themselves.
• Keep the notice.• No need to apply to get the Extra Help.• If you don’t join a plan, Medicare will enroll you in
one.• Compare Medicare prescription drug plans with
others to meet your needs.• For more information, call 1-800-MEDICARE
(1-800-633-4227), check “Medicare & You,” visitMedicare.gov, or contact the SHIP for free,personalized help. TTY users can call 1-877-486-2048.
As of June 2018. Available at: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/LimitedIncomeandResources/Downloads/Consumer-Mailings.pdf
Mail date Sender Mailing/color Main message Consumer action
Daily– ongoing
CMS
Auto-Enrollment - Retroactive Notice (Product No. 11429) (YELLOW Notice)
Sent to people who automatically qualify for Extra Help with a retroactive effective date because they either 1) qualify for Medicare & Medicaid or 2) get Supplemental Security Income (SSI). These people will be automatically enrolled in a drug plan unless they decline coverage or enroll in a plan themselves.
• Keep the notice.
• No need to apply to get the Extra Help.
• If you don’t join a plan, Medicare will enroll you inone.
• Compare Medicare prescription drug plans withothers to meet your needs.
• For more information, call 1-800-MEDICARE, check“Medicare & You,” visit Medicare.gov, or contact theSHIP for free, personalized help.
Daily– ongoing
CMS
Facilitated Enrollment Notice (Product No. 11186 & Product No. 11191) (GREEN Notice)
Informs people that they’ll be automatically enrolled in a drug plan unless they decline coverage or enroll in a plan themselves, including people who:
1. Belong to a Medicare Savings Program
2. Get Supplemental Security Income (SSI),
3. Applied and qualified for Extra Help
• Keep the notice.
• If you don’t join a plan, Medicare will enroll you inone.
• Compare Medicare prescription drug plans withothers to meet your needs.
• For more information, call 1-800-MEDICARE, check“Medicare & You,” visit Medicare.gov, or contact theSHIP for free, personalized help
Daily– ongoing
CMS
FBDE RDS Notice(Product No. 11334)
Informs people with Medicare and Medicaid who already have qualifying creditable drug coverage through an employer or union that they automatically qualify for Extra Help, and can join a Medicare drug plan if they want to at no cost to them.
Contact your employer or union plan to learn how joining a Medicare drug plan may affect your current coverage
Daily– ongoing
Social Security
Initial IRMAA Determination Notice
Sent to people with Medicare Part B and/or Part D when Social Security determines whether any IRMAA amounts apply. Notice includes information about Social Security’s determination and appeal rights.
Keep the notice.
As of June 2018. Available at: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/LimitedIncomeandResources/Downloads/Consumer-Mailings.pdf
You have the right to get Medicare information in an accessible format, like large print, Braille, or audio. You also have the right to file a complaint if you feel you’ve been discriminated against. Visit Medicare.gov/about-us/nondiscrimination/accessibility-nondis-crimination.html, or call 1-800-MEDICARE (1-800-633-4227) for more information. TTY users can call 1-877-486-2048.
For training purpose only – do NOT share with consumers.
SHIBA job aid
Contact: SHIBA | 800-562-6900 | [email protected]
SHIBA and PEBB: Counseling roles The PEBB (Public Employees Benefits Board) in Washington state offers health care benefits to many active and retired public employees. The Washington State Health Care Authority manages eligibility, enrollment and plan changes. See: https://www.hca.wa.gov/employee-retiree-benefits
Ways SHIBA can assist PEBB retirees on Medicare
Potential enrollees often contact SHIBA for help with Medicare questions and may ask about choosing and enrolling in PEBB plans. SHIBA counselors are not trained to provide detailed assistance with choosing PEBB plans, but there is some very helpful information at: www.hca.wa.gov. Type “Retiree Enrollment Guide” in the search tool. You can share this guide with clients.
When PEBB members should contact SHIBA
Clients should contact SHIBA at 1-800-562-6900, Monday through Friday, 8 am to 5 pm if they need help with the following questions:
• How and when should I enroll in Medicare?• What does Medicare cost and cover?• I’m choosing the PEBB retiree Premera Medicare Supplement plan that does not
include prescription drug coverage. Can you help me choose a Part D prescriptiondrug plan?
• I already have a Part D prescription drug plan and it’s Open Enrollment. Can you helpme compare drug plan options for the next year? (Medicare Annual Open Enrollmentruns Oct. 15 through Dec. 7 each year.)
• I have limited income. Am I eligible for any help with my Medicare costs?
When clients should contact PEBB Benefits Services
Clients who are PEBB members can contact PEBB Benefits Services at 1-800-200-1004, Monday through Friday, 8 am to 4:30 pm or send a secure online message via https://www.fuzeqna.com/pebb/consumer/question.asp for help with the following services:
Continued on back
SHIBA and PEBB: Counseling roles job aid
For training purpose only – do NOT share with consumers.
Contact: SHIBA | 800-562-6900 | [email protected] Page 2 of 2
SHIBA JOB AID – CREATED 7.19.19
• Enroll or change plans in the Annual Open Enrollment Period (Nov. 1 through Nov. 30each year) or in a Special Open Enrollment (for example, new to Medicare, moved toanother area, change in eligibility)
• Compare and contrast medical coverage options• Provide information about dental coverage• Add or drop dependents• Defer retiree coverage• Make a change to a name, phone number, etc.• Help with eligibility or eligibility changes (like divorce, or becoming eligible for
Medicare)• Eligibility complaints or appeals• Forms• Payroll deductions or premium payments
After clients enroll in a PEBB medical coverage plan, they should contact their plan directly for questions about their coverage, benefits or costs. The phone number is listed on their plan ID card, or go to: https://www.hca.wa.gov/employee-retiree-benefits.
Medicare plan comparison form
Insurance plan name:
Plan type (HMO, PPO, Original Medicare, etc.):
Monthly premium: $ ______________ $ ______________ $ ______________
Part B monthly premium: $ ______________ $ ______________ $ ______________
Part D monthly premium: $ ______________ $ ______________ $ ______________
Coinsurance or copay: $ ______________ $ ______________ $ ______________
Annual deductible: $ ______________ $ ______________ $ ______________
Out-of-pocket maximum:$ ______________ $ ______________ $ ______________
Primary care provider visit: ___________% ___________% ___________%
Specialist visit: ___________% ___________% ___________%
Emergency room visit: ___________% ___________% ___________%
Inpatient hospital stay: ___________% ___________% ___________%
Prescriptions:
Vision:
Dental:
Hearing:
Other services:
Other plan costs you pay
Yes No
Separate cost
Included in plan
Yes No Yes No
Yes No Yes No Yes No
Yes No Yes No Yes No
Option 1: Option 2: Option 3:
Separate cost
Included in plan
Separate cost
Included in plan
Plan considerations Option 1: Option 2: Option 3:
If you’re shopping for a Medicare plan, use this form to help you compare insurance plans.
SHP838-2223-SHIBA-Worksheet-Health plan comparison - 08/19
This project was supported, in part by grant number 90SAPG0012-02, from the U.S. Administration for Community Living, Dept. of Health and Human Services, Washington, D.C. 20201.
Your notes
The Statewide Health Insurance Benefits Advisors (SHIBA) program is a free, unbiased service of the:
Questions?Call our Insurance Consumer Hotline at
1-800-562-6900www.insurance.wa.gov
www.insurance.wa.gov/shiba | 1-800-562-6900 | [email protected]
SHP855-SHIBA-Medicare-action-plan-Rev. 8-16
Your SHIBA Medicare action plan Name: Date:
Thank you for attending a SHIBA (Statewide Health Insurance Benefits Advisor) appointment. We offer free, confidential and unbiased help to understand and navigate health care coverage and Medicare. Please keep this action plan for your records.
The notes that are marked are for you:
� This is the information needed to retrieve my Plan Finder results:o Zip Code:o Drug List ID #:o Date:
� I need more information about my plan choices before I enroll. I will call and ask about:
� I have chosen to enroll in the following plan:
� I will enroll by:o Calling 1-800-MEDICAREo Calling the plan directly at:o Other:
� Date enrollment was completed:
� Other action(s) I will take:
_____________________________________________________________________________ Notes:
If you enroll by December 7, your new plan will take effect January 1.
After you complete your enrollment, the plan should send you an enrollment confirmation in about two weeks. Call your plan if you have any questions. Write down your plan’s customer service phone number here:
If you have any other questions, call SHIBA at 1-800-562-6900 or locally at:
Contact: SHIBA | 800-562-6900 | [email protected] CREATED 7.19.19
Your SHIBA Medicare problem-solving action plan Help with determining next steps and referrals
Thank you for working with SHIBA (Statewide Health Insurance Benefits Advisors) to assist with your Medicare planning and problem-solving. We offer free, confidential and unbiased help to understand and navigate health care coverage and Medicare.
Your name: ________________________________ Date: ___________________
Please keep this step-by-step action plan for your records.
My primary Medicare-related problems or concerns are:
1. __________________________________________________________________2. __________________________________________________________________3. __________________________________________________________________4. __________________________________________________________________5. __________________________________________________________________
Your recommended action plan is:
Recommend you complete by date
Action and comments Actual date completed
Notes:
If you have questions, call SHIBA at 1-800-562-6900 or locally at: ___________________
Medicare PlanFinder worksheet
Questions to consider during Medicare Open Enrollment Note: Medicare Open Enrollment runs October 15 - December 7 for coverage to take effect on January 1.
• Are you comparing options for the coming year?• Are you new to Medicare this year?• Did you recently move to your county?• Is your plan leaving the area?
You can get help with your Medicare options three different ways! You will first need to gather some information and then fill out the worksheet on the following pages to help you with Medicare coverage decisions.
Option 1: Call your local Statewide Health Insurance Benefits Advisors (SHIBA) program <Sponsor name> hosts your local SHIBA program whose network of volunteers serves <County name> County residents with their Medicare options. Our volunteers provide one-on-one counseling and will research options and share them with you so you make an informed decision. SHIBA is a free, unbiased and confidential service of the Washington State Office of the Insurance Commissioner.
Call us for in-person and phone appointments; we also have language assistance available.
Placeholder for sponsor label with local phone no. and address
Option 2: You can self-serve by going online Go to: www.medicare.gov and click on the green button “Find health & drug plans” under the first row of blue buttons near the top of the page. Use the worksheet to enter your personal information to find the plan that best meets your needs and pocketbook.
Option 3: Give 1-800-MEDICARE a call Call 1-800-MEDICARE (800-633-4227) and a Medicare representative will ask you for the information you entered on the worksheet. They’ll use www.medicare.gov to help offer you options so you can find a plan that fits your needs.
Medicare PlanFinder Worksheet - Page 2
Note: If you plan to move, please note the ZIP code you anticipate moving to.
Name: Date of Birth: (Please provide your name as it appears on your Medicare card)
Address: City: (Please provide the mailing address and ZIP code you have on file with Social Security Administration)
State: ZIP: Phone: ( )
Need an interpreter? Circle one: Spanish Russian Chinese Korean Vietnamese Other?________
Authorized Representative Name: ____________________ Phone:_______________ Relationship to you: ____________ Auth. rep. email:__________________________ (The person you designate to advocate, assist or handle affairs related to your health care services.)
Can we contact and share info with your auth. rep.? YES NO
How do you want us to follow up with you? Phone Email Both Phone & Email
Your email address: _________________________________________________
Briefly describe what sort of Medicare plan information you would like us to provide you with, such as “I want help choosing a Medicare Advantage plan for next year.” ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
After we research your options, do you want us to contact you for a phone or in-person appointment? Yes No
Continues on the next page
What is your Medicare Number?
What is your Part A start date?
What is your Part B start date?
Medicare PlanFinder Worksheet - Page 3
Continues on the next page
I currently have the following coverage … (Check all that apply) Original Medicare Parts A and BMedicare Part D plan – Company
name: ________________________Medicare Supplement plan –
Co. name: ____________________Medicare Advantage plan –
Co. name: ____________________Apple Health MedicaidEmployer-sponsored health
insurance from my own job/spouse’sjob
Tricare for Life/CHAMPVAVeterans Administration Indian Health Services Federal Employee Health Plan Public Employee Benefits Board plan Other retiree coverage – plan name:_______________________________WAHealthplanfinder Marketplaceplan:_______________________________
If yes, please provide your client ID #:
To narrow down your options… List clinics & providers you go to: ____________________________________________________ ____________________________________________________ ____________________________________________________
Current Medicare assistance
Do you get help paying for your Medicare Part B premium? Yes No I’m not sure
Do you have a ProviderOne card like the one shown below? Yes No I’m not sure
Medicare PlanFinder Worksheet - Page 4
Get help with Medicare costs We help screen and apply for Medicare assistance programs on your behalf to see if you qualify for help to pay for your medical and prescription drug costs. What is your household’s monthly gross income (before taxes/deductions are taken out)? $_________ single $__________ couple/married $______ (3+ people in household)
Would you like us to help you apply for these programs? Yes No
Please provide us with a list of your current prescriptions. If you can get a computerized list of the drugs you currently take, please attach a copy of it to this worksheet. Otherwise, if you need more space below, attach an additional piece of paper. DRUG NAME STRENGTH DAILY DOSAGE Example: Metformin Example: 30mg tablet Example: Take it twice
daily 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Pharmacy information I prefer to have my prescriptions filled at these pharmacies: ______________________________________________________________________ Please check all that apply: I’m unwilling to use a different pharmacy than the one listed above I prefer to use a mail-order pharmacy I live in a long-term care facility/Name of facility: ______________________________
For office use only: Date Plan finder Worksheet was received: ______ Received by (fax/email/mail)? __________ Medicare.gov details: Zip code: _____________ Drug ID: _____________ Password Date: _______________ Follow up call/email: Attempt 1 (date): __________ Attempt 2 (date): __________ BCF#: __________________ Time duration to process PlanFinder: _____________(minutes) Created 8-7-2019
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INSTRUCTIONAL NOTES: MACRA
I. MACRA is on the way…let’s be ready!a. The Medicare Access and CHIP Reauthorization Act of 2015
(MACRA) is a bipartisan legislation signed into law onApril 16, 2015.
b. What is MACRA?i. The MACRA Quality Payment Program, or QPP, was set by
the government to encourage medical providers toemphasize quality of care over quantity of service.
ii. The first is a Merit-based incentive payment system, orMIPS. Will determine Medicare payment adjustments.
iii. MACRA was created to control Medicare costs,iv. According to the Centers for Medicare and Medicaid
Services (CMS), MACRA was enacted to create a newpayment framework that rewards health care providers forgiving better care instead of more service.
v. What is MACRA www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html
c. SHIBA client publication: New Medigap changes takeplace in 2020, see P. 35
i. www.insurance.wa.gov/new-medigap-changes-take-place-2020
ii. Lots of changes on the wayiii. Review SHIBA client publication
d. Some Medigaps Phased Out for Certain Beneficiaries, loginrequired: portal.shiptacenter.org/resource-published/r1/some-medigaps-phased-out-for-certain-beneficiaries/
e. What You Need to Know About MACRAi. Impacts beneficiaries, doctors and hospitals
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ii. Has several components, most important establishing newways to pay doctors to work with Medicare beneficiaries.
f. Implementation Guidance for MACRA Revisions to MedigapModel Regulationwww.naic.org/documents/cmte_b_senior_issues_related_macra_faq_2018.pdf (first two pages of this 22-page document may beuseful to review)
g. Ways to help clientsi. Tell them about MACRA’s impact.ii. Remind beneficiaries of their new, free Medicare card that
helps protect their identity.iii. Clients should know that after January 2020, zero-
deductible Medigaps plans will no longer be available tonew enrollees. Anyone new to Medicare on January 1,2020 or later cannot purchase Plans F, C or high-deductible F.
iv. Premiums for Part B and Part D may increase if they earnabove a certain threshold.
II. Discussion example from Centers for Medicare & Medicaid Services(CMS)
Question: I turn 65 in November 2019 and I’m eligible for Medicare.If I’m still working and covered by my employer-group medical plan,there might not be any reason for me to enroll in Part B during mybirthday month. If I decide not to enroll during my birthday month,and end up enrolling when I retire, which is sometime after Jan. 1,2020, under the MACRA rule, would a Medigap plan view me as a“newly eligible” Medicare beneficiary? And as a result, would I not beable to buy a Plan C or F?
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Answer: The MACRA rule would NOT consider you “newly eligible” because you turned age 65 before Jan. 1, 2020. You could buy a Plan C or F because you turned age 65 before Jan. 1, 2020.
III. Job Aids: See August 2019 Medicare Minute (MM)a. See Advance Study Resources of this packet for links
i. Login is requiredii. There are usually 3-4 documents
1. Script2. Teaching Materials3. Handout(s)
IV. Job Aid: CMS Module 03: Supplemental Insurance (Medigap)Policies. https://cmsnationaltrainingprogram.cms.gov/?q=global-search&combine=module
i. Module 03 Provides insight on how Medigap policieswork with Medicare, what the policies cover and how theyare structured, and when to buy a Medigap policy.
1. Objectives:a. Explain what Medigap policies areb. Recognize key Medigap termsc. Provide steps to buying a Medigap policyd. Define the best time to buy a Medigap policye. Explain guaranteed issue rightsf. Learn where to get information on Medigap
rights and protectionsV. Reference: October 2018 training packet for MACRA information
www.insurance.wa.gov/shiba-monthly-person-traininga. Topic: Medigaps
i. Four Handouts for the October 2018 packet1. Switching Medicare Supplement (Medigap) plans
job aid
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2. CMS Module 3 WA SHIBA version: MedicareSupplement Insurance (Medigap) Policies – notesversion (PDF)
3. Medigaps and the year 2020i. Some Medigaps phased out in 2020 for certain
beneficiariesii. Switching Medicare Supplement *(Medigap) plans
4. www.insurance.wa.gov/sites/default/files/documents/medicare-switching-medicare-supplements_0.pdf
5. Discuss possible scenarios using this job aid, suchas:
a. Medigaps and snowbirdsb. STARS Beneficiary Contacts – qualifying
MIPPA topicsVI. See Advanced study resources on P. 44 for additional MACRA
research.
Who’s affected by the MACRA Medigap 2020 changes?
New Medigap changes take place in 2020
www.insurance.wa.gov/shiba
Starting Jan. 1, 2020, the Medicare Access and CHIP Reauthorization Act (MACRA), which the federal government enacted in 2015, stops the sale of Medigap Plans C, F and high-deductible Plan F to newly eligible Medicare beneficiaries. All three of these Medigap plans cover the Medicare Part B (medical insurance) deductible.
• People turning 65 on or after Jan. 1, 2020. • If you first become eligible for Medicare due to age, disability or end-stage renal disease on
or after Jan. 1, 2020, under MACRA you’re considered “newly eligible.”• You cannot buy and no one can sell you Medigap Plans C, F or high-deductible Plan F on or
after Jan. 1, 2020. • Medigap Plans D, G and high-deductible plan G replace Medigap Plans C, F, and high-
deductible Plan F for “newly eligible” beneficiaries.
Who’s not affected by the MACRA Medigap 2020 changes?• People already age 65 or who will turn 65 before Jan. 1, 2020. • If you first become eligible for Medicare due to age, disability or end-stage renal disease
before Jan. 1, 2020, you don’t need to take any action or make any changes, unless you want to make a change.
• If you first become eligible for Medicare due to disability or end-stage renal disease before Jan. 1, 2020, and turn age 65 on or after Jan. 1, 2020, you’re still eligible to buy a Medigap Plans C or F.
• You can keep your Medigap Plan C, F or high-deductible Plan F, or you may still buy them on or after Jan. 1, 2020. You don’t lose your Medigap coverage. If an insurance agent or broker tells you will lose it and must buy new coverage, it’s NOT TRUE!
• Medigap coverage is guaranteed renewable. As long as you pay the premiums, your insurer cannot cancel your coverage.
• Medigap Plans C, F and high-deductible Plan F premiums will not dramatically increase to the point you’ll need to buy other coverage. If an insurance agent or broker tells you the premiums will, they might be improperly trying to get you to switch coverage. This is FALSE and they’re in clear violation of Medigap insurance laws.
For more detailed information or questions, contact the Statewide Health Insurance Benefits Advisors (SHIBA) at 800-562-6900.
SHP870/4.24.2019
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INSTRUCTIONAL NOTES: Confidentiality and Unique IDs
I. Confidentiality:a. Review Volunteer Handbook (VH) requirements and
expectationsi. SHIBA volunteers are responsible for protecting private
information obtained while volunteering. You cannotdisclose to unauthorized people any confidentialinformation you acquire through official duties. You alsocannot use such information for personal gain or benefit,or for the gain or benefit of others. VH p. 47.
ii. VH pages 47-62b. Review of Volunteer Risk Program Management (VRPM) policies
and requirementsi. Volunteers take all steps necessary to safeguard the
confidentiality of all SHIBA- and client-related informationand to prevent personal client information from fallinginto the possession unauthorized people. Volunteers canonly use any information collected or obtained in theircourse of their SHIBA work to assist the client orotherwise fulfill volunteer role responsibilities. VRPMPolicy 3.94, P. 34
ii. VRPM Policies: 2.6, 3.27, 3.43, 3.82, 3.94, 3.98, 4.1, 4.3c. SHIPTA Protecting Client Privacy and Confidentiality Webinar
Login requiredi. Webinar: https://portal.shiptacenter.org/resource-
published/r1/protecting-client-privacy-and-confidentiality-webinar/
ii. PowerPointhttps://portal.shiptacenter.org/media/4956/protecting-client-confidentiality-and-privacy-powerpoint-training-template-march-2019-4.pdf
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II. Sending emails: Cannot send an email with confidential info withoutencrypting it first
III. OPTIONAL TRAINING: Using your Medicare Unique ID:a. A Medicare Unique ID allows SHIBA advisors to get more
detailed information from Medicare to assist clients. It allowsfor:
i. Get through to Medicare right away;ii. Provide elevated assistance for SHIBA clients when you
have the facts about their Medicare coverage; andiii. Call Medicare – even if the beneficiary is not on the phone
or with you.b. Volunteers should consult with their volunteer coordinator (VC)
or regional training consultant (RTC) if they have any questionsabout how to obtain or use a Medicare Unique ID.
c. Check the Advanced Resources section on P. 47 of this packetfor additional information and links.
IV. GROUP confidentiality training discussiona. RTCs and volunteers MUST COVER THIS TOGETHER DURING
TRAININGb. SHIBA Job Aid: SHIBA’s confidentiality requirements,
see P. 39
For training purposes only – do NOT share with consumers.
SHIBA job aid
Contact: SHIBA | 800-562-6900 | [email protected]
SHIBA’s confidentiality requirements
What is confidentiality: Trusting someone, especially when sharing private matters. Firm belief, trust or reliance that another person will not disclose private and personal matters to unauthorized people.
Why it’s important: Confidentiality is about building and maintaining trust. It frees clients to share personal information that counselors need to do their work. It shows respect for and helps protect clients. It builds SHIBA’s reputation as a trusted, reliable resource. It helps prevent costly privacy and security breaches (e.g., legal fees and fines). Federal and state laws authorize fines for certain privacy and security breaches.
What is HIPAA? Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy rule: Federal law that protects all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. It defines, establishes permitted use and disclosure of, and regulates uses of Protected Health Information (PHI).
Who must comply?: “Covered Entities” and their business associates including health plans, health care providers, health care clearinghouses and business associates.
How does HIPAA apply to SHIBA?: Local co-sponsors may be covered entities if they provide health care services or contract with those who do. Most third parties SHIBA interacts with are covered entities (i.e., Medicare, Medicare Advantage plans, hospitals, doctor offices, 1-800-MEDICARE, etc.).
There are a variety of individually identifiable health information rules, privacy rule protections, required disclosures, permitted disclosures, and privacy rule protections associated with HIPPA. State privacy protection laws apply to individuals and organizations, including non-profit agencies and define Personal Protected Information (PPI).
VRPM Confidentiality Policy: Policy 3.94 - SHIBA volunteers are responsible for maintaining the confidentiality of all proprietary or privileged information to which they are exposed while serving as a volunteer, whether this information involves a member of staff, a volunteer, a beneficiary or other person, or involves the overall business of SHIBA.
SHIBA’s confidentiality requirements
For training purposes only – do NOT share with consumers.
Contact: SHIBA | 800-562-6900 | [email protected] Page 2 of 3
SHIBA JOB AID – CREATED 7.30.19
NOTE: Technically, SHIBA is not subject to HIPAA, however, confidentiality applies to volunteer’s work and HIPAA applies to the work of some of our partners.
What are PII, PHI and PPI and why are these important?: In conducting SHIBA work, we collect both Personally Identifiable Information (PII) and PHI. The biggest differences between PII and PHI are:
• PII is ANY potentially identifying information either on its own or when combined with other information. It’s information that can be used to trace an individual’s identity, such as their name, social security number, biometric records, etc., alone or when combined with other personal or identifying information that is linked or linkable to a specific individual, such as a data and place of birth, mother’s maiden name, etc.
• PHI is HEALTH information and specifically identifies a person. It includes many common identifiers (e.g., name, address, birth date, Social Security Number) when they can be associated with the health information listed. This is sometimes entered in a notes/comment field.
• PPI = PII and PHI. PPI is a beneficiary’s first name and last name or first initial and last name in combination with at least one from the following: o Social Security number o Driver’s license number or state-issued identification card number o Financial account number or credit or debit card number, with or without any
required security code, access code, personal identification number or password, that would permit access to a resident’s financial account
Keep in mind that PPI is the combination of PII and PHI, so there could be more personal identifiers than just those listed above, such as Medicare ID number, date of birth, account numbers or health record information. PPI does not, however, include information that is lawfully obtained from federal, state, or local government records that are available to the general public.
What is a security breach?: A security violation that occurs when unauthorized people gain access to confidential, private and personally identifiable information by stealing, overhearing, dumpster diving, reading documents, extracting data and any other means.
• Do not disclose any information you collect or obtain through your SHIBA work other than when it’s clearly approved by an authorized SHIBA representative.
• There is zero tolerance for breaching confidentiality in connection with any SHIBA work. (VRPM Policy 3.94)
SHIBA’s confidentiality requirements
For training purposes only – do NOT share with consumers.
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SHIBA JOB AID – CREATED 7.30.19
• Immediately notify your supervisor if you misplace, lose or someone stole information, files or data so SHIBA can appropriately notify the affected clients and authorities, and can institute the appropriate future safeguards. (VRPM Policies 3.94, 4.3 and Volunteer Handbook pages 47-48).
Confidentiality best practices: Use private spaces, use computer screens with covers, store confidential documents in secured locations and shred written notes when no longer needed. If you need help, consult with your volunteer coordinator.
Computer Internet Technology (IT) Policy: Do’s: Do control access, maintain safe operation of computers, use password protection as required, clear browser history, report lost or stolen information to your supervisor, use strong passwords and lock your computer and portable devices. Be sure to use encrypted email when sending sensitive and confidential data unless otherwise authorized. For questions about encrypted email, consult your volunteer coordinator.
Don’ts: Don’t send or forward emails with PPI to personal email accounts and don’t use unauthorized devices. Source: Protecting Client Privacy and Confidentiality https://portal.shiptacenter.org/media/4956/protecting-client-confidentiality-and-privacy-powerpoint-training-template-march-2019-4.pdf
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INSTRUCTIONAL NOTES: Discussion options
These options may be presented as a discussion, demonstration or practical exercise.
• Open discussion about Open Enrollment concerns, suggestions,requests for information or additional training.
• Discussion about confidentiality. Review of any open issues orquestions about expectations and processes.
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INSTRUCTIONAL NOTES: Advanced study resources These resources are supplemental to this month’s topic and provide more in-depth content and information. The links are accessible from the electronic version of this training packet located on My SHIBA.
Optional advanced learning projects: • Compare Medigaps and MA plans• Switching Medicare supplement plans: See the tool in the September
2018 Medicare Minute, links below
Checklist for SHIBA open enrollment counseling www.insurance.wa.gov/sites/default/files/documents/shiba-open-enrollment-counseling-checklist_0.pdf
Comparing Medicare Supplement (Medigap) and Medicare Advantage plans www.insurance.wa.gov/sites/default/files/documents/ma-medigap-compare-chart_0.pdf
HHS Health Information Privacy Website www.hhs.gov/hipaa/index.html
MACRA: Advanced research This section has several MACRA-related links.
Implementation guidance for MACRA Revisions to Medigap Model Regulation www.naic.org/documents/cmte_b_senior_issues_related_macra_faq_2018.pdf
MACRA: What’s MACRA www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html
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2020 Medigap Changes: No New Plans C and F: Learn what the Congressional change means for your Medigap plan www.senior65.com/medicare/article/medigap-changes-for-2020-no-new-plans-c-and-f
Is Medicare Supplement Plan F Going Away? medicare.com/medicare-supplement/is-medicare-supplement-plan-f-going-away/
H.R. 2 – Medicare Access and CHIP Reauthorization Act of 2015 www.congress.gov/bill/114th-congress/house-bill/2 Section 401 Marketing Models, Standard Documents, and Educational Material www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/MarketngModelsStandardDocumentsandEducationalMaterial.html Medicare Advantage plans Fact Sheet: What you need to know before you buy (Also in Mandarin and Spanish) www.insurance.wa.gov/sites/default/files/documents/medicare-advantage-plans-before-buy_1.pdf Medicare Marketing Guidelines: Downloads www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/FinalPartCMarketingGuidelines.html Medicare Minute – August 2019: Medigaps Login required https://portal.shiptacenter.org/resource-published/r2/august-2019-medicare-minute-medigaps/ Medicare Minute – September 2019: Fall Open Enrollment Period Login required Available at the end of August 2019 in the shiptacenter.org resource library.
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Medicare Minute Script – September 2018: Medicare’s Open Enrollment Period Login required https://portal.shiptacenter.org/resource-published/r2/september-2018-medicare-minute-medicare-s-open-enrollment-period/
Medicare Plan comparison form www.insurance.wa.gov/sites/default/files/documents/medicare-plan-comparison-form_0.pdf
Medicare Plan Finder 101: Tips and Tricks for Navigating the Plan Finder www.insurance.wa.gov/sites/default/files/documents/medicare-plan-finder-tips.pdf
New Medigap changes take place in 2020 www.insurance.wa.gov/new-medigap-changes-take-place-2020
Prohibited and Appropriate Agent/Broker Behavior for MA/PD Plans 2011 version: www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/downloads/AgentBrokerDosDonts080411.pdf Check with your VC or RTC for the 2018 version or visit dfr.vermont.gov/sites/finreg/files/doc_library/cms-marketing-medicare-agent-broker-dos-and-donts.pdf (October 2018 version)
Protecting Client Privacy and Confidentiality (PowerPoint template) Login required portal.shiptacenter.org/resource-published/r2/protecting-client-privacy-and-confidentiality-powerpoint-template/
Quality Payment Program measure development: What are the CMS Quality Measure Development Plan (MDP) & the MDP Annual Report? www.cms.gov/Medicare/Quality-Payment-Program/Measure-Development/Measure-development.html
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SHIBA and PEBB: Ways SHIBA volunteers can assist PEBB retirees www.insurance.wa.gov/sites/default/files/documents/shiba-pebb_0.pdf
SHIBA September 2018 training and supplemental content www.insurance.wa.gov/shiba-monthly-person-training
Packet: Paving the way for Medicare open enrollment (PDF, 815.61 KB)
Medicare prescription drug coverage • Medicare Prescription Drug Coverage slides with notes (PDF, 4.63 MB)• Medicare Prescription Drug Coverage (PowerPoint, 1.86 MB)• Medicare Prescription Drug Coverage slides (PDF, 1.22 MB)
Medicare Plan Finder• Medicare Plan Finder instructions webinar (www.youtube.com)• Medicare Plan Finder 101: Tips and tricks for navigating the Plan
Finder (PowerPoint, 3.70 MB)• Medicare Plan Finder 101: Tips and tricks for navigating the Plan
Finder (PDF, 1.84 MB)• Print a customized Medicare Plan Finder report (PDF, 336.20 KB)
Other September packet material• SHIBA complaints process (PDF, 77.42 KB)
SHIP Resource Library: STARS Security Slick Sheet Login required https://portal.shiptacenter.org/resource-published/r1/stars-resources-stars-security-slick-sheet/
Switching Medicare Supplement (Medigap) plans www.insurance.wa.gov/sites/default/files/documents/medicare-switching-medicare-supplements_0.pdf
Unique ID Information This section has several Unique ID-related links
Confidentiality Agreement for Receipt of Unique ID www.insurance.wa.gov/sites/default/files/documents/unique-id-confidentiality-agreement_1.pdf
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Using your Medicare Unique ID www.insurance.wa.gov/sites/default/files/documents/using-medicare-unique-id_1.pdf
Using your CMS unique ID Webinar from July 10, 2019 Login required www.smpresource.org/ResourceLibrary/Resources/1AA34A6E-D3D3-4CEB-A3D4-00C682EBE832/Using-Your-CMS-Unique-ID-Webinar.aspx PowerPoint Handout www.smpresource.org/Handler.ashx?ItemResourceId=734b3604-f571-4a66-b2e9-1bd835e9661f&ItemType=File
Medicare Unique IDs www.insurance.wa.gov/medicare-unique-ids
How to Request a Medicare Unique ID (5 page slide presentation) www.insurance.wa.gov/sites/default/files/documents/request-unique-id-number.pdf
Your SHIBA Medicare action plan www.insurance.wa.gov/sites/default/files/documents/shiba-medicare-action-plan.pdf
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Reminders and future training
Training Evaluation Please fill out the training evaluation. We value your feedback!
2019 and 2020 training
Training topics are subject to change.
Content ideas If you have ideas, include them on your evaluation form and return it to your RTC.
New content: We are working to reformat all the SHIBA Job Aids (formerly QRCs) so they are in an easy-to-recognize format with “SHIBA job aid” at the top and a created/revised date at the bottom.
We’re also working to centralize all the SHIBA Job Aids in one easy-to-find location on My SHIBA. More information soon!
October How to afford drug costs November Accessing supplemental benefitsDecember No trainingJanuary 2020 Welcome to 2020February TBDMarch TBDApril Volunteer Recognition, topic TBD
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Continuing education evaluation Date of Training: _______________ Training Location: ______________________
How can SHIBA improve the monthly trainings? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
What additional trainings within our SHIBA scope would you like to see? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
What SHIBA training materials — including SHIBA Job Aids (formerly QRCs) — would you like to see added to My SHIBA? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Other: _________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________
Optional: If you would like to be contacted, please provide your name and contact information. Someone in our office will contact you. Thank you! Name: ________________________________________________________________________ Day Phone: ________________________Email: ____________________________________
If you prefer to give electronic feedback about curriculum or training, please contact: Diana Schlesselman: [email protected] or Liz Mercer: [email protected].
Thank you!
