2010 Medicare Updates

Posted on January 22, 2010

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The Medicare Improvements for Patients and Providers Act –

What You Need to Know

The Medicare Improvements for Patients and Providers Act of 2008 will be beneficial for Medicare beneficiaries in 2010. Important highlights of changes are listed below. The Low-Income Subsidy Program (LIS) that assists with premiums and copayments for Medicare Prescription Drug Plans and Medicare Savings Programs which assist with the Medicare Part B Premiums will have some positive changes in regards to eligibility.

  • Effective January of 2010 the Medicare Savings Program (MSP) will have the same asset test as the Low Income Subsidy (LIS) asset level for full subsidy individuals. With this asset increase it will allow many more beneficiaries to benefit from this program which assists by paying for the Medicare Part B premium. The new asset limit will be going up from $4,000 for an individual and $6,000 for a couple to $8,100 for an individual and $12,910 for a couple. This asset test has not changed since 1986.
  • The Social Security Administration has designed the 2010 Low Income Subsidy application to include the beneficiaries consent to provide application data to MassHealth regarding potentially eligibility for the Medicare Savings Program. If the beneficiary permits, the state then contacts with the client regarding accessing eligibility. This will be very helpful as many beneficiaries first connection to Medicare takes place at the local Social Security office upon their 65th birthday.
  • Eliminates estate recovery for those who are enrolled in the Medicare Savings Program. The state will not be allowed to collect from the estates of deceased beneficiaries for the amounts paid to Medicare Savings Program recipients. This will encourage more people to enroll in this program, which provides additional monthly income, with no strings attached.
  • Change to LIS income and Resources
  • Social Security Administration will not consider in-kind support and maintenance as income for LIS applicants.
  • Cash Surrender value of Life Insurance policies will no longer be considered as a re-source, again making it easier to qualify for this helpful benefit.

Part A and Part B beneficiaries will benefit due to:

  • Mental health services now covered under Medicare at 50% will gradually increase over the next six years to 80%, which is the coinsurance rate for other Medicare services. The in-crease for 2010 will go from 50% to 55%.

This article was written in cooperation with the Health Assistance Partnership from a comprehensive list of the changes called “MIPPA Act Changes Effective January 2010” for more detailed information.

CMS Announced the Medicare Part B Premiums for 2010

Most Medicare beneficiaries will not see a Part B monthly premium increase as a result of a “hold harmless” provision in the current law. This allows for 73 percent of beneficiaries to be protected from an increase raising the 2010 Part B monthly premiums from $96.40 to $110.50.

Approximately 27 percent of beneficiaries are not subject to the hold-harmless provision be-cause they are new enrollees during the year (3 percent), they are subject to the income-related additional premium amount (5 percent), they do not have their Part B premiums with-held from social security benefit payments (19 percent), including those who qualify for both Medicare and Medicaid and have their Part B premiums paid on their behalf by Medicaid (17 percent).

2010 Medicare & You Handbooks

The 2010 Medicare & You Handbooks were mailed to Medicare beneficiaries mid to late October. Let me know if you need any.

2010 Part D Benchmark Premium

The Centers for Medicare and Medicaid (CMS) has announced the regional benchmark premium for 2009; it will be $34.60. If you are a dual eligible and your plan’s premium is at or below the regional benchmark, your full premium will be covered. If your plan’s premium is above the benchmark, you will pay the cost above the benchmark. Dual eligibles will have 13 plans to choose from.

Beneficiaries who have full LIS “Extra Help” in a plan that will exceed the benchmark, due to premium increase, will be re-assigned to a new plan. Additionally, a beneficiary whose plan is leaving the market will be re-assigned to a new plan. CMS will be sending letters.

Colored Letters Beneficiaries May Receive From CMS

  • Grey Letter: Those who were “deemed” eligible for Extra Help because they receive another benefit but who have lost their “deemed” status Loss of Deemed Status – Action
    • Reapply for Low Income Subsidy ASAP
    • Re-qualify through the program through which they were deemed.
  • Orange Letter: Those whose co-payment will change in January 2010 Change in Extra Help Co-payment – Nearly all Extra Help recipients should receive letter from CMS and were mailed in early October. – Action
    • Recipients of this letter should keep it for their records; unless they dispute its contents and wish to appeal, they need take no action.
  • Tan Letter: Those who have chosen a Part D plan that will no longer be a “benchmark”, plan starting in January 2010 (benchmark plans have been designated by Medicare to meet certain coverage requirements and have a monthly premium amount that is fully subsidized by Extra Help). People Who Choose Non-Benchmark Plans
    • Recipients are advised that they might want to review plan choices and chose a different plan that will be a benchmark plan in 2010.
    • A list of 2010 benchmark plans is included with the letter.
    • If they do not choose a benchmark plan, they will be liable for, and pay out-of-pocket, a portion of their plan’s premium.
  • Blue Letter Version 1: Reassigned because their current Part D plan is leaving the market – CMS will be reassigned to new plan.
  • Blue Letter Version 2: Letting beneficiary know their current plan is above the benchmark in 2010. These letters will inform beneficiaries that they will be reassigned to new plan below the benchmark.
    • Individuals who are reassigned are advised to look at the plan to which they have been assigned to see if it meets their needs
    • Beneficiaries choosing their own plan can sign up for a plan until December 31 and its effective date will be January 1.
  • Purple Letter: Daily ongoing – This letter informs people that they will automatically get Extra Help, including people 1) with Medicare and Medicaid, 2) in Medicare Savings program and who receive Supplement security benefits
    • Keep the notice
    • No need to apply for Extra Help
    • Compare plans
  • Yellow Letter: Sent to people who automatically qualify for Extra Help because they qualify for Medicare & Medicaid and currently get their benefits through the Original Medicare Plan. These people will be automatically enrolled in a drug plan if they don’t enroll themselves or decline coverage.
    • 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 Plans
  • Green Letter: Informs people who either 1) belong to a Medicare Savings Program or 2) get Supplemental Security Income (SSI), or 3) applied and qualified for the Extra Help that they will be automatically enrolled in a drug plan if they don’t enroll themselves or decline coverage.
    • Keep the notice
    • If you don’t join a plan, Medicare will enroll you in one.

The later people sign up in the enrollment period, however, the more likely they are to experience delays in getting plan documents and having their enrollment appear in the relevant databases that will allow them to get drugs with their subsidy. It is wise, therefore, to enroll in a plan as early as possible; open enrollment begins November 15, 2009.

2010 Plan Reassignments

Reassignment happens when a plan is no longer below the benchmark for the upcoming year. Auto assigned Low Income Subsidy (LIS) members in 2009 LIS plans that will not be available in 2010 will be reassigned to a new plan under the benchmark by CMS. The reassignment effective date will be January 1, 2009. LIS members who voluntarily chose to join such plans will NOT be reassigned. All members who have been reassigned will receive a Welcome Kit from their new plan effective 1/1/10.

Medicare Part D and Enrollment: Choosing a Plan that Works for You

The steps you can take to help you maneuver through Medicare Part D.

Medicare Part D is Medicare’s prescription drug coverage. It covers drugs that you would purchase at the pharmacy. You can only get Part D through a private plan. If you want or need part d, now is the time to research the plans that will best meet your needs. Medicare Part B is the part of Medicare that covers outpatient doctors and providers as well as durable medical equipment like walkers and wheelchairs. Medicare Part B has a monthly premium. Medicare Part A is the part of Medicare that covers inpatient hospitalization and skilled nursing facilities as well as some type of home health care. Most people get Part A for free, if they have worked a certain number of quarters.

What are the best Medicare advantage products in Massachusetts?

We can’t really answer this question outright. So much depends upon your own personal healthcare needs. There are different types of Medicare Advantage Plans: HMO’s, PPOs, PFFS. Each has its own set of rules. For example, HMO’s require that you go to doctors and hospitals within a very prescribed network. PPO’s allow you to go out of network. You really need to ask your doctors what plans they take and then choose a plan that will allow you to go to your favorite doctors and providers.

How can I find out which drugs, Medicare D requires a company to cover?

There are only about 7 categories of drugs that Medicare Part D does not cover — by law. Most D covers most categories of drugs. Generally speaking, every part D plan must cover a few drugs within each category. So if you can’t get the brand that you want, you may be able to get a generic in that same category, if the doctor thinks that would work for you. If you can ONLY take a certain brand and the plan doesn’t cover the drug, then you can ask the plan to make an exception. You will need your doctor’s support in order to get an exception. We have lots of information about how to “appeal” a drug denial on Medicare Interactive.

There is a one-page resource PDF available called “Find the Right Medicare Part D Plan” from the PHAssociation.

What happens while in the donut hole…

When you are in the donut hole, you must pay 100% out of pocket for drugs. However, there are some plans that will cover generics through the donut hole. If you are researching drug plans, this may be something to consider. In addition, if one is of limited income, then he/she may be eligible for Extra Help — the federal program that help pay for the cost of prescription drug coverage. If you are in Extra Help, this program will cover your covered drugs through the donut hole. IN addition, many states have State Pharmaceutical Assistance Programs. For example, in Massachusetts we have Prescription Advantage. These programs can be helpful through the donut hole. Not all states have these programs. Finally, pharmaceutical programs have Patient Assistance Programs. These programs allow you to apply for assistance through the company. If you qualify, they will help subsidize the drug. In Massachusetts, you can find out more about these programs by calling the Mayor’s Health Line at 617-534-5050.

Where can I find info on part D plans available?

You can find information and compare drug plans on Medicare’s website.

The Medicare booklet has a list of available plans. What you don’t see is whether certain medications are excluded. For example, a patient on blood thinners may be required to go to Lovenox (very expensive) in advance of a heart cath or other surgical procedure. Is there a way to know whether certain medications are excluded from respective programs?

The best and quickest resource, I believe, is the Medicare website. It allows you to look at plans that are available in your area and to look at whether they cover certain drugs and, if they do, to see how they’re covered.

Is this drug covered under Medicare Part B?

If you want information on a specific drug you can call this hotline and they can research it for you. The hotline number 1-800-333-4114 and we are open M-F 9am-5pm ET.

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