aging services of washington - hc reform and medicare - resident's forum - sept 16 2010[1]

8/8/2019 Aging Services of Washington - HC Reform and Medicare - Resident's Forum - Sept 16 2010[1]

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Patient Protection and Affordable

Care Act

Whats New For Older Americans &

How It Will Affect Medicare BenefitsAging Services of Washington - Residents Forum

September 16, 2010


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Presentation Outline

Impacts to Medicare

Paying for Long Term Care the CLASS Act

New Opportunities


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Medicare What Remains the Same

The guaranteed Medicare benefits you currently receivewill remain the same.

Medicare will continue to cover your health costs the wayit always has, and there are no changes in eligibility.

During open enrollment this fall, you will continue tohave a choice between Original Medicare and a MedicareAdvantage plan.

Look for more details in your Medicare and YouHandbook.


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Medicare:More Affordable Prescription Drugs

If you enter the Part D donut hole anytimein 2010, you will receive a one-time, $250rebate check if you are not already receivingMedicare Extra Help.

These checks began mailing in June, 2010

and will continue monthly throughout theyear as beneficiaries enter the coverage gap.


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Medicare:Brand-Name Prescription Drugs

In 2011, if you reach the coverage gap, you will receive a50% discount when buying Part D-coveredbrand-name prescription drugs (dependent upon agreements reached withpharmaceutical companies).

By 2020, Part D enrollees will receive the 50 % discountfrom pharmaceutical manufacturers AND a 25% federalsubsidy.

The federal subsidy percentage will be phased in, beginning

in 2013.

By 2020, Part D enrollees will have to pay out-of-pocket for25 % of the total cost of the drug coverage gap.


7/30SOURCE:Kaiser Family Foundation illustration of standard Medicare drug benefit in 2020 under the Patient Protection and Affordable Care Act, asamended by the Health Care and Education Reconciliation Act of 2010.

75%paid by

plan

15% paid by plan; 80% paid by MedicareEnrolleepays 5%

25%paid byenrollee

100% paid by enrollee

100% paid by enrolleeBeneficiaries with spending in the

doughnut hole get $250 rebate in 2010

Deductible:$310

Initial coverage limit:$2,830 in total drug costs($940 out-of-pocket)

Catastrophic coverage limit:$6,440 in total drug costs($4,550 out-of-pocket)

Coverage gap:$3,610 Coverage Gap(Doughnut Hole)

Standard Medicare Prescription Drug Benefit, 2010

Exhibit 6


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SOURCE: Kaiser Family Foundation illustration of standard Medicare drug benefit in 2020 under the Patient Protection and Affordable Care Act, asamended by the Health Care and Education Reconciliation Act of 2010.

75%paid by

plan

15% paid by plan; 80% paid by Medicare5% paid by

enrollee


25%paid byenrollee

100% paid by enrollee Deductible

Initialcoverage

limit

Catastrophiccoverage

Coverage gap

Before: After:

75%paid by

plan

15% paid by plan; 80% paid by Medicare

25%paid byenrollee


25%paid byenrollee

Brands:

50% discount25% paid by plan

Generics:75% paid by plan

Standard Medicare Prescription Drug Benefit, 2020Before and After Health Reform

Exhibit 7


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Medicare:Generic Prescription Drugs

By 2020, 75 percent of the cost of generic drugsin the gap will be subsidized by Medicare.

The federal subsidy percentage will be phased in,beginning in 2011.

By 2020, Part D enrollees will have to pay out-of-pocket for 25 % of the total cost of the drugcoverage gap.


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Medicare:Catastrophic Coverage

Between 2014 and 2019, the catastrophiccoverage threshold is reduced to provideadditional support for those with relativelyhigh drug costs.


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Medicare:Helping You Stay Healthy

Beginning in 2011, no coinsurance ordeductibles will be charged in traditionalMedicare for preventive services likecolorectal cancer screening andmammograms.

Medicare will cover a free annualcomprehensive wellness visit andpersonalized prevention plan.


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Changes toMedicare Advantage plans

If you are in a Medicare Advantage plan, you will still receive guaranteedMedicare benefits.

Medicare Advantage plans receive payments from the federal governmentto provide Medicare-covered benefits based on a predetermined formula.

77% of seniors are NOT enrolled in a Medicare Advantage plan.

Medicare payments to Medicare Advantage plans are currently higher, onaverage, than local fee-for-service costs.

Beginning in 2012, payments to Medicare Advantage plans will be setcloser to the costs of enrollees in traditional Medicare in each county.


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Changes toMedicare Advantage plans

Medicare Advantage plans will be receiving payment incentivesfor quality and program performance.

Changes the annual enrollment period from October 15 toDecember 7 of each year, beginning in 2011 for plan year 2012.

Beneficiaries enrolled in a Medicare Advantage plan as of January1 will be allowed 46 days after the beginning of the calendar yearto dis-enroll from the plan and return to original Medicare,

beginning in 2011; they will not be allowed to switch from oneMedicare Advantage plan to another during this time period.


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Medicare Better Access to Care

Your choice of doctor will be preserved.

The law will increase the number of primary care doctors, nurses, andphysician assistants through training grants, etc.

Community health centers will be able to serve 20 million new patients.

Provides a 10 percent bonus payment for primary care services furnished byprimary care physicians, nurse practitioners, clinical nurse specialists andphysician assistants if at least 60 percent of their Medicare -allowed chargeshave been for primary care services, effective 2011-2015.

Provides a 10 percent bonus payment to general surgeons practicing in healthprofessional shortage areas, from 2011 through 2015.


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Medicare Chronic Care

Community health teams will providepatient- centered care so you wont have to see

multiple doctors who dont work together.

If youre hospitalized, the new law also helpsyou return home successfully and avoid goingback by helping to coordinate your care andconnecting you to services and supports in yourcommunity.


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Medicare:Keeping It Strong & Solvent

Over the next 20 years, Medicare spending isexpected to grow at a slower rate as a resultof reductions in waste, fraud, and abuse.

The new law contains important new toolsto help crack down on criminals seeking to

scam seniors and steal taxpayer dollars. This will extend the life of the Medicare Trust

Fund by 12 years.


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Medicare:Expected Consumer Savings

In 2018, seniors can expect to save onaverage almost $200 per year in premiumsand over $200 per year in co-insurance,compared to what they would have paidwithout the new law.


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Medicare: Premium Changes The income thresholds for the Part B income-related

premium are frozen at 2010 levels ($85,000/individual,$170,000/couple) through 2019.

Establishes a new income-related monthly Part Dpremium, requiring higher-income Part D enrollees(those with incomes greater than $85,000/individual,$170,000/couple) to pay a higher income-related Part Dpremium, beginning in 2011.

Freezes the income thresholds for the income-relatedPart D premium at $85,000/individual, $170,000/couplethrough 2019.


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On-line Resources PPACA &Medicare

Medicare and you 2010: http://www.medicare.gov/Publications/Pubs/pdf/10050.pdf

Washington State Health Insurance Benefits Advisors (SHIBA) office: http://www.insurance.wa.gov/shiba/index.shtml

Federal Agency website on PPACA regards seniors: http://www.healthcare.gov/foryou/seniors/index.html

Medicare and the New Health Care Law what it Means for You: http://www.medicare.gov/Publications/Pubs/pdf/11467.pdf

A tutorial offered by Kaiser Family Foundation on PPACA and Medicare: http://www.kff.org/medicare/med072810oth.cfm

An issue brief offered by Kaiser Family Foundation on PPACA and Medicare: http://www.kff.org/healthreform/upload/7948-02.pdf
http://www.medicare.gov/Publications/Pubs/pdf/10050.pdfhttp://www.insurance.wa.gov/shiba/index.shtmlhttp://www.healthcare.gov/foryou/seniors/index.htmlhttp://www.medicare.gov/Publications/Pubs/pdf/11467.pdfhttp://www.kff.org/medicare/med072810oth.cfmhttp://www.kff.org/healthreform/upload/7948-02.pdfhttp://www.kff.org/healthreform/upload/7948-02.pdfhttp://www.kff.org/healthreform/upload/7948-02.pdfhttp://www.kff.org/healthreform/upload/7948-02.pdfhttp://www.kff.org/medicare/med072810oth.cfmhttp://www.medicare.gov/Publications/Pubs/pdf/11467.pdfhttp://www.healthcare.gov/foryou/seniors/index.htmlhttp://www.insurance.wa.gov/shiba/index.shtmlhttp://www.medicare.gov/Publications/Pubs/pdf/10050.pdf


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The CLASS Act ~ Community Living Assistance Services and Support Act:

Voluntary for both the employer and employee;

Federally administered;

Consumer-financed;

Insurance plan;

Provides Cash to Help Pay for Needed Assistance;

Promotes Personal Responsibility and Choice.

Health Care Reform:Paying for Long Term Care


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Enrollment Begins After October 1, 2012;

Eligibility for Enrollment:

All Americans Actively at Work, Including Part Time or Self Employed;

Age 18 and Older;

Not Living In a Nursing Home (or other institution) at the Time of Enrollment

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CLASS ACT


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Cash Benefit Not Less than $50/Day On Average;

Benefit Amount Based on Assessment of Need Due to Physical or Cognitive Limitation:Higher Cash Benefit for People with Greater Need for Help with Activities of Daily Living(bathing, eating, dressing, and mobility).

Benefit Amount Increases Annually;

No Lifetime Limit ~ Benefit Continues Until Person No Longer Has Qualifying Disability;

A Qualifying Disability Will Be Either:Loss of Ability to Perform 2 ADLs (Activities of Daily Living); orLoss of Ability to Perform 3 ADLs

Disability Continues or Expected to Continue for At Least 90 Days;

Rules Must Be Written for Assessment Process Used to Determine Benefit Eligibility.

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CLASS ACT


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After Enrolling, Participant Must Pay Premiums for Five Yearsand Be Actively at Work for 3 of These Years Before ReceivingBenefits.

Example: Person Retires After 3 Years is Eligible for Benefits asLong as They Pay For 5 Years and Subsequently Has aQualifying Disability.

Special Rules will Apply for People Who Enroll For a Time, DropOut, but Then Sign Up Again.

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CLASS ACT


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Premiums may be lower for younger people than for older people whenthey sign up.

Premiums Remain the Same From the Time the Person Signs.

Persons with Health Issues or a Disability May Not be Charged HigherPremiums.

Working Students and People with Low Income (up to the federal povertylevel) Charged a Special Low Premium ~ $5/month.

Initial Premium Estimates ~ Average $123/month (lower for youngerpeople, higher for older people).

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CLASS ACT


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CLASS ACT Allows Cash Benefits to Be Used to Purchase Non-Medical Services and

Supports to Maintain Independence at Home or In Another CommunityResidential Setting, Including (but not limited to):

Home Modifications,Assistive Technology,Accessible Transportation,Homemaker Services,Respite Care,Personal Assistance Services,Home Care Aides, andNursing Support.


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CLASS ACT Authorizes States to Develop a New Method of Providing

Home Care for Enrollees With Chronic Conditions;

Use of Health Information Technology in Providing HomeHealth Services Including Use of Wireless Patient Technologyto Improve Coordination and Management of Care andPatient Compliance;

A Team of Health Care Providers can be Virtual.


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The Independence at Home Demonstration

Incentive For Physicians or Nurse Practitioners to be Paid for CareCoordination and Must Provide Home-Based Primary Care;

Medicare Beneficiary has 2 or More Chronic Illnesses ~ Congestive HeartFailure, Diabetes, COPD, Stroke, Alzheimers Disease and OthersDesignated by HHS That Result in High Costs;

Demonstration would begin on January 1, 2012;

Goals: Reduce Preventable Hospitalizations, Prevent Hospital Readmissions,Reduce ER Visits, Improve Health Outcomes.

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Health Care Reform: New Opportunities


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Healthy Aging, Living Well Evaluation

5 Year Pilot between 2010-2014 and $50 Million Total Funding;

Evaluate Community-based Prevention and Wellness Programsfor Medicare Beneficiaries, 55-64 in Age;

Focus on Nutrition, Physical Activity, Reduction of Tobacco Use,

Substance Abuse, Screenings and Referrals for Treatment of Chronic Diseases;

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Medication Management in the Treatment of Chronic DiseaseGrants

Began May 1, 2010.

Licensed Pharmacist, as a Part of an Interdisciplinary Team, Workwith Targeted Individuals Taking 4 or More Prescription Medicationsfor the Treatment of Chronic Diseases.

Assessment, Initial Medication Review, Formulation of a MedicationTreatment Plan, Monitoring Safety and Effectiveness and ProvidingEducation and Training on Appropriate Use of Medication.


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Patient Protection and Affordable Care ActWhats New For Older Americans

&How It Will Affect Medicare Benefits

Presented

September 16, 2010

aging services of washington - hc reform and medicare - resident's forum - sept 16 2010[1]

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