The Health Care Law What it Means for

The Health Care Law: What it Means for People with Medicare

What We’ll Cover Ø What’s changing Ø What’s not changing Ø When changes take place Ø Q&A 2

How The Law Improves Medicare Ø Protects guaranteed Medicare benefits Ø Improves Medicare benefits • Lowers prescription drug costs • Adds more preventive benefits 3

What’s The Doughnut Hole? Ø Medicare Part D coverage gap • Fall into the doughnut hole after total drug costs reach $2, 970 • Leave the doughnut hole when total out-of-pocket drug costs reach $4, 750 4

Medicare Drug Coverage Doughnut Hole Initial Benefit You pay: Deductible and 25% of drug costs Discount: 52. 5% for Brand 21% for Generic Catastrophic Benefit You pay: 5% of drug costs

Doughnut Hole Disappears Ø 52. 5% discount on brand name drugs Ø 21% discount on generic drugs Ø By 2020, the doughnut hole will disappear Ø Part D cost sharing will remain AARP’s Doughnut Hole Calculator www. aarp. org/doughnuthole 6

www. aarp. org/doughnuthole 7

Adds More Preventive Care Benefits Ø Yearly wellness visit Ø Screenings for diabetes and cancers Ø No co-payments or deductibles Call Medicare at 1 -800 -633 -4227 www. medicare. gov 8

Improves Access To Primary Care Doctors ØPrimary care doctors get bonus payments ØMedicare gives extra payments where shortage of providers 9

Improves Care Coordination Ø Must have a face-to-face visit from a health practitioner Ø A physician must certify home health services Ø Visit must occur within • 90 days before you receive home health care or • 30 days after you start care 10

Medicare Advantage Plans Ø Alternative to Original Medicare Ø Offered by Medicare-approved private insurance companies Ø Pays for the same basic health care services as Original Medicare Ø May also pay for additional services 11

Changes To Medicare Advantage Plans Ø Guaranteed Medicare benefits are protected Ø Choose either a Medicare Advantage plan or Original Medicare 12

More Emphasis On Quality & Value ØBonuses for providing quality care ØUse some of the bonus for extra benefits and rebates ØCan’t charge more than Original Medicare for certain services ØMust limit how much they spend each year on administrative expenses 13

How Medicare Advantage Plans Are Paid Ø Subsidies to private insurance companies will be lower Ø Changes in payments will result in savings to the Medicare program 14

What Lower Subsidies Could Mean Ø May drop extra services Ø May raise premiums and co-payments Ø May leave the Medicare program 15

What Lower Subsidies Could Mean Ø You will receive a notice of changes, if any Ø You can stay with your plan, switch your plan, or go to Original Medicare Contact your Medicare Advantage plan or call Medicare at 1 -800 -633 -4227 www. medicare. gov 16

Part D Income-Related Premiums Ø Income levels for higher premiums start Ø $85, 000 -- single person Ø $170, 000 -- married couple 17

Reduces Waste, Fraud & Abuse Ø Cuts inefficient care Ø Identifies fraudulent providers Ø Reduces overpayments to insurance companies Ø Protects personal information Call Medicare at 1 -800 -633 -4227 www. aarp. org/fightfraud 18

Remember! Ø Helps lower prescription drug costs Ø Protects guaranteed Medicare benefits Ø Improves Medicare-covered benefits Ø Makes some changes to Medicare Advantage plans Ø Reduces waste, fraud and inefficiencies 19

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For More Information Ø The Health Care Law § Health. Law. Answers. org § Mi. Leyde. Salud. org Ø Medicare § www. Medicare. gov 1 -800 -633 -4227 Ø SHIP § www. SHIPtalk. org 1 -800 -677 -1116 21

Has the Health Care Law helped you? Share your personal story www. healthlawanswers. org 22

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