HealthCare Choices Resource Center - AgeOptions



HealthCare Choices Resource

Center Bulletin

December 27, 2013

To view other MMW materials and resources, including past MMW Bulletin newsletters, fact sheets, and recorded webinars, visit our MMW Coalition webpage at

|Medicare Updates |

2014 Medicare Premiums, Deductibles and Co-insurance Amounts

The Centers for Medicare and Medicaid Services (CMS) recently released the 2014 Medicare premiums, deductibles and cost-sharing amounts. These are the out-of-pocket amounts a beneficiary is responsible for and that Medicare does not cover. Some individuals may purchase a Medicare Supplement policy (Medigap plan) or enroll in a Medicare Advantage plan to help offset these costs. Click here to view a fact sheet created by Medicare that lists these amounts for 2014.

Higher Medicare Part B and Part D Premiums for Beneficiaries with Higher Incomes

In 2014, the monthly Medicare Part B premium will remain at $104.90 (same as 2013) for most people with Medicare. Medicare beneficiaries with annual incomes greater than $85,000 ($170,000 if married and filing a joint tax return) will pay a higher Part B premium. This is called the Income Related Adjustment Amount (IRMA). The extra amount individuals pay will depend on their federal tax returns and is based on a sliding scale. The same individuals will also have to pay higher monthly Medicare Part D premiums in addition to the premium amount their Part D plan charges. Click here to read more about IRMA and here to see the 2014 IRMA amounts.

Medicare Advantage Disenrollment Period

The Medicare Advantage Disenrollment period is a period during the first six weeks of the year when Medicare beneficiaries can disenroll from a Medicare Advantage (MA) plan and return to original Medicare. This disenrollment period begins January 1st and ends February 14th of every year.

During this time, Medicare beneficiaries can only disenroll from their Medicare Advantage plan with or without prescription drug coverage (MA or MA-PD) and return to original Medicare with Part A and Part B. Individuals cannot switch to another MA or MA-PD plan during this disenrollment period. Individuals who use this disenrollment period will receive a special enrollment period (SEP) to enroll in a stand-alone Part D plan that covers only drugs but will not receive any special guaranteed issue rights to purchase a Medicare Supplement (Medigap) policy. Medigap plans help pay for the out-of-pocket costs not covered by Medicare, such as the deductibles and co-insurance. Individuals may apply to any Medigap company for a policy, but could be denied.

However, there are two companies in Illinois that currently offer guaranteed issue Medicare Supplement policies for individuals age 65 and older throughout the year. BlueCross BlueShield of Illinois and Health Alliance will sell a policy to beneficiaries who qualify regardless of their health history. Individuals may be charged the highest premium rate on file with the Illinois Department of Insurance but cannot be denied coverage. People with disabilities under age 65 and on Medicare have guaranteed issue with these plans only during the Medigap open enrollment period for people on Medicare under 65 (October 15 through December 7 of each year).

You can read more about the Medicare Advantage Disenrollment Period here (see page 45 of the Medicare Managed Care Manual).

2014 Low-Income Subsidy (Extra Help) Asset Limits

The new 2014 asset (resource) limits for the Low-Income Subsidy program (also referred to as LIS or Extra Help) were recently announced by the Centers for Medicare and Medicaid Services (CMS). Click here to view the announcement. LIS helps people with Medicare pay for their Medicare Part D plan costs including the monthly premium, deductible and prescription drug co-payments. There are two levels of LIS available to Medicare beneficiaries – full or partial. Whether individuals qualify for full or partial LIS depends on their income and assets. Full LIS provides more assistance with Part D costs than partial LIS does, but the allowable income and asset limits an applicant may have to qualify are lower than partial LIS.

The LIS asset limits include a $1,500 allotment per person for burial or funeral expenses (the Social Security Administration (SSA) automatically excludes $1,500 when processing an individual’s application unless the applicant expresses that they do not intend to use $1,500 for funeral/burial expenses).

In 2014, the asset limits for LIS are as follows:

• Full LIS: $8,660 (single), $13,750 (married)

• Partial LIS: $13,440 (single), $26,860 (married)

The 2014 income limits for LIS will be released early next year once the 2014 Federal Poverty Levels are announced. Click here to view the current income and asset limits and to learn more about the LIS program.

Loss of Extra Help Special Enrollment Period

People with Medicare who will no longer automatically receive Extra Help (called “deemed eligibles”) beginning January 1, 2014 will be eligible for a special enrollment period (SEP) to change Part D plans. The SEP is valid for a one-time Part D plan switch January 1st through March 31st. Any plan change will take effect the 1st of the following month. These individuals should have received a letter from CMS in September on grey colored paper notifying them that they since they are no longer deemed eligible, they will no longer receive assistance through the Extra Help program in 2014. Click here to view the letter. Individuals should review their current plan to determine if it will continue to be the most affordable and best suited plan for them, since Extra Help will no longer help them pay for their Part D costs, including premiums, deductible and co-pays.

A person is deemed eligible and automatically qualifies for Extra Help without having to apply if s/he meets one of the following criteria listed below:

• Have Medicare and Medicare (meeting a Medicaid spenddown, even for just one month during the year, will also “deem” an individual for Extra Help)

• Enrolled in one of the Medicare Savings Programs (QMB, SLMB or QI)

• Receive Medicare and Supplemental Security Income (SSI)

If a person is no longer “deemed” eligible for Extra Help, it is because they no longer qualify for one of the programs listed above. Some of these individuals may still qualify for Extra Help and should submit an Extra Help application to SSA to determine eligibility.

Medicare Handouts with 2014 Costs Now Available in Additional Languages

CMS recently posted handouts in multiple languages that list the 2014 Medicare Parts A and B premium, deductible and co-insurance amounts. Click here to view the handouts. These handouts are currently available in the following languages:

• English

• Spanish

• Armenian

• Bengali

• Chinese

• Farsi

• Korean

• Russian

• Tagalog

• Vietnamese

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|Training Opportunities |

The Centers for Medicare and Medicaid Services (CMS) will be hosting an “Understanding Medicare” webinar. This webinar is a good training opportunity for counselors new to Medicare or for individuals who would like to learn the basics. The webinar will take place on January 14, 2014 from 12:00 p.m. – 1:30 p.m. CST. Pre-registration is not required and you can join the webinar on 1/14/14 at noon by visiting . Please note you will be prompted to enter your information on the day of the webinar.

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|Affordable Care Act Updates |

CountyCare Frequently Asked Questions

CountyCare has created a new Frequently Asked Questions (FAQ’s) list that provides information on the application process, network and services, and additional information. Click here to view the FAQ’s.

CountyCare is the new Medicaid health care program for adults ages 19-64 living in Cook County who meet the income and citizenship requirements. The program is an early version of the Adult Medicaid expansion through the Affordable Care Act scheduled to begin on January 1, 2014 statewide. Eligible individuals interested in applying for the new adult Medicaid can do so now through the new ABE (Application for Benefits Eligibility) system.

For additional background information on CountyCare visit .

Affordable Care Act FAQs

The Illinois Department of Healthcare and Family Services has created a FAQ list on the Affordable Care Act as related to the Illinois Marketplace, Medicaid, and Medicare. The document includes information about the application, benefits and useful tips on helping clients navigate through the process. The list also includes information about how Medicare beneficiaries do not need to go to the Marketplace for coverage. Click here to view the FAQ’s.

Kaiser Family Foundation Marketplace Videos

The Kaiser Family Foundation has created an informational and consumer friendly video that explains how the various coverage options for individuals through the Affordable Care Act will work. The video includes details about how the Marketplace and subsidies work, the individual mandate, and how the Affordable Care Act affects people with Medicare. At about seven minutes long, the video is a great resource to show at community presentations. Click here to view the video.

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As always, feel free to contact us with any comments or questions. If you would like to unsubscribe and not receive updates and information from the Make Medicare Work Coalition, please contact us by calling (708)383-0258 or emailing Georgia.Gerdes@ or Erin.Weir@.

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