2015 National Training Program Module 11 Medicare Advantage

2015 National Training Program Module 11 Medicare Advantage and Other Medicare Health Plans Session Objectives This session should help you to Define Medicare Advantage (MA) Plans Describe how MA Plans work Explain eligibility requirements and enrollment Recognize types of MA Plans

Identify other Medicare Health plans Recall rights, protections, and appeals Summarize Medicare Marketing Guidelines 05/01/2015 Medicare Advantage and Other Medicare Health Plans 2 Lesson 1Medicare Advantage (MA) Plan Overview What is an MA Plan How MA Plans work

When you can join or switch plans Types of MA Plans 05/01/2015 Medicare Advantage and Other Medicare Health Plans 3 What Is a Medicare Advantage Plan? Health plan options Approved by Medicare Run by private companies Part of the Medicare program

Sometimes called Part C Available across the country Provide Medicare-covered benefits May cover extra benefits 05/01/2015 Medicare Advantage and Other Medicare Health Plans 4 How Medicare Advantage Plans Work Receive services through the plan All Part A and Part B covered services Some plans may provide additional benefits Most plans include prescription drug coverage You may have to use network doctors/hospitals May differ from Original Medicare Benefits

Cost sharing 05/01/2015 Medicare Advantage and Other Medicare Health Plans 5 How Medicare Advantage (MA) Plans Work (Continued) Youre still in the Medicare program Medicare pays the plan every month for your care You still have Medicare rights and protections If the plan leaves Medicare you can Join another MA Plan, or Return to Original Medicare 05/01/2015 Medicare Advantage and Other Medicare Health Plans

6 Medicare Advantage Costs You still pay the Part B premium A few plans may pay all or part for you State assistance for some You may pay plan an additional monthly premium You pay deductibles, coinsurance, and copayments Different from Original Medicare Vary from plan to plan May be higher if out of network 05/01/2015 Medicare Advantage and Other Medicare Health Plans 7

Who Can Join a Medicare Advantage Plan? Eligibility requirements Enrolled in Medicare Part A (Hospital Insurance) Enrolled in Medicare Part B (Medical Insurance) Live in the plans service area To join you must also Provide necessary information to the plan Follow the plans rules Can only belong to one plan at a time 05/01/2015 Medicare Advantage and Other Medicare Health Plans 8 Medicare Advantage and End-Stage Renal Disease (ESRD) Usually you cant enroll if you have ESRD

There are limited exceptions Transition from one plan to another within the same parent organization No break between coverage Must meet all other enrollment requirements Person who receives a kidney transplant or no longer requires a regular course of dialysis Isnt considered to have ESRD for Medicare Advantage (MA) eligibility purposes 05/01/2015 Medicare Advantage and Other Medicare Health Plans 9 When You Can Join or Switch Medicare Advantage Plans Initial Enrollment

Period 7-month period begins 3 months before the month you turn 65 Includes the month you turn 65 Ends 3 months after the month you turn 65 Medicare Open Enrollment Period Open Enrollment October 15December 7 Coverage begins January 1 Medicare due to a Disability 7-month period begins 3 months before the 25th month of disability. Ends 3 months after the 25th month of

disability. Plans must be allowing new members to join 05/01/2015 Medicare Advantage and Other Medicare Health Plans 10 When You Can Join or Switch Plans Special Enrollment Periods (SEP) 05/01/2015 Move out of your plans service area Plan leaves Medicare program or reduces its service

area Leaving or losing employer or union coverage You enter, live at, or leave a long-term care facility You have a continuous SEP if you qualify for Extra Help Losing your Extra Help status You join or switch to a plan that has a 5-star rating Retroactive notice of Medicare entitlement Other exceptional circumstances Medicare Advantage and Other Medicare Health Plans 11 When You Can Join or Switch MA Plans 5-Star Special Can enroll in 5-star Medicare Advantage (MA), Enrollment Prescription Drug Plan (PDP), Medicare Advantage Period (SEP) Plan with prescription drug coverage (MA-PD), or

Cost Plan Enroll once per year from December 8, 2014 November 30, 2015 New plan starts first day of month after enrolled Star ratings given once per year Ratings assigned in October and effective January 1st Use Medicare Plan Finder to see star ratings Look at Overall Plan Rating to find eligible plans 05/01/2015 Medicare Advantage and Other Medicare Health Plans 12 Low Performing Plan Low performing star rating status You may have a one-time option to switch to another Medicare drug plan with a rating of 3, 4, or 5 stars if your plans summary rating was less than 3 stars for 3

years Low Performance Icon (LPI) appears on Plan Finder Plans may not attempt to discredit their LPI status by showcasing a separate higher rating 05/01/2015 Medicare Advantage and Other Medicare Health Plans 13 When You Can Leave Medicare Advantage Plans January 1 You can leave a Medicare Advantage (MA) February 14 Plan Switch to Original Medicare Coverage begins first day of month after switch May join Part D Plan Drug coverage begins first day of month after

plan gets enrollment May not join another MA Plan during this period May be able to buy a Medicare Supplement Insurance (Medigap) policy 05/01/2015 Medicare Advantage and Other Medicare Health Plans 14 Medicare Advantage Trial Rights and Medigap Special Medigap rights for people who join a Medicare Advantage Plan for the first time When first eligible at 65 or Leave Original Medicare and drop a Medigap policy Can disenroll during the first 12 months

Return to Original Medicare Have guaranteed issue rights for Medigap 05/01/2015 Medicare Advantage and Other Medicare Health Plans 15 Types of Medicare Advantage Plans Health Maintenance Organization (HMO) HMO Point-of-Service Preferred Provider Organization

Special Needs Plan Private Fee-for-Service Medicare Medical Savings Account 05/01/2015 Medicare Advantage and Other Medicare Health Plans 16 Medicare Health Maintenance Organization (HMO) Plan Can you get your health care from any doctor or hospital? No. You generally must get your care and services from doctors, other health care providers, or hospitals in the plans network (except emergency care, outofarea urgent care, or outofarea dialysis). In some ofofarea urgent care, or outofarea dialysis). In some area urgent care, or outofarea urgent care, or outofarea dialysis). In some ofofarea urgent care, or outofarea dialysis). In some area dialysis). In some plans, you may be able to go out of network for certain services, usually

for a higher cost. This is called an HMO with a point-of-service option. Are prescription drugs covered? In most cases, yes. Ask the plan. If you want Medicare drug coverage, you must join an HMO Plan that offers prescription drug coverage. Do you need to choose a primary care doctor? In most cases, yes. Do you need a referral to see a specialist? In most cases, yes. Certain services, like yearly screening mammograms, dont require a referral. What else do you need

to know about this type of plan? If your doctor or other health care provider leaves the plan, your plan will notify you and you can choose another plan doctor. If you get health care outside the plans network, you may have to pay the full cost. Its important that you follow the plan rules. For example, the plan may require prior approval for certain services. 05/01/2015 Medicare Advantage and Other Medicare Health Plans 17 Medicare Preferred Provider Organization (PPO) Plan Can you get your health In most cases, yes. PPOs have network doctors, other health care from any doctor or care providers, and hospitals, but you can also use

outofarea urgent care, or outofarea dialysis). In some ofofarea urgent care, or outofarea dialysis). In some network providers for covered services, usually for a hospital? higher cost. Are prescription drugs covered? In most cases, yes. If you want Medicare drug coverage, you must join a PPO Plan that offers prescription drug coverage. You may contact individual plans to find out if they offer prescription drug coverage. Do you need to choose a primary care doctor? No. Do you need a referral to see a specialist?

In most cases, no. What else do you need PPO Plans arent the same as Original Medicare or Medigap. to know about this type Medicare PPO Plans usually offer extra benefits than Original of plan? Medicare, but you may have to pay extra for these benefits. 05/01/2015 Medicare Advantage and Other Medicare Health Plans 18 Medicare Special Needs Plans (SNPs) Can you get your health care from any doctor or hospital? You generally must get your care and services from doctors, other health care providers, or hospitals in the plans network (except emergency care, out-of-area

urgent care, or outofarea urgent care, or outofarea dialysis). In some ofofarea urgent care, or outofarea dialysis). In some area dialysis). Are prescription drugs covered? Yes. All SNPs must provide Medicare prescription drug coverage (Part D). Do you need to choose a Generally, yes. primary care doctor? Do you need a referral to see a specialist? 05/01/2015 In most cases, yes. Certain services, like yearly screening mammograms, dont require a referral. Medicare Advantage and Other Medicare Health Plans

19 Medicare Special Needs Plans (SNPs) Continued What else do you need to know about this type of plan? 05/01/2015 A plan must limit plan membership to people in one of the following groups: 1. Those living in certain institutions (like a nursing home), or who require nursing care at home 2. Those eligible for both Medicare and Medicaid 3. Those with specific chronic or disabling conditions Plan may further limit membership

Plan should coordinate your needed services and providers Plan should make sure providers that you use accept Medicaid if you have Medicare and Medicaid Plan should make sure that plans providers serve people where you live, if you live in an institution Medicare Advantage and Other Medicare Health Plans 20 Medicare Private Fee-for-Service (PFFS) Plan Can you get your health care from any doctor or hospital? In some cases, yes. You can go to any Medicare-approved doctor, other health care provider, or hospital that accepts the plans payment terms and agrees to treat you. If you join a PFFS Plan that has a network, you can also see any of the network providers who have agreed

to always treat plan members. You can choose an outofarea urgent care, or outofarea dialysis). In some ofofarea urgent care, or outofarea dialysis). In some network doctor, hospital, or other provider who accepts the plans terms, but you may pay more. Are prescription drugs covered? Sometimes. If your PFFS Plan doesnt offer drug coverage, you can join a Medicare Prescription Drug Plan (Part D) to get coverage. Do you need to choose a No. primary care doctor? Do you need a referral to see a specialist? 05/01/2015 No. Medicare Advantage and Other Medicare Health Plans

21 Medicare Private Fee-for-Service (PFFS) Plan (Continued) What else do you PFFS Plans arent the same as Original Medicare or Medigap need to know The plan decides how much you must pay for services about this type of Some PFFS Plans contract with a network of providers who plan? agree to always treat you even if youve never seen them before Out-of-network doctors, hospitals, and other providers may decide not to treat you even if youve seen them before For each service you get, make sure that your doctors, hospitals, and other providers agree to treat you under the plan, and accept the plans payment terms In an emergency, doctors, hospitals, and other providers must treat you

05/01/2015 Medicare Advantage and Other Medicare Health Plans 22 Medicare Private Fee-for-Service (PFFS) Plan Access Requirements Employer/union-sponsored PFFS Plans must meet access requirements Plans may meet access requirements through a contracted network of providers Non-employer PFFS Plans must meet access requirements through contracts with providers Where 2 or more network-based Medicare Advantage Plan options exist 05/01/2015 Medicare Advantage and Other Medicare Health Plans

23 Medicare and Medical Savings Accounts Medical Savings Account Plans Combine high-deductible plan with a bank account Medicare deposits money into account Use money to pay for services 05/01/2015 Medicare Advantage and Other Medicare Health Plans 24 Medicare Advantage (MA) Plan Network Changes Many types of MA Plans have provider networks Plans may change networks at any time Must protect beneficiaries from interruptions in

medical care Must maintain adequate access to services Must notify beneficiaries who see affected providers At least 30 days prior to termination Mid-year network changes arent a basis for a Special Enrollment Period in most cases 05/01/2015 Medicare Advantage and Other Medicare Health Plans 25 Check Your KnowledgeQuestion 1 Medicare Advantage Plans are sometimes called a. b. c.

d. Part A Part B Part C Part D 05/01/2015 Medicare Advantage and Other Medicare Health Plans 26 Check Your KnowledgeQuestion 2 Most people enrolled in a Medicare Advantage Plan are no longer required to pay a monthly Medicare Part B premium.

a. True b. False 05/01/2015 Medicare Advantage and Other Medicare Health Plans 27 Lesson 2Other Medicare Health Plans Medicare Cost Plans Medicare Innovation Projects and Pilot Programs Programs of All-inclusive Care for the Elderly (PACE) 05/01/2015 Medicare Advantage and Other Medicare Health Plans 28

Other Medicare Health Plans Other types of Medicare health plans that provide health care coverage arent part of Medicare Advantage But are still part of Medicare Some provide Part A and/or Part B coverage Some provide Medicare prescription drug coverage 05/01/2015 Medicare Advantage and Other Medicare Health Plans 29 Medicare Cost Plans Available in limited areas Must have Medicare Part B to join Can see a non-network provider Services covered under Original Medicare

Join anytime new members are being accepted Leave anytime and return to Original Medicare Get Medicare prescription drug coverage From the plan (if offered) Join a separate Medicare Prescription Drug Plan 05/01/2015 Medicare Advantage and Other Medicare Health Plans 30 Innovation Projects and Pilot Programs Special projects that test improvements in Medicare coverage Payment Quality of care Eligibility usually limited Specific group of people or specific area of country

Examples of how they help shape Medicare MA Plan for End-Stage Renal Disease patients New Medicare preventive services 05/01/2015 Medicare Advantage and Other Medicare Health Plans 31 Medicare Program of All-inclusive Care for the Elderly (PACE) Plans Combines services for frail, elderly people Medical, social, and long-term care services Include prescription drug coverage Alternative to nursing home care Only in states that offer it under Medicaid Qualifications vary from state to state Contact state Medical Assistance (Medicaid) office

for information 05/01/2015 Medicare Advantage and Other Medicare Health Plans 32 Check Your KnowledgeQuestion 3 Programs of All-inclusive Care for the Elderly (PACE) is a type of Medicare Advantage Plan. a. True b. False 05/01/2015 Medicare Advantage and Other Medicare Health Plans

33 Lesson 3Rights, Protections, and Appeals Guaranteed Rights and Protections Appeals Required Notices Medicare Advantage Plan Marketing Reminders 05/01/2015 Medicare Advantage and Other Medicare Health Plans 34 Guaranteed Rights

Get needed health care services Get easy-to-understand information Have personal medical information kept private 05/01/2015 Medicare Advantage and Other Medicare Health Plans 35 Rights in Medicare Health Plans Choice of health care providers

Access to health care providers (treatment plan) Know how your doctors are paid Fair, efficient, and timely appeals process Grievance process Coverage/payment information before service Privacy of personal health information 05/01/2015 Medicare Advantage and Other Medicare Health Plans 36 Appeals in Medicare Advantage Plans Plan must say in writing how you can appeal if it Wont pay for a service Doesnt allow a service Stops or reduces course of treatment Can ask for expedited (fast) decision

Plan must decide within 72 hours See plan membership materials Instructions on how to file an appeal or grievance 05/01/2015 Medicare Advantage and Other Medicare Health Plans 37 Medicare Part C Appeals Process Initial Determination Plan Reconsideration Independent Review Entity (IRE) Administrative Law Judge (ALJ) Medicare Appeals Council (MAC) Judicial Review *These pre-service time frames include a possible extension of up to 14 days.

05/01/2015 Medicare Advantage and Other Medicare Health Plans 38 Rights If You File an Appeal With Your Medicare Health Plan Right to get your files from the plan Call or write your plan Plan may charge a fee 05/01/2015 Medicare Advantage and Other Medicare Health Plans 39 Marketing Materials The Centers for Medicare & Medicaid Services

(CMS) requires review and approval of certain materials Exceptions are listed in Section 20 of the Medicare Marketing Guidelines Plans must maintain materials and make them available upon CMSs request CMS creates standardized and model marketing materials 05/01/2015 Medicare Advantage and Other Medicare Health Plans 40 Marketing Reminders Marketing for upcoming plan year May not occur before October 1 Marketing star ratings in materials

Individual measures may be marketed Communicated in conjunction with overall performance rating Low-performing star rating status Low Performance Icon (LPI) Plans may not attempt to discredit their LPI status by showcasing a separate higher rating 05/01/2015 Medicare Advantage and Other Medicare Health Plans 41 Disclosure of Plan Information for New and Renewing Members Medicare Advantage and Prescription Drug Plans must disclose plan information

At time of enrollment and at least annually Required Annual Notice of Change/Evidence of Coverage Low Income Subsidy (LIS) rider Comprehensive or abridged formulary Member ID card at the time of enrollment/as needed At time of enrollment and at least every 3 years after

Pharmacy directory Provider directory Documents for new enrollees must be provided to CMS 05/01/2015 Medicare Advantage and Other Medicare Health Plans 42 Nominal Gift Reminders Nominal gifts Organizations can offer gifts to potential enrollees

05/01/2015 Must be of nominal value Defined in Medicare Marketing Guidelines Currently $15 or less based on retail value Given regardless of beneficiary enrollment May not be in the form of cash or other monetary rebates Medicare Advantage and Other Medicare Health Plans 43 Unsolicited Beneficiary Contact Prohibited Unsolicited Marketing Activities Electronic communications

Unless express permission is given Door-to-door solicitation Calls/visits after attending sales event Unless express permission given Common areas 05/01/2015 Medicare Advantage and Other Medicare Health Plans 44 Cross-Selling Prohibition Cross-selling Prohibited during any Medicare Advantage or Part D sales activity or presentation Cant market non-health related products Annuities

Life insurance Other products Allowed on inbound calls per beneficiaries request 05/01/2015 Medicare Advantage and Other Medicare Health Plans 45 Scope of Appointment Reminders Scope of Appointment Must specify product type Medicare Advantage, Medicare Prescription Drug Plans, Medigap, or other 48 hours prior to marketing and/or in-home appointment Additional products can only be discussed

Upon beneficiary request At separate appointment 05/01/2015 Medicare Advantage and Other Medicare Health Plans 46 Marketing in Health Care Settings Marketing allowed in health care common areas Hospital or nursing home cafeterias Community or recreational rooms Conference rooms No marketing in health care settings where patients intend to receive care Waiting rooms Exam rooms and hospital patient rooms

Dialysis centers and pharmacy counter areas 05/01/2015 Medicare Advantage and Other Medicare Health Plans 47 Promotional Activity Reminders Prohibition of meals Prospective enrollees may not Be provided meals Have meals subsidized At any event or meeting where Plan benefits are being discussed, or Plan materials are being distributed

05/01/2015 Medicare Advantage and Other Medicare Health Plans 48 Educational Event Reminders Educational events for prospective members No marketing activities at educational events Plans may distribute Medicare and/or health educational materials Agent/broker business cards Distributed material must not contain marketing information 05/01/2015 Medicare Advantage and Other Medicare Health Plans

49 Rewards and Incentives Regulation 4159-F expands rewards and incentive programs Applies to Medicare Advantage Organizations Focus on encouraging participation in activities that promote Improved health Prevention of injuries and illness Efficient use of health care resources 05/01/2015 Medicare Advantage and Other Medicare Health Plans 50 Licensure and Appointment of Agents

Medicare Advantage and Prescription Drug Plan organization agents/brokers or other marketing representatives Must comply with state-licensure laws Applies to contracted and employed agents/brokers Organizations must comply with state appointment laws Plans must give information about agents 05/01/2015 Medicare Advantage and Other Medicare Health Plans 51 Reporting of Terminated Agents Organizations must report termination of agents/brokers

Must include reasons for termination To the state(s) where agent/broker is appointed In accordance with state appointment law 05/01/2015 Medicare Advantage and Other Medicare Health Plans 52 Agent/Broker Compensation Rules The Centers for Medicare & Medicaid Services compensation rules For contracted or independent agents/brokers Designed to eliminate incentives For example, encouraging inappropriate moves from plan to plan Guidelines for plan recoupment of compensation under certain circumstances

05/01/2015 Medicare Advantage and Other Medicare Health Plans 53 Agent/Broker Compensation Definition The Centers for Medicare & Medicaid Services defines compensation as monetary or nonmonetary remuneration of any kind relating to the sale or renewal of a policy Compensation year January 1December 31 Initial compensation Unlike plan type Renewal compensation Like plan type 05/01/2015

Medicare Advantage and Other Medicare Health Plans 54 Agent/Broker Training and Testing Agents/brokers must be trained and tested annually Medicare rules and regulations Plan details specific to plan products sold Applies to contracted and employed agents Completed prior to start of marketing season Must pass with 85% to market after that date

05/01/2015 Medicare Advantage and Other Medicare Health Plans 55 Check Your KnowledgeQuestion 4 Whos responsible for training and testing agents/brokers about the Medicare program and proper marketing of Medicare products? a. The Centers for Medicare & Medicaid Services b. Medicare health and drug plans c. State Department of Insurance d. Insurance associations 05/01/2015 Medicare Advantage and Other Medicare Health Plans

56 Check Your KnowledgeQuestion 5 Agents or brokers are permitted to set up individual marketing appointments at educational events. a. True b. False 05/01/2015 Medicare Advantage and Other Medicare Health Plans 57 Medicare Advantage and Other Medicare Plans Resource Guide

Resources Resources Centers for Medicare & Medicaid Services (CMS) 1-800-MEDICARE (1-800-633-4227) TTY users should call 1-877-486-2048 Medicare.gov 2015 Medicare Marketing Guidelines CMS.gov/Regulations-and-Guidance/Guidanc e/Manuals/Downloads/mc86c03.pdf CMS.gov Medicare Managed Care Manual CMS.gov/Regulations-and-Guidance/Guidanc e/Manuals/Internet-Only-Manuals-IOMs-Ite ms/CMS019326.html

Social Security 1ofarea urgent care, or outofarea dialysis). In some 800ofarea urgent care, or outofarea dialysis). In some 772ofarea urgent care, or outofarea dialysis). In some 1213. TTY users should call 1ofarea urgent care, or outofarea dialysis). In some 800ofarea urgent care, or outofarea dialysis). In some 325ofarea urgent care, or outofarea dialysis). In some 0778 socialsecurity.gov State Health Insurance Assistance Programs For telephone numbers call CMS 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048 Railroad Retirement Board 1-877-772-5772. TTY users should call 1-312-751-4701 RRB.gov Affordable Care Act HealthCare.gov/law/full/index.htm Medicare Products

Medicare & You Handbook CMS Product No. 10050 Have You Done Your Yearly Medicare Plan Review? CMS Product No. 11220 Medicare Supplement Insurance, Getting Started CMS Product No. 11575 Your Guide to Medicare Private Fee-for-Service Plans CMS Product No. 10144 Understanding Medicare Enrollment Periods CMS Product No. 11219 Your Guide to Medicare Savings Account Plans CMS Product No. 11206 Your Guide to Special Needs Plans CMS Product No. 11302 To access these products View and order single copies at Medicare.gov/publications

Order multiple copies (partners only) at productordering.cms.hhs.gov. You must register your organization Appendix A 05/01/2015 Medicare Advantage and Other Medicare Health Plans 59 Appendix BAppeals Flowcharts Footnote a: Plans must process 95% of all clean claims from out-of-network providers within 30 days. All other claims must be processed within 60 days; b: The AIC requirement for all ALJ hearings and Federal District Court hearings is adjusted annually in accordance with the medical care component of the Consumer Price Index.; AIC = Amount in Controversy; ALJ = Administrative Law Judge; MAC = Medicare Administrative Contractor;

IRE = Independent Review Entity; QIC = Qualified Independent Contractor; This chart reflects the CY 2015 AIC amounts. 05/01/2015 Medicare Advantage and Other Medicare Health Plans 60 CMS National Training Program To view all available NTP training materials, or to subscribe to our email list, visit CMS.gov/Outreach-and-Education/Training/ CMS NationalTrainingProgram/index.html For questions about training products email [email protected]

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