HIICAP Regional Training Fall 2022 The Medicare Rights Center is a national notforprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through ID: 999246
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1. Medicare changes in 2023HIICAP Regional TrainingFall 2022
2. The Medicare Rights Center is a national not-for-profit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through:Counseling and advocacyEducational programsPublic policy initiativesMedicare Rights Center Page 2
3. Medicare Rights CenterThe Medicare Rights Center has a helpline available for HIICAP counselors:800-480-2060hiicap@medicarerights.org Page 3
4. Learning objectivesThis presentation will discuss the following expected changes for 2023:MSP and Medicaid expansion in New York stateEnrollment periods Part B coverage of immunosuppressant drugs Prescription drug costs Page 4
5. MSP and Medicaid Expansion in New York State Page 5
6. MSP and Medicaid expansionThe New York fiscal year 2022-2023 budget will expand eligibility for the Medicare Savings Program (MSP) and Medicaid starting January 2023New Yorkers with limited incomes may be newly eligible to receive assistance with their health care costs through an MSP or MedicaidThose currently enrolled may qualify for more comprehensive benefits Currently three MSPs have different income limits and benefitsQualifying Individual (QI)Specified Low-Income Medicare Beneficiary (SLMB)Qualified Medicare Beneficiary (QMB)A fourth MSP, Qualified Disabled Working Individual (QDWI) for people who are eligible for Medicare due to disability and have returned to work, is unchanged by this expansion Page 6
7. MSP and Medicaid eligibility in 2022Figures include automatic $20 disregard for every applicationProgramMonthly income limitAsset limitSingleCoupleSingleCoupleQI$1,549$2,080No asset limit in New York StateSLMB$1,379$1,851QMB$1,153$1,546Medicaid$954$1,387$16,800$24,600 Page 7
8. Changes in 2023QMB upper limit will increase from 100% federal poverty level (FPL) to 138% FPLSLMB will be eliminatedQI will increase from 135% FPL to 186% FPLNew York’s aged, blind, and disabled (ABD) Medicaid limit will increase to 138% FPLAsset limits will still apply, but are increased Page 8Beneficiaries do not need to do anything except respond to any requests for more information from Medicaid, including the request to recertify their MSP or Medicaid.
9. MSP and Medicaid eligibility in 2023These eligibility limits are estimates based on the 2022 FPL The state will announce the expanded limits in January 2023ProgramMonthly income limitAsset limitSingleCoupleSingleCoupleQI$2,107$2,839No asset limit in New York StateQMB$1,563$2,106Medicaid$1,563$2,106$28,134$37,908 Page 9
10. Enrollment periods Page 10
11. Initial Enrollment Period (IEP) - 2022Seven-month period including the three months before, the month of, and three months following a beneficiary’s 65th birthdayCoverage starts depending on when in the IEP a person enrollsCurrently, a beneficiary’s IEP if they turned 65 on June 14: Page 11JuneMayJulAugSepAprMarCoverage starts:June 1July 1Sept 1Nov 1Dec 1Enroll:
12. General Enrollment Period (GEP)GEP runs from January 1 – March 31 of each yearMedicare-eligible individuals who missed their IEP or don’t have a Special Enrollment Period (SEP) can enroll during the GEPPeople who use the GEP may have to pay a Part B late enrollment penalty (LEP) for the rest of their lifeFor 2022, coverage started July 1 Page 12
13. IEP and GEP in 2023The Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act provisions that were passed in 2020 will reduce or eliminate gaps in coverage for Medicare beneficiaries starting in 2023 by reforming the IEP and GEP effective dates.Starting in 2023, Medicare coverage will be effective the month after enrollment for people who enroll in the last three months of their IEP or during the GEP. Page 13
14. Proposed SEP changes in 2023Additional changes for 2023 have been proposed by CMSIf finalized, new SEPs for Part B and Premium Part A will be established for people who:Lose Medicaid Are in an area with a disaster or emergencyAre released from incarcerationMake an enrollment mistake based on some types of misinformation from their employerExperience other exceptional circumstances These flexibilities would expand Medicare enrollment opportunities, reduce gaps in coverage, and prevent late enrollment penalties Page 14
15. Part B coverage of immunosuppressants Page 15
16. Immunosuppressant drugsAfter getting a kidney transplant, individuals with End-Stage Renal Disease (ESRD) need to take immunosuppressant drugs for the rest of their life to prevent their body from rejecting the donor organMedicare covers these drugs differently depending on the circumstances of the transplant Page 16
17. Part B coverageIf kidney transplant is in Medicare-approved facility, Medicare Part B covers immunosuppressant drugs if the beneficiary:Had Part A at the time of the transplantIndividuals can enroll retroactively in Part A within a year of the transplantHas Part B when getting the prescription filled Page 17People who are eligible for Medicare ONLY because of ESRDPeople who are also eligible for Medicare due to age or disabilityPart B will cover immunosuppressants until ESRD Medicare ends, 36 months after the month of transplant Part B coverage of immunosuppressants continues as long as the person is enrolled
18. Extended Part B immunosuppressant coverageStarting in 2023, there is a new, limited Medicare benefit called the immunosuppressive drug benefit, or the Part B-ID benefitProvides Part B coverage of immunosuppressant drugs for people whose ESRD Medicare benefits have ended 36 months after their transplant who do not have other health insuranceTo get coverage, the person must:Qualify for Part B coverage of immunosuppressants prior to losing Medicare Part BNot have Medicaid or other public or private health insurance that covers immunosuppressants Page 18
19. Enrolling in extended coveragePart B-ID coverage may not be the best choice if any other insurance is availableOnly covers immunosuppressant drugs and does not include coverage for any other Part B benefits or servicesDoes not allow a person to access Part ACostsPeople must pay a premium, set at a percentage of the standard Part B premiumIndividuals enrolled in Part B-ID can apply for the Medicare Savings Program for help with premium costs and, if eligible for QMB, cost-sharing assistanceBeneficiaries who qualify can enroll in extended Medicare coverage for immunosuppressants starting October 1, 2022Beneficiaries whose ESRD Medicare eligibility expires or expired before January 1, 2023 can enroll Page 19
20. Prescription drug costs Page 20
21. Inflation Reduction Act changes for 2023$0 cost-sharing and no deductibles for Part D vaccinesApplies to vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), including the shingles vaccine Limits insulin copays to $35 per month for Part D and Part B-covered products, with no deductible Requires drug manufacturers to pay rebates to Medicare if they increase drug prices faster than the rate of inflationFor single-source drugs and biologicals covered under Part BAll covered drugs under Part D except those with average annual cost < $100 Page 21
22. IRA changes effective after 20232024: The 5% coinsurance in the catastrophic coverage phase will be eliminated, and beneficiaries will have $0 cost sharing Income eligibility for Full Extra Help will be expanded to 150% FPLPartial Extra Help will be eliminated — anyone currently eligible for Partial Extra Help will be entitled to the full benefit2025: Annual out-of-pocket Part D costs will be capped at $2,0002026 onward: Federal government will be required to negotiate prices for certain high-cost drugs 2024-2030: Part D premium growth will be limited to no more than 6% per year Page 22
23. For more information & helpMedicare Rights Center HIICAP Technical Assistance Helpline: hiicap@medicarerights.org (800) 480-2060Medicare Rights Center National Helpline(800) 333-4114 Medicare Interactivewww.medicareinteractive.org Page 23
24. Thank you! Page 24