A Social Innovator for Healthcare, Economic Security, and Personal Dignity. Update on Medicare for Youth & Adults with Disabilities Health & Disability.

A Social Innovator for Healthcare, Economic Security, and Personal Dignity.

Update on Medicare for Youth & Adults with Disabilities

Health & Disability AdvocatesOctober 20, 2015


Objectives of this Presentation:

• Brief review of Medicare • Overview of how Medicare works for young

adults and people with disabilities• Update on how Affordable Care Act impacts

Medicare


What is Medicare?

• A federal health insurance program

• Run by the Centers for Medicare and Medicaid Services (CMS)

• Benefit decisions controlled by the U.S. Congress and President (state has no role)

• Social Security Administration (SSA) handles enrollment and eligibility


Medicare has 4 Parts – A, B, C, D

Original Medicare• Part A – Hospital Insurance• Part B – Medical Insurance

Provided through private companies that have contracts with Medicare

• Part C – Medicare Advantage Plans

• Part D – Prescription Drug Plans

Medicare Puzzle Pieces

Part A

Part B

Part D Part C


Who is Eligible for Medicare?

• Age and work history• People age 65+

– eligible for benefits under Social Security Railroad Retirement, federal, state or local employee

– Have 40+ quarters of Social Security covered (FICA) employment (10 years full time) • Eligible for Social Security AND premium free Medicare Part A. You

pay a monthly premium for Part B.

– If married, may receive benefits under a spouse’s work record

– Married at least 10 years to receive benefits under a former spouse


Others Eligible for Medicare

• Persons with disabilities under age 65 – Receiving disability benefits under Social Security

(SSDI) or Railroad Retirements for 24 months or more

• At any age – including children– Receiving regular kidney dialysis or a kidney

transplant– Amyotrophic Lateral Sclerosis (ALS) – Lou Gehrig’s

disease(waiting periods apply, go to SSA.gov for details)


Youth with Disabilities Eligible for Medicare (Disabled Adult Child or DAC)

• Young adults can receive Social Security Disability Insurance and Medicare if the following:– Onset of disability is prior to age 22;– Parent is receiving Social Security retirement or

disability benefits (SSDI); OR– Parent is deceased and worked enough quarters to

qualify for Social SecurityThere is still a 24 month waiting period for Medicare

after found eligible for SSDI.


Paths to Coverage During Waiting Period

Medicaid

• “Regular”/AABD Medicaid or Health Benefits for Workers with Disabilities (if earning wages)

ACA Medicaid

• Between 100- 139% fpl, no asset test or Health Benefits for Workers with Disabilities (if earning wages)

Private Health Plan

• Up to Age 26 on Parent’s plan

ACA Marketplace Plan

• Purchase a plan in the Marketplace


Enrolling in Medicare• Initial Enrollment Period –

– Age 65: 7 months (3-1-3 rule)• 3 months, before, month of, and 3 months after 65th birthday

– SSDI : 25th month of SSA disability

• Special Enrollment Period (SEP)– May be able to delay enrollment if you (or a spouse ) are still working and

covered under an employer group health plan. Check with your employer.– Must enroll in Part B within 8 months after you stop working or employer

coverage ends – whichever happens first

• General Enrollment Period – if you don’t enroll when you are first eligible or miss SEP– January 1 – March 31 of each year– Coverage begins July 1st

– Penalties may apply (10% for each 12 months missed)


The ACA and Medicare

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ACA Changes to Medicare

11

Medicare Part D donut hole will close by 2020



12

More plan options for individuals with Extra Help

People with higher annual incomes pay higher Part D premiums

https://www.medicare.gov/find-a-plan/questions/home.aspx





13

Annual Medicare Enrollment Period: Oct. 15- Dec. 7

New Medicare Advantage Disenrollment Period: Jan. 1- Feb. 14



14

No out of pocket costs for most preventative services

New Annual Wellness Visit



15

New demonstration programs to improve quality of care

Reduced payments to Medicare Advantage plans



16


Transitioning onto Medicare


Already on AABD Medicaid• Need to enroll in Medicare when first eligible

(Medicaid is secondary to Medicare)• Will be automatically enrolled in Extra Help

program• If currently enrolled in a managed care plan as

part of the Integrated Care Program, you will be automatically enrolled into a managed care plan for “dual eligibles” with the same company as their Integrated Care Program plan


Currently on ACA Adult Medicaid• Need to enroll in Medicare when first

eligible (Medicaid is secondary to Medicare)

• Will likely not be automatically enrolled in Extra Help program or AABD Medicaid – should apply if the person qualifies


Currently enrolled in a Marketplace plan

• Need to enroll in Medicare when first eligible – will face penalties otherwise – Individuals who have not paid into Social Security 40

quarters and therefore must buy into Medicare Part A are allowed to remain in Marketplace instead of buying Medicare

• Enroll in Medicare first, then contact Marketplace plan to drop coverage when Medicare begins (should use 3 months before birthday to enroll in Medicare so that Medicare coverage will begin when first eligible)


Enrollment: Medicare, Medicare Supplement Etc.

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• Local SSA office• www.medicare.gov• 1-800-MEDICARE• SHIP (Senior Health Insurance Program) 1-

800-548-9034 or SHAP (Senior Health Assistance Programs) listed at http://www.state.il.us/aging/1directory/SHAP.pdf.

http://www.medicare.gov/

http://www.allkidscovered.com/pregnant.html

http://www.allkidscovered.com/pregnant.html


Questions or Comments

A Social Innovator for Healthcare, Economic Security, and Personal Dignity. Update on Medicare for Youth & Adults with Disabilities Health & Disability.

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