SHIBA advisor continuing education | October 2020 · • At the time of publishing this CE...

SHIBA advisor continuing education | October 2020

Acronyms:• SHIBA continuing education

https://www.insurance.wa.gov/sites/default/files/documents/frequent-used-acronyms_0.pdf

• CMShttps://www.insurance.wa.gov/sites/default/files/2019-12/cms-frequently-used-acronyms.pdf


Please be sure to share that we do not advise using the Medicare site to look for Medicare Supplement (Medigap) plans. This site has been very incomplete and inaccurate and we recommend using the OIC list of Medigaps and the OIC Medigap booklet: “What you need to know about Medigaps/Medicare Supplements.”

NOTE: As in past years, not all counties will have MA plans, so the last 2 bullets on the Learning Objectives may not apply in the counties your clients live.


We will post any new or more up-to-date information on My SHIBA as soon as it is available.


We will include info about MA plans with Vision, Hearing, Fitness and Dental to our County list of plans. Remember that the details are important, like if there is an additional premium, or a restricted network of providers, or other limits. You can sort the Plan Finder to show some of the supplemental options. You can compare options side by side in Plan Finder. Make sure to have interested clients check with the plan before enrolling, because the details are important!


Not Basic plans and not for people with LIS, who should already pay less.

Cap is at all coverage phases (deductible, initial coverage, coverage gap and catastrophic).

Most important is to help clients evaluate all of the costs, and focus on using the Plan Finder to calculate the annual costs that roll up premium, any deductible and all costs over the course of the year. It is possible that the Senior Savings Model won’t save money after all of these costs are considered and we won’t know for sure until we can compare plans.


People on End Stage Renal Disease Medicare may ask you if they should enroll in an

MA plan. You can help them evaluate their options by explaining the costs associated

with an MA plan including monthly premium, out of pocket costs to get Part A and B

services and supplies, primary care and specialist visits and the annual out‐of‐pocket

maximum. You can help them compare those costs with what they may currently

have such as a Medicare Supplement with a fixed monthly premium, or an employer

or retiree plan.

After an overview with an ESRD Medicare client you can encourage them to call the

MA Plan directly to understand coverage and costs.

One very important consideration is if any drugs are covered under Part B and not Part D. The Plan Finder will show cost-sharing for Part B (It could be 20%, the same as for Original Medicare.)

For more information:

The 21st Century Cures Act amended the Social Security Act to allow all Medicare-eligible individuals with ESRD to enroll in MA plans beginning January 1, 2021. With this new enrollment option, the Cures Act also made related payment changes in the Medicare Advantage (MA) and fee-for-service (FFS) programs. www.cms.gov


• https://www.insurance.wa.gov/medicare-and-people-end-stage-renal-disease-esrd

• 2020_Medicare for People with ESRD_508_FINAL2.pptx from the CMS NTP websitehttps://cmsnationaltrainingprogram.cms.gov.

• https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans/what-if-i-have-end-stage-renal-disease-esrd


• SHIBA hopes to have a statewide map of the WA counties which have plans along with some information from the HCA website.

• At the time of publishing this CE training, the information was not available. • Check My SHIBA for more information after mid-September 2020. • More information about D-SNPs and which counties will or will not have plans

should be posted on September 30th.


Objective: Describe three Part D types of coverage rules.


Your volunteer coordinator and/or trainer may lead a discussion on Module 9: Medicare Part D Prescription Drug Coverage.

Also see the job aids section as the end of this presentation for a list of CMS trainingwebinars including:CMS NTP Virtual Workshop: Medicare Prescription Drug Coverage (Part D) (Recorded August 4, 2020)https://www.youtube.com/watch?v=ezR7Q17R7GE&feature=youtu.be


Your volunteer coordinator and/or trainer may lead a discussion on Module 11: Medicare Advantage and Other Medicare Health Plans.

Also see the job aids section as the end of this presentation for a list of CMS trainingwebinarsincluding:CMS NTP Virtual Workshops: Medicare Advantage (Recorded August 5, 2020)https://www.youtube.com/watch?v=PUZV-xKvKNY&feature=youtu.be


Others topics posted on CMS include:• COVID-19• Fraud• Opioids• Medicare A and B and Medicare Basics


The LINET information is new and recently posted to My SHIBA.


The Rainbow chart is accurate through the end of 2020. It will be updated in 2021 when the new Federal Poverty Levels are released.


January 2020Topic: Welcome to 2020!• Debrief Open Enrollment• Preview 2020 continuing education and feedback• What’s new for 2020• Counseling tips for veterans: Recorded webinar

Job aids and client publications1. 2020 Medicare hospital insurance (Part A) covered services & 2020 Medicare

medical insurance (Part B) covered Services2. Understanding Medicare Advantage & Prescription Drug Plan Enrollment Periods3. Get your new Medicare Card4. Veteran health care and Medicare

February 2020Topic: Trusted advising resourcesMedicare & You Sections 9 and 10• SHIBA issues and reference materials


• SHIBA resources: Volunteer Handbook and VRPM (and POM)• Scope and confidentiality• Secure email protocol• Primary trusted resources• Medicare & You, Sections 9 and 10• CMS training modules• Advising and helping with complaints

Job aids and client publications1. Medicare & You 20202. Who is KEPRO3. CMS Module 01: Understanding Medicare4. SHIBA job aid: Advising complaint process and checklist

March 2020Topic: Signing up for Medicare and learning what it coversMedicare & You Sections 1 and 2• Medicare & You: Signing up for Medicare• Medicare & You: Find out if Medicare covers your test, service or item• Discussion

Job aids and client publications1. Medicare & You2. CMS Module 00: Medicare Getting started3. How to Apply Online for Medicare Only4. Application for Enrollment in Medicare Part B5. 2020 Medicare Costs6. Medicare Outpatient Observation Notice (MOON)7. Medicare-covered preventive services

April 2020Topic: Volunteer recognition and Help paying for MedicareMedicare & You Section 7• SHIBA issues and reference materials


• Medicare & You, Section 7, Get help paying your health & prescription drug costs

Job aids and client publications1. Medicare & You2. Application for Medicare Savings Programs3. Calling the Health Care Authority Medicaid Phone System4. Get Help Paying for Medicare5. Medicare Help Rainbow Chart

May 2020Topic: Medicare fraud and the Senior Medicare Patrol (SMP)Medicare & You Section 8• Medicare & You, Section 8, Know your rights & protect yourself from fraud• SMP Foundations training• Fraud, abuse and errors• STARS reporting• Resources, references and wrap-up

Job aids and client publications1. Medicare & You2. SMP Foundations Training (SMP PowerPoint)3. Tips to help you recover from scam calls4. STARS Beneficiary Contacts SMP instructions

June 2020Topic: Disabilities and transitioning to Medicare• Topic Overview• Disabilities• Case examples discussion

Job aids and client publications1. Medicare & You2. Disability basics3. Eligibility Overview Washington Apple Health (Medicaid) Programs


4. Washington Apple Health (Medicaid) and Long Term Services & Supports (LTSS) for Adults

5. Calling the Health Care Authority Medicaid Phone System6. Washington health plan finder

July 2020Topic: Original Medicare and Medicare Supplement (Medigap) InsuranceMedicare & You sections 3 and 5• Original Medicare• Medigaps• Case sharing and group discussions

Job aids and client publications1. Medicare & You2. What you need to know about Medigap (Medicare Supplement) plans3. Approved Medicare Supplement (Medigap plans)4. COVID-19 resources: Videos, scams, and fraud alerts

September 2020Topic: Getting ready for Medicare Open Enrollment and using Plan FinderMedicare & You Section 8• Getting ready for Medicare Open Enrollment • Counseling logistics for OEP during COVID-19• Optional: Mechanics of Plan Finder practice sessions• Effective communication with clients• Job aids to support you during OEP

Job aids and client publications1. Medicare & You2. 2020-2021 Medicare Open Enrollment Period (OEP) timeline3. Medicare Minute: Medicare Open Enrollment Period4. CMS Guide to consumer mailings5. SHIBA and PEBB: Counseling roles6. Medicare plan comparison form (SHP838)7. Medicare Plan Finder worksheet


8. Medicare Plan Finder: Find a Medicare plan9. SHIBA’s confidentiality requirements10. Your SHIBA Medicare action plan (SHP 855)


Scenario Mrs. Allen just retired and is at her senior center. She’s telling her friend that she just turned 65 on April 12 and enrolled in Medicare Part A and Part B in February during her IEP. After that, she decided to enroll online in an MA Plan to start April 1. She says she’s not sure if she made the right decision. She’s worried that her doctors or medications won’t be covered by the plan she chose. She needs to understand her options for changing MA Plans if she chooses.

Q&A Q1: What options does Mrs. Allen have if she decides the MA Plan she selected doesn’t meet her needs? Explain your answer. • Mrs. Allen can make changes during the MA Open Enrollment Period (MA OEP).

Since she’s new to Medicare, her MA OEP starts the month she’s entitled to Medicare Part A and Part B (April 1, since her birthday’s that month), and ends the last day of the third month of entitlement (June 30). (See bottom of page 65 M&Y 2020, or bottom of page 67 M&Y 2021 OR Page 5 of https://www.medicare.gov/Pubs/pdf/11219-Understanding-Medicare-Part-C-D.pdf )

• Since she enrolled in an MA Plan when she was first eligible for Medicare when she turned 65, she has a Special Enrollment Period (SEP). This SEP is referred to as “SEP65.” It allows her to disenroll from the MA Plan and elect Original Medicare


any time during the 12-month period that begins on the effective date of coverage in the MA Plan. People who are eligible for MA and elect an MA Plan during their Initial Enrollment Period (IEP) at age 65 have this SEP. (M&Y does not specifically cover this, see top of page 3 of https://www.medicare.gov/Pubs/pdf/11219-Understanding-Medicare-Part-C-D.pdf . She can also make changes during the Medicare Open Enrollment Period (OEP), which is October 15–December 7 each year.

• She can use the MA OEP to make plan changes from January 1–March 31 the following year and each year after that, as long as she’s enrolled in an MA Plan. During the MA OEP she can:

• Switch to another MA Plan (with or without drug coverage). • Disenroll from the MA Plan and return to Original Medicare. If she chooses,

she may join a Medicare Prescription Drug Plan. • She can also make changes if she qualifies for other SEPs throughout the year—for

instance, if she moves out of the service area of the plan. • She can only make one change during the MA OEP. She can change to another

plan OR disenroll and go back to Original Medicare. The change she makes will be effective the first of the month after the request is made.

• Her first chance to enroll in Medicare (and join an MA Plan) is the 7-month period that includes the 3 months before her birthday month (April), the month of her 65th birthday, and the 3 months after. Therefore, her Medicare IEP began January 1 and ends July 31. If she chooses to enroll in a MA Plan, her coverage in the plan can’t take effect before April 1 (the effective date of Part A and Part B). Her effective date for Medicare Part A and Part B and her MA Plan is April 1 because she signed up for Medicare and then requested enrollment in an MA plan during the 3 months before April, the month she turned 65.

Q2: If she enrolls in an MA Plan during the last 3 months of her Medicare IEP, is she eligible for the MA OEP? No. The MA OEP is for a newly eligible person who enrolled in a MA Plan during the first three months of entitlement to both Part A and B. It begins the month you’re enrolled in Part A and Part B and ends on the last day of the third month of entitlement for Medicare Part A and Part B.

Q3: If Mrs. Allen waited until July to enroll in an MA Plan, what would be the effective date of her MA Plan, and when would her MA OEP begin and end? • Mrs. Allen’s MA Plan effective date would be August 1, the first of the month

following the month the enrollment request was made. She wouldn’t qualify for the MA OEP since she didn’t enroll in the MA Plan during the first 3 months of her Medicare Part A and B effective date.


• If she doesn’t enroll in Medicare Part B during her IEP at age 65, and she enrolls at a later time, such as during the Medicare Part B General Enrollment Period (GEP) or a Special Enrollment Period (SEP), her MA IEP moves to occur 3 months before the Part B effective date. If she enrolls in an MA Plan during the 3 months before the Part B effective date, the MA OEP begins the month she’s enrolled/entitled to Medicare Part A and Part B and ends the last day of the third month following the Part B effective date.

Resources “Medicare & You” (Handbook available for download in multiple formats) Medicare.gov/medicare-and-you https://www.medicare.gov/medicare-and-you

“Medicare Advantage Enrollment and Disenrollment,” Chapter 2 in the Medicare Managed Care Manual (PDF) CMS.gov/Medicare/Eligibility-and-Enrollment/MedicareMangCareEligEnrol/ https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicareMangCareEligEnrol/Downloads/CY_2019_MA_Enrollment_and_Disenrollment_Guidance.pdfDownloads/CY_2019_MA_Enrollment_and_Disenrollment_Guidance.pdf https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicareMangCareEligEnrol/Downloads/CY_2019_MA_Enrollment_and_Disenrollment_Guidance.pdf

“Medicare Advantage Open Enrollment Period” (Web page) Medicare.gov/node/33581 https://www.medicare.gov/node/33581

“Understanding Medicare Advantage & Prescription Drug Plan Enrollment Periods,” CMS Product No. 11219 (PDF) Medicare.gov/pubs/pdf/11219-understanding-medicare-part-c-d.pdf https://www.medicare.gov/Pubs/pdf/11219-understanding-medicare-part-c-d.pdf


This is what we have planned for 2021.

Topics are subject to change.

SHIBA advisor continuing education | October 2020 · • At the time of publishing this CE...

Documents

Transcript of SHIBA advisor continuing education | October 2020 · • At the time of publishing this CE...