1 benefits update statewide senior action council annual convention east greenbush, ny october 12,...
TRANSCRIPT
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Benefits update
StateWide Senior Action Council annual convention
East Greenbush, NY October 12, 2011
Presenter: Cathy Roberts, Senior Paralegal
Empire Justice Center, Albany, NY
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Today’s presentation
A review of changes affecting: Medicare Medicaid Food stamps HEAP
(Home Energy Assistance Program)
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Medicare update: what’s
new in 2012
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Medicare Part D
New open enrollment period: Oct 15 - Dec 7 Special enrollment period for 5 star plans Higher Part D premiums for higher income
beneficiaries Gradual closing of coverage gap
14% discount for generics 50% discount for brand name drugs
$0 drug co-pays for HCBS Medicaid waiver participants
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Medicare Advantage
Same change to open enrollment period:
Oct 15 - Dec 7
Preventive services must be free
Other limitations on cost sharing: Chemotherapy Dialysis Skilled nursing facility
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Original Medicare
Mental health co-pays reduced to 40% Were 45% in 2011
Coming soon: Info regarding Part A and B premiums, deductibles, etc.
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Programs that help with Medicare cost-sharing
PROGRAM MONTHLY INCOME LIMIT (after disregards)
RESOURCE LIMIT
Extra Help (Part D Low Income Subsidy)
$1,362 single$1,839 couple
$12,640 single$25,260 couple
Medicare Savings Program: QI-1
$1,226 single$1,655 couple
none
Medicare Savings Program: SLIMB
$1,089 single$1,471 couple
none
Medicare Savings Program: QMB
$908 single$1,226 couple
none
Community Medicaid for 65+, disabled or blind
$767 single$1,117 couple
$13,800 single$20,100 couple
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What’s new in Medicaid
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No more Medicaid “wrap” for dual eligibles
Medicaid no longer pays for any Part D covered drugs (as of 10/1/2011)
Medicaid continues to cover: Part B drugs (co-insurance) Benzodiazepines Barbiturates Prescription vitamins Certain OTC drugs
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New limitations in Medicaid services
Affects access to: Compression stockings Prescription footwear Enteral nutritional formula Level 1 personal care services Physical, occupational and speech
therapy
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Dramatic expansion of mandatory managed care
Does not affect most Medicare beneficiaries (yet), except for: New requirements governing
managed long term care (MLTC). Beginning in NYC in May 2012:
Anyone needing personal care for more than 120 days will be required to enroll in an MLTC plan
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Reduction in reimbursement rates to providers
Decreased reimbursement rates may affect access to care, especially:
Home care services
Adult dental care
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Food Stamps
(aka SNAP: Supplemental Nutrition
Assistance Program)
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Many eligible seniors are not participating
Estimated “take-up” rate for seniors: 34%
Recent changes have improved access No asset test for most seniors No in-person interview required Can apply by mail or internet
Most seniors getting Part D Extra Help or EPIC
premium assistance can qualify
For more info, go to https://www.mybenefits.ny.gov/
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HEAP:
Home Energy Assistance Program
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Cuts on the federal level will drastically affect New York
this winter Shorter HEAP season:
Regular HEAP opens Nov 16, 2011 Emergency HEAP not expected to open until
January 3, 2012
Significant reduction in benefit levels: Most households will get 30-40% less than what they got last year
More info is available at http://otda.ny.gov/programs/heap/
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Where to go for help
Health Insurance Information Counseling and Assistance Program (HIICAP) NYS toll-free helpline: 1-800-701-0501
1-800-MEDICARE or www.medicare.gov
Social Security Administration (to enroll in Medicare): 1-800-772-1213 or
www.socialsecurity.gov
Food stamps and HEAP:https://www.mybenefits.ny.gov/
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Questions? www.nyhealthaccess.org
My contact information:
Cathy Roberts, Senior Paralegal
Empire Justice Center
119 Washington Avenue
Albany, NY 12210
1-800-635-0355 x 112
www.empirejustice.org