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Older Minnesotans

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Health reform is helping to bring down costs for older Minnesotans through discounts on prescription drugs, free preventive services and screenings, and assistance in paying for health care services that help them maintain their independence. 

What Older Minnesotans Should Know About Health Reform

• Minnesotans in the Medicare Part D prescription drug coverage gap now receive a 50 percent discount on their brand-name prescriptions. The prescription drug coverage gap will be closed entirely in 2020. Read more about the Medicare Part D prescription drug coverage gap.

• Medicare now covers preventive care and screenings, such as mammograms, colonoscopies and an annual wellness exam at no cost to the patient. Learn more about preventive services/wellness exams.

• The Early Retiree Reinsurance Plan helps employers offset the cost of providing health coverage to retiring employees, increasing access to health coverage for those who retire before the age of 65. Learn about the Early Retiree Reinsurance Plan.

• Starting in 2014, Medical Assistance will expand to cover more people, including those making up to 138 percent of the federal poverty level—about $15,000 a year in 2011. Read more about Medicaid expansion

How does the prescription drug coverage gap work in 2011?

Generally, after paying a deductible of $310, beneficiaries with Medicare Part D coverage are responsible for paying 25 percent of the cost of their prescription drugs. However, once beneficiaries run up an additional $2,530 in costs ($632.50 of which is paid out-of-pocket and $1,897.50 is picked up by the Medicare drug plan), beneficiaries enter the prescription drug coverage gap. The Affordable Care Act changed the law so that beneficiaries are no longer fully responsible for paying 100 percent of their drug costs in the coverage gap. Instead, in 2011, beneficiaries receive a 50 percent discount on brand name drugs and a 7 percent discount on generic drugs until they have spent an additional $3,607.50. At that point, beneficiaries move out of the prescription drug coverage gap and Part D catastrophic coverage kicks in, and Medicare covers about 95 percent of the cost of prescription drugs for the remainder of the year.

How is the prescription drug coverage gap/donut hole closed by 2020?

The schedule below outlines how much Medicare Part D beneficiaries will pay for drugs while in the prescription drug coverage gap from 2012 to 2020.

• 2012: 50% for brand name drugs and 86% for generics
• 2013: 47.5% for brand name drugs and 79% for generics
• 2014: 47.5% for brand name drugs and 72% for generics
• 2015: 45% for brand name drugs and 65% for generics
• 2016: 45% for brand name drugs and 58% for generics
• 2017: 40% for brand name drugs and 51% for generics
• 2018: 35% for brand name drugs and 44% for generics
• 2019: 30% for brand name drugs and 37% for generics
• 2020: 24% for brand name drugs and 25% for generics

Will I still receive a Welcome to Medicare exam under health reform?

Medicare will continue to cover a Welcome to Medicare physical exam when Medicare coverage begins. This free exam is available during the first 12 months of Medicare enrollment and has no deductibles or copayments. However, those who are new to Medicare cannot get both the Welcome to Medicare exam and the annual wellness visit during the first 12 months of enrollment. The annual wellness visit takes place each year after that.

Do the requirements to cover preventive services change for Medicare Advantage plans?

Most Medicare Advantage plans already offer Medicare-covered preventive care services with no deductibles or copayments. Health reform does not require these plans to offer preventive care services free of charge. If you have a Medicare Advantage plan, please check with your plan to find out whether there may be deductibles and copayments for preventive care services.

If I retire from my employer before age 65, does the Early Retiree Reinsurance Program reimburse me for my premiums, deductibles or other out-of-pocket costs?

The Early Retiree Reinsurance Program is a program for employers. It does not require enrollment by individual early retirees. If an employer participates, all early retirees, as well as covered spouses, surviving spouses, and dependents are automatically included. A list of participating Minnesota companies is located under documents on the Early Retiree Reinsurance Program page of this site.

What is being done on the state or federal level to encourage people to purchase coverage for long-term care?

Minnesota implemented a Long-Term Care Partnership program effective July 1, 2006.  Under this program, Minnesota residents who purchase a specific type of long-term care insurance policy, called a Long-term Care Partnership policy, are able to protect more of their assets if they later need to turn to Medical Assistance (MA) to help pay for long-term care services.  Information on this program is available on the Minnesota Long Term Care Partnership website.

What if I have more questions about programs for aging?

The Senior LinkAge Line® is the Minnesota Board on Aging’s free statewide information and assistance service. The Senior LinkAge Line® service is provided by six Area Agencies on Aging that cover all 87 counties of Minnesota and helps connect you to local services.  1-800-333-2433. The free call that does it all!

How is health reform helping Minnesotans stay in their homes and communities?

In 2011, Minnesota was one of 13 states chosen to participate in the Money Follows the Person (MFP) program under health reform.  MFP helps Minnesotans transition from institutions and nursing homes into community settings by:

• Supporting Minnesotans as they return to their homes after hospital or nursing facility stays.
• Better serving individuals with complex needs in the community.
• Helping individuals in their homes by strengthening connections between healthcare, community supports, employment and housing systems.
• Increasing the use of home and community-based services overall 

How does the prescription drug coverage gap work in 2011?

Generally, after paying a deductible of $310, beneficiaries with Medicare Part D coverage are responsible for paying 25 percent of the cost of their prescription drugs. However, once beneficiaries run up an additional $2,530 in costs ($632.50 of which is paid out-of-pocket and $1,897.50 is picked up by the Medicare drug plan), beneficiaries enter the prescription drug coverage gap. The Affordable Care Act changed the law so that beneficiaries are no longer fully responsible for paying 100 percent of their drug costs in the coverage gap. Instead, in 2011, beneficiaries receive a 50 percent discount on brand name drugs and a 7 percent discount on generic drugs until they have spent an additional $3,607.50. At that point, beneficiaries move out of the prescription drug coverage gap and Part D catastrophic coverage kicks in, and Medicare covers about 95 percent of the cost of prescription drugs for the remainder of the year.

How much will Part D beneficiaries save this year?

The discounts can save beneficiaries as much as $1,800 a year in 2011. Minnesotans who have received discounted prescription drugs in the prescription drug coverage gap have saved an average of $522.38.

Won’t drug makers raise prices to make up their losses?

Possibly. Drug makers could partially offset that lost income by raising the prices they charge Medicare drug plans.

What if I don’t get a discount and I think I should?

If you think that you have reached the coverage gap and you don’t get a discount when you pay for your brand-name prescription, you should review your next Explanation of Benefits (EOB) notice. If the discount doesn’t appear on the EOB, you should work with your drug plan to make sure that your prescription records are correct and up-to-date. If your drug plan doesn’t agree that you are owed a discount, you can appeal. You can get help filing an appeal from your State Health Insurance Assistance Program (SHIP) or by calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Call 1-800-MEDICARE or look at the back cover of your Medicare & You handbook to get the telephone number for your local SHIP.

How is the prescription drug coverage gap/donut hole closed by 2020?

The schedule below outlines how much Medicare Part D beneficiaries will pay for drugs while in the prescription drug coverage gap from 2012 to 2020.

• 2012: 50% for brand name drugs and 86% for generics
• 2013: 47.5% for brand name drugs and 79% for generics
• 2014: 47.5% for brand name drugs and 72% for generics
• 2015: 45% for brand name drugs and 65% for generics
• 2016: 45% for brand name drugs and 58% for generics
• 2017: 40% for brand name drugs and 51% for generics
• 2018: 35% for brand name drugs and 44% for generics
• 2019: 30% for brand name drugs and 37% for generics
• 2020: 24% for brand name drugs and 25% for generics

Will preventive services be covered under my health plan?

If you are enrolled in employer health coverage or a health insurance plan that was created after March 23, 2010, preventive services are covered at no cost to you. In 2014, all plans will cover preventive services, including those purchased on the Minnesota exchanges.  Please note that the health plan is only required to cover preventive services at 100 percent if you are using an approved, in-network provider.   Also, if the preventive service is not the primary reason for your doctor’s visit, you may be charged some of the cost of the visit.  If you have questions, it’s always best  to check with your employer or insurance carrier directly to confirm.

What services are considered “preventive services”?

Depending on your age and health plan, you may receive the following preventive services at no cost to you. For a full list of preventive services, visit healthcare.gov.
• Blood pressure, cholesterol and diabetes screenings
• Cancer screenings, including mammograms and colonoscopies
• Counseling on such topics as quitting smoking, losing weight, eating healthfully, treating depression and reducing alcohol use
• Routine vaccinations against diseases such as measles, hepatitis or meningitis
• Flu and pneumonia shots
• Counseling, screening, and vaccines to ensure healthy pregnancies
• Regular well-baby and well-child visits, from birth to age 21

Will I still receive a Welcome to Medicare exam under health reform?

Medicare will continue to cover a Welcome to Medicare physical exam when Medicare coverage begins. This free exam is available during the first 12 months of Medicare enrollment and has no deductibles or copayments.  However, those who are new to Medicare cannot get both the Welcome to Medicare exam and the annual wellness visit during the first 12 months of enrollment.  The annual wellness visit takes place each year after that.

Do the requirements to cover preventive services change for Medicare Advantage plans?

Most Medicare Advantage plans already offer Medicare-covered preventive care services with no deductibles or copayments.  Health reform does not require these plans to offer preventive care services free of charge.  If you have a Medicare Advantage plan, please check with your plan to find out whether there may be deductibles and copayments for preventive care services.

Who is an early retiree?

The term ‘‘early retiree’’ means an individual, age 55 and older who is not yet eligible for Medicare and who is not an active employee of the employer maintaining the health benefit plan.  The term early retiree also includes the retiree’s spouse, surviving spouse and dependents.

I would like to retire early. Is my employer required to provide early retiree coverage under federal health reform?

No.  The Early Retiree Reinsurance Program is a voluntary program for employers who wish to provide benefits for their early retirees.

I will be an early retiree. How do I sign up for the Early Retiree Reinsurance Program?

The Early Retiree Reinsurance Program is a program for employers.  It does not require enrollment by individual early retirees.  If an employer participates, all early retirees, as well as covered spouses, surviving spouses, and dependents are automatically included.  A list of participating Minnesota companies is located under documents on the Early Retiree Reinsurance Program page of this site.

If I retire from my employer before age 65, does the Early Retiree Reinsurance Program reimburse me for my premiums, deductibles or other out-of-pocket costs?

No.  The Early Retiree Reinsurance Program reimburses the employer for a portion of claims paid for early retirees, their spouses, surviving spouses and dependents.  This program is designed to make it easier for employers to provide health insurance benefits to their early retirees.

What is the effective date of the Early Retiree Reinsurance Program? And when will it end?

The Early Retiree Reinsurance Program took effect on June 1, 2010.  The U.S. Department of Health and Human Services (HHS) began accepting enrollment applications in June 2010.  The program will end on Jan. 1, 2014 or earlier if the funds are paid out before Jan. 1, 2014.

How do employers qualify to receive payments under the Early Retiree Reinsurance Program?

Employer-sponsored retiree health plans must submit an application and be accepted into the program.  Once accepted, the participating employer can apply for reimbursement of actual claims paid on behalf of an early retiree.  The employer will need to submit evidence that the plan has implemented programs and procedures to generate cost-savings with respect to participants with chronic and high-cost conditions and documentation of the actual cost of medical claims involved.  Employers who have been accepted into the program can find information on how to submit claims at ERRP.gov.

What types of employer-sponsored plans are eligible?

All non-federal employer-sponsored health benefit plans for early retirees are eligible to participate in the program, including employer-sponsored plans that are self-funded by the employer or funded by a health insurance policy (fully insured).  Among the eligible program participants are private entities, state and local governments, nonprofits, religious entities, unions and other employers.

How much will an employer health plan covering early retirees receive?

The reinsurance program will reimburse an employer based on the actual amount of health benefits provided to an early retiree, even if the claims were paid by health insurance.  The threshold for filing a claim is $15,000 per individual retiree for each plan year.  Once the threshold is met, the program will reimburse participating plans for 80 percent of claims paid in excess of the $15,000 threshold until $90,000 has been paid for that retiree in that plan year.

During the first year of the program, claims paid before June 1, 2010, can be used to meet the $15,000 threshold if they are paid in the same plan year.  Only claims paid after June 1, 2010, are eligible for reimbursement. 

How much funding did Congress appropriate for the Early Retiree Reinsurance Program?

The Affordable Care Act provides $5 billion nationally to fund the reinsurance program until an Exchange is available to provide affordable coverage beginning in 2014.

What is long-term care?

Long-term care refers to care that individuals may need for a long time because they are unable to take care of themselves due to an illness, disease, the aging process, or cognitive impairment (for example, Alzheimer’s disease).
Most long-term care is non-skilled personal care, such as help with everyday tasks, called Activities of Daily Living (ADLs):
• Bathing
• Dressing
• Using the toilet
• Transferring (moving to or from a bed or chair)
• Caring for incontinence and
• Eating.

The goal of long-term care is to provide help with routine functions when being fully independent is not possible. Long-term care can be provided at home, in a community setting or in an institution.

What is the difference between long-term care and standard/basic health care?

Long-term care generally refers to the full spectrum of services needed due to physical and/or mental impairments, and includes both nursing facility care and home and community-based services.  It can include things like housing with services, assisted living, and in-home services such as home care, transportation, companion services, and home delivered meals.  Standard/basic health care services include hospital, physician, and prescription coverage.

What is home care?

Home care provides health-related services and assistance with day-to-day activities to people in their home. It can be used to provide short-term care for people moving from a hospital or nursing home back to their home and can also be used to provide continuing care to people with ongoing needs. Home care services may also be provided outside the person’s home when normal life activities take them away from home.

Who is eligible for home care services?

Home care services are available to some people through Medical Assistance and waiver programs for Minnesotans who have needs that are medically necessary, physician ordered and are provided according to a written service plan.  Minnesotans with long-term care insurance may also have access to these services.  The CLASS program will provide a new option for Minnesotans to purchase long-term care insurance. 

How can I get home care services?

You can call a home health agency or your county public health nurse. To find a home health agency in your area, look in the yellow pages of your local calling area telephone book under Home Health Services.

What is being done on the state or federal level to encourage people to purchase coverage for long-term care?

Minnesota implemented a Long-Term Care Partnership program effective July 1, 2006.  Under this program, Minnesota residents who purchase a specific type of long-term care insurance policy, called a Long-term Care Partnership policy, are able to protect more of their assets if they later need to turn to Medical Assistance (MA) to help pay for long-term care services.  Information on this program is available on the Minnesota Long Term Care Partnership website.

The health reform includes a Community Living Assistance Services and Supports program (CLASS).  The program will provide assistance with long-term care services and supportive services that allow people to stay in their homes.  The Affordable Care Act requires the Secretary of Health and Human Services to announce the details of the CLASS benefit plan by Oct. 1, 2012.  Information on this program is available through the Office of Community Living Assistance Services and Supports

What if I have more questions about programs for aging?

The Senior LinkAge Line® is the Minnesota Board on Aging’s free statewide information and assistance service. The Senior LinkAge Line® service is provided by six Area Agencies on Aging that cover all 87 counties of Minnesota and helps connect you to local services.  1-800-333-2433. The free call that does it all!

How is health reform helping Minnesotans stay in their homes and communities?

In 2011, Minnesota was one of 13 states chosen to participate in the Money Follows the Person (MFP) program under health reform.  MFP helps Minnesotans transition from institutions and nursing homes into community settings by:

• Supporting Minnesotans as they return to their homes after hospital or nursing facility stays.
• Better serving individuals with complex needs in the community.
• Helping individuals in their homes by strengthening connections between healthcare, community supports, employment and housing systems.
• Increasing the use of home and community-based services overall