The Health Care Law:
What it Means for
People with Medicare
Welcome
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Agenda
 What’s changing
 What’s not changing
 When changes
take place
 Q&A
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How The Law Improves Medicare
Protects guaranteed Medicare benefits
 Improves Medicare benefits
• Lowers prescription drug
costs
• Adds more preventive
benefits
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What’s The Doughnut Hole?
Medicare Part D coverage gap
• Fall into the doughnut hole after total
drug costs reach $2,970
• Leave the doughnut hole when total
out-of-pocket drug costs reach $4,750
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Medicare Drug Coverage
Doughnut Hole
Initial Benefit
You pay: Deductible and 25%
of drug costs
Discount:
52.5% for Brand
21% for Generic
Catastrophic
Benefit
You pay: 5% of drug costs
Doughnut Hole Disappears
 52.5% discount on brand name drugs
 21% discount on generic drugs
 By 2020, the doughnut hole will disappear
 Part D cost sharing will remain
AARP’s Doughnut Hole Calculator
www.aarp.org/doughnuthole
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www.aarp.org/doughnuthole
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Adds More Preventive Care Benefits
 Yearly wellness visit
 Screenings for diabetes and cancers
 No co-payments or deductibles
Call Medicare at 1-800-633-4227
www.medicare.gov
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Improves Access To Primary Care Doctors
Primary care doctors get
bonus payments
Medicare gives extra
payments where shortage of
providers
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Improves Care Coordination
Must have a face-to-face visit from a
health practitioner
A physician must certify home health
services
Visit must occur within
• 90 days before you receive home health care
or
• 30 days after you start care
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Medicare Advantage Plans
Alternative to Original Medicare
Offered by Medicare-approved private
insurance companies
Pays for the same basic health care
services as Original Medicare
May also pay for additional services
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Changes To Medicare Advantage Plans
Guaranteed Medicare benefits are
protected
Choose either a Medicare Advantage plan
or Original Medicare
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More Emphasis On Quality & Value
Bonuses for providing quality care
Use some of the bonus for extra benefits and
rebates
Can’t charge more than Original Medicare for
certain services
Must limit how much they spend each year
on administrative expenses
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How Medicare Advantage Plans Are Paid
Subsidies to private insurance companies
will be lower
Changes in payments will result in savings
to the Medicare program
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What Lower Subsidies Could Mean
May drop extra services
May raise premiums and co-payments
May leave the Medicare program
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What Lower Subsidies Could Mean
 You will receive a notice of changes, if
any
 You can stay with your plan, switch your
plan, or go to Original Medicare
Contact your Medicare Advantage plan or
call Medicare at 1-800-633-4227
www.medicare.gov
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Part D Income-Related Premiums
 Income levels for higher premiums start
 $85,000 -- single person
 $170,000 -- married couple
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Reduces Waste, Fraud & Abuse
 Cuts inefficient care
 Identifies fraudulent providers
 Reduces overpayments to insurance companies
 Protects personal information
Call Medicare at 1-800-633-4227
www.aarp.org/fightfraud
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Remember!
Helps lower prescription drug costs
 Protects guaranteed Medicare benefits
 Improves Medicare-covered benefits
 Makes some changes to Medicare
Advantage plans
 Reduces waste, fraud and inefficiencies
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www.HealthLawAnswers.org
For More Information
 The Health Care Law
 HealthLawAnswers.org
 MiLeydeSalud.org
 Medicare
 www.Medicare.gov 1-800-633-4227
 SHIP
 www.SHIPtalk.org 1-800-677-1116
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Has the Health Care Law helped you?
Share your personal story
www.aarp.org/ShareYourThoughts
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Upcoming Web Events
www.aarp.org/HealthWebinars
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