HealthCare Choices Resource Center
Bulletin
January 23, 2012
Medicare Updates
Medicare Advantage Disenrollment Period and Guaranteed Issue Rights
The Medicare Advantage Disenrollment Period (MADP) is a period during the first six weeks of the
year when Medicare beneficiaries can switch from their Medicare Advantage plan to Original
Medicare. The MADP begins January 1st and ends February 14th of every year.
During this time, people with Medicare can disenroll from their Medicare Advantage plan with or
without prescription drug coverage (MA or MA-PD) and return to Original Medicare to receive Parts A
and B services. Individuals cannot switch to another MA or MA-PD plan during the MADP.
Individuals who use the MADP will receive a special enrollment period (SEP) to enroll in a standalone prescription drug plan (PDP) but will not have any special guaranteed issue rights to buy a
Medicare Supplement (Medigap) policy. That is, they may apply for a Medigap policy, but could be
denied.
However, there are two companies in the state of Illinois that currently offer guaranteed issue policies
for individuals 65 and older throughout the year. BlueCross BlueShield of Illinois and Health Alliance
will sell a policy to beneficiaries who qualify for a Medigap policy plan regardless of their health
history. Individuals may be charged the highest premium rate on file with the Illinois Department of
Insurance but cannot be denied coverage. People with disabilities under age 65 and on Medicare
have guaranteed issue with these plans only during the Medigap open enrollment period for people
with disabilities (October 15 – December 7 of each year).
Click here to view a fact sheet created by the National Council on Aging’s Center for Benefits
Outreach and Enrollment that explains the MADP and coverage options a beneficiary has during this
time.
New Medicare Preventive Benefits
The U.S. Department of Health and Human Services (HHS) has recently expanded the list of
Medicare preventive services to include the following:
 expanded coverage of screening for cardiovascular disease
 screening and counseling for alcohol misuse and
 screening for depression.
A beneficiary must have Medicare Part B to be eligible to receive Medicare covered preventive
services. All these services must be provided in a primary care setting (like a doctor’s office) by a
qualified primary care physician or other primary care practitioner.
AgeOptions on behalf of the Make Medicare Work Coalition
January 23, 2012
Expanded Coverage for Cardiovascular Disease
The expanded coverage is part of the Million Hearts Initiative that is jointly led by CMS, the Centers
for Disease Control and Prevention and a number of organizations partnering with HHS. The program
aims to prevent one million heart attacks and strokes in the next five years.
What the service includes: One face-to-face visit each year to reduce the risk of cardiovascular
disease. The visit will also allow providers to screen for hypertension, encourage a healthy diet plan.
Who is eligible? All people with Medicare.
Cost: Nothing if the provider accepts assignment.
Click here to view the CMS press release and here to view a detailed description of what the service
includes.
Screening and Counseling for Alcohol Abuse
What the service includes: Screening for alcohol misuse. This service will also cover four
behavioral counseling sessions each year if the beneficiary screens positive for alcohol misuse.
Who is eligible? People with Medicare including pregnant women and individuals who misuse
alcohol but are not alcohol dependent.
Cost: Nothing if the provider accepts assignment.
Click here to view the decision memo that details what is included in this service.
Screening for Depression
What the service includes: An annual screening for depression in a primary care setting that has
the clinical staff (such as nurse or physician assistant) that can facilitate and coordinate treatment and
referrals to mental health resources.
Who is eligible? All people with Medicare.
Cost: Nothing if the provider accepts assignment.
Click here to view the decision memo that details what is included in this service.
Obesity Screening and Counseling
What the service includes: Intensive counseling to help lose weight, including one face-to-face
counseling session weekly for one month followed by one counseling visit every other week for up to
five months. Beneficiaries may continue to receive one monthly visit for an additional six months if
they lose at least 6.6 lbs within the first 6 months of counseling.
Who is eligible? People with Medicare who have a body mass index of 30 or more.
Cost: Nothing if the provider accepts assignment and the service is provided in a primary care setting
where it can be coordinated in a comprehensive prevention plan.
Click here to read the CMS decision memo for more information.
Social Security
Social Security Announces New Compassionate Allowances
The Social Security Administration (SSA) has announced 12 additional compassionate allowances
that involve heart disease. Compassionate Allowances are a list of medical conditions meant to
quickly identify individuals for disability status. Compassionate Allowances allow SSA to avoid delays
AgeOptions on behalf of the Make Medicare Work Coalition
January 23, 2012
for people with these conditions in being awarded Social Security Disability Insurance (SSDI) or
Supplemental Security Income (SSI).
Click here to view a list of the new 12 Compassionate Allowances. Click here to view a complete list
of over 100 compassionate allowances.
Social Security Spanish Website Launched
The Social Security Administration (SSA) recently launched a Spanish version of the SSA website at
http://www.segurosocial.gov/. Applications for retirement benefits, Medicare and Extra Help are now
available in Spanish and can be submitted to SSA through their website. In addition to other
information and services available in Spanish, the website also offers an online calculator that
estimates retirement benefits. This tool can be used by individuals planning for retirement and to
estimate the amount of their monthly Social Security benefit.
Click here to view the Social Security’s press release.
Resources and Training Opportunities
Chart of Benefits
Please click here to view an updated Chart of Benefits created by AgeOptions. The chart of benefits
lists the income, asset and eligibility requirements for various benefit programs including Illinois Cares
Rx, Circuit Breaker, Low-Income Subsidy (LIS), Medicare Savings Programs and Medicaid. It also
includes eligibility information for Supplemental Security Income, LIHEAP, Food Stamps, Access to
Care, Section 8, and Community Spousal Impoverishment.
Q&A
I have a client who is 47 years old, receiving Social Security Disability Insurance (SSDI)
benefits and is in his 24 month waiting period for Medicare. He needs help paying for his
diabetes medications but is not yet eligible for Medicare. I heard that Illinois Cares Rx may be
able to help him with his medication even if he does not have Medicare yet. How does this
work?
ICRx not only assists people with Medicare pay for their Part D plan and drug costs, but also helps
people without Medicare pay for medications. To qualify for ICRx without Medicare, individuals must
live in Illinois and meet the criteria listed below:
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Be age 65 and older OR age 16+ with a qualifying disability
Have a social security number and
Meet these income limits:
o $21,780 – household of one
o $29,420 – household of two
o $37,060 – household of three
Individuals without Medicare will qualify for either Illinois Cares Rx Basic or Plus. The level of ICRx an
individual qualifies for depends on his or her age and citizenship status (described below.)
For each 30-day prescription filled, individuals in ICRx Basic or Plus pay:
AgeOptions on behalf of the Make Medicare Work Coalition
January 23, 2012

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$5 for generics
$15 for brand names
Once the total cost of drugs (what ICRx pays plus what the member pays) reaches $1,750, the
individual pays 25% plus $5.00 or $15.00 for each prescription filled for the remainder of the calendar
year.
ICRx Plus for people without Medicare
ICRx Plus will cover most prescription drugs. To qualify for ICRx Plus, an individual must:
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meet the income limits listed above
be a US citizen or a qualified noncitizen AND
be age 65 or older
The ICRx Plus drug list may be found here. Please note this is also the Illinois Medicaid formulary.
ICRx Basic for people without Medicare
People with a qualifying disability aged 16 through 64 or who do not meet the citizenship
requirements for ICRx Plus, will qualify for ICRx Basic. They will receive assistance paying for drugs
used to treat the following ten conditions:
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Alzheimer’s
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Heart disease and its related conditions
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Arthritis
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Lung disease/ smoking related illnesses
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Cancer
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Multiple sclerosis
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Diabetes including insulin, syringes, and
needles
Glaucoma
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Osteoporosis
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Parkinson’s Disease
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The ICRx Basic Drug List can be found here .
Note: If a person with a qualifying disability does not receive Social Security Disability Insurance
(SSDI) or is in the process of applying for SSDI, he or she may still qualify for ICRx prescription drug
assistance if his or her doctor completes and signs a Schedule A Physician’s Statement (located in
the back of the IL-1363 booklet.) Schedule A forms cannot be submitted online and must be filed on
paper along with the original IL-1363 application.
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AgeOptions on behalf of the Make Medicare Work Coalition
January 23, 2012