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What is MACRA?

There are many acronyms in the Medicare insurance industry. So much so, that it can be hard to keep them all straight. It is helpful to focus on the vitally important ones. MACRA is one of those acronyms that any informed agent needs to know about in order to best serve their customer base.   What is MACRA stand for?

MACRA stands for the Medicare Access and CHIP Reauthorization Act of 2015. This bipartisan piece of legislation was signed into law on April 16, 2015. It created what is known as a Quality Payment Program (QPP). The Quality Payment Program is an incentive program that replaced the Sustainable Growth Rate (SGR) formula that Medicare was using. The Sustainable Growth Rate would have made payment rates for participating Medicare physicians go down significantly, which would have caused problems in the industry. Instead, the Center for Medicare and Medicaid Services (CMS) is now using the Quality Payment Program.

There are two different ways that physicians can choose to participate in the Quality Payment Program.

1. The Merit-Based Incentive Payment System (MIPS). This means that physicians would be reviewed and their payment would be based on how well they perform.

2. Advanced Alternative Payment Models (APMs). For physicians who choose this route, they may earn Medicare Incentive Payments by participating in an innovative payment model rather than have their rate based on their reviewed merit.

Other things that MACRA accomplished, other than implementing the Quality Payment Program and doing away with the Sustainable Growth Rate, are as follows:

• It changed the way that Medicare rewards physicians, which puts the onus on quality of service rather than volume of service.

• Under the Merit-based Incentive Payment System (MIPS), many quality programs are streamlined.

• Rewards physicians for participating in Advanced Alternative Payment Models (APMs).

• MACRA also required CMS to remove social security numbers from Medicare ID cards by 2019, in an effort to prevent identity theft and increase security for their beneficiaries.

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Medicare savings program CT 2018

There have been major changes made to the Medicare Savings Program CT 2018.  The changes have substantially lowered the income guidelines for those receiving help with their Medicare Part B premium, drug co-pay costs and Medical cost shares.  Prior to 1-1-18 anyone that was under the monthly income levels below qualified for help. There is not an asset test on the programs.

Those who no longer qualify for programs based on the new income limits will notice changes for 2018. If you no longer qualify, you will start to again pay your Medicare part B premium which is $134 a month for most people.  If you are taking Social Security payments, they will start to take it out of your payment every month. Those not taking Social Security will be billed quarterly for it.

Anyone receiving drug help with co-pays will continue to receive that help throughout 2018 even if they no longer qualify for the program. Those receiving cost share help with co-pays and Medicare deductibles and coinsurance will cease getting that help as of 1-1-18. (assuming you no longer qualify based on the new income amount)  Anyone qualifying at any of the below levels does not pay the monthly part B premium, has help on drug costs and is not subject to the drug plan coverage gap. Those that qualify at QMB level also have help with medical costs.

Medicare Savings Program CT 2018 – Update

NOTE:  UPDATE: It has recently been decided the program will be extended under the 2017 income levels through the month of February 2018

**Please note: The chart below gives income levels for 2017 and the new income levels for 2018.  Allowable income levels for all program have dropped.

Medicare Savings Program CT

If you would like some information on Medicare Savings Program CT, you should read this post.  The Medicare Savings Programs (MSP), has multiple levels called QMB (qualified Medicare beneficiary), SLMB (specified low income medicare beneficiary) as well as ALMB (additional low income Medicare beneficiary). As you can see, there can be many confusing terms used for the same program. We hope this will help you sort it out a little.  All are programs that can help qualified individuals pay for both their Medicare premiums and drug costs.  In fact, QMB will also help you by paying your Medicare coinsurance as well as your deductibles.

Who is eligible for the Medicare Savings Program CT

If you are eligible for Medicare Part A and your income is below the program limit, you could be eligible for one of CT’s Medicare assistance programs.  Eligibility for the programs is determined by the amount of your annual adjusted gross income.  The amount of your assets will not matter when determining your eligibility.  However, any money being drawn out of a qualified retirement plan such as an IRA will count as income in the year it is taken. Individuals with income below $2,265 a month are eligible for MSP at the ALMB level.  Couples under $3,064 are also eligible.

Benefits

MSP does more than pay the monthly part B Medicare premium.  Depending on the level of help, the program can reduce drug copays, pay monthly part D drug premiums (up to the benchmark) create a special election period and pay medical copays.  (QMB level and higher)

Single vs. Couple Medicare Savings Program CT

If a couple is married, the income of both spouses is considered. They are not able to qualify as an individual.  Any Medicare Part B premium deductions you have will also count towards your income.  Even though the part B premium is being pulled out of your Social Security check, it still counts as income.

Re-determination of Medicare Savings Program CT

Those on MSP will need to re-certify for the program on an annual basis.  Failure to fill out the re-determination notice will result in removal from the program.

Click for MSP Application

Click for MSP Brochure and Income levels

Medicare special election periods

Anyone that is currently enrolled in Medicare or that will be soon should be familiar withe Medicare special election periods.  The information in this post will explain about the Medicare special election periods.  Special election periods pertain to Medicare Advantage and Medicare stand alone part D rx plans.

Medicare special election periods for MAPD and Part D Rx plans

• You’re limited in when and how often you can join, change or leave a Medicare Advantage Plan (also known as a Managed Medicare plan or Medicare part C) or drug plan (Part D).
• You can enroll in a Medicare Advantage or Part D plan during the initial period when you first qualify for Medicare. (3 months before, the month of and 3 months after you are eligible for Medicare parts A and B.
• During the first 45 days of each year (the Medicare Advantage Disenrollment Period, called the MADP, January 1 through February 14), you can leave your Medicare Advantage Plan and change to Original Medicare with or without also selecting a separate stand-alone Medicare drug plan.  Please note: You can’t make any changes to your coverage during this period
  if you have Original Medicare. You also can’t switch from one Medicare Advantage Plan to another during this period.
• During Fall Open Enrollment, October 15 through December 7 of each year, you can change how you get your Medicare health coverage and enroll in, change or drop Medicare drug coverage.
• Outside of the above three periods, you can only change how you get your health coverage and enroll in, change or drop Part D drug coverage if you qualify for a Special Enrollment Period (SEP).

The link below will list all the Medicare special election periods. Some notable ones to pay special attention to are the SEP for moving out of the service area, losing group/employer coverage or losing or gaining prescription drug assistance and the MAPD Trial Right.

CLICK HERE FOR MEDICARE SEP CHART

Medicare Savings Program Connecticut

Medicare Savings Program Connecticut (MSP) is a drug help program available to Connecticut residents on Medicare.   The program provides help for drug copays, deductibles and premium to those who qualify based on income.

MSP is available to individuals and couples making under stated income guidelines which have been provided here:

• QMB – $2,088.90 for a single person and $2,816.85 for a couple
• SLMB – $2,286.90 for a single person and $3,083.85 for a couple
• ALMB – $2,435.40  for a single person and $3,284.10 for a couple

MSP applications and brochures

Do you have questions or need more help?  Are you looking for more information? If you are, we can help with whatever you may need with MSP, Medicare plan choices or any other questions.  Call us at 203-796-5403 or email Edward@croweandassociates.com