2017 National Training Program

Module 1

Understanding Medicare
 Contents
Lesson 1—Program Basics………………………….. 4-42
Lesson 2—Medicare Coverage Choices………. 43-89
Lesson 3—Rights and the Appeals Process…. 90-100
Lesson 4—Programs for People with Limited
Income and Resources………………. 101-108
Lesson 5—Medicare and the Health
Insurance Marketplace……………… 109-116
Introduction to Medicare Resources Guide… 117-118
Acronyms…………………………………………………… 119-120

June 2017 Understanding Medicare 2

 Session Objectives

This session should help you

 Summarize the Medicare Program
 Compare the parts of Medicare and coverage
options
 Describe Medicare-covered services and supplies
 Recognize Medicare rights and appeals
 Explain programs for people with limited income
and resources

June 2017 Understanding Medicare 3

 Lesson 1—Program Basics

 What is Medicare?
 Enrolling in Original Medicare
 Part A and Part B benefits and costs

June 2017 Understanding Medicare 4

 What Is Medicare?

 Health insurance for people

• 65 and older
• Under 65 with certain disabilities

ALS (Amyotrophic Lateral Sclerosis, also called Lou
Gehrig’s disease) without waiting period
• Any age with End-Stage Renal Disease
 Administered by
• Centers for Medicare & Medicaid Services
NOTE: To get Medicare Part A and/or Part B, you must be a
U.S. citizen or be lawfully present in the United States

June 2017 Understanding Medicare 5

 The 4 Parts of Medicare

June 2017 Understanding Medicare 6

Automatic Enrollment—Part A and Part B

 Automatic enrollment for those getting

• Social Security benefits
• Railroad Retirement Board benefits
 Initial Enrollment Period Package
• Mailed 3 months before

Your 65th birthday

25th month of disability benefits
• Includes your Medicare card

June 2017 Understanding Medicare 7

 Medicare Card

 Keep it and accept Medicare Part A and

Part B
 Return it to refuse Part B
• Follow instructions on back of card
Front Back

June 2017 Understanding Medicare 8

 When Enrolling Isn’t Automatic
 If you’re not automatically enrolled
• You need to enroll with Social Security

Visit [Link]

Call 1-800-772-1213

TTY: 1-312-751-4701

Visit your local office
• If retired from the Railroad, enroll with the Railroad
Retirement Board (RRB)

Call your local RRB office or 1‑877‑772‑5772
 Apply 3 months before you turn 65
• Don’t have to be retired to get Medicare
June 2017 Understanding Medicare 9
 When to Enroll in Medicare
 You can first enroll during your Initial Enrollment Period (IEP), which
lasts 7 months

 Can enroll in premium-free Part A anytime after IEP begins

 Can only enroll in Part B (and premium Part A) during IEP and other
limited times
 May have a lifetime penalty if you don't enroll during IEP
June 2017 Understanding Medicare 10
 General Enrollment Period (GEP)

 For people who didn’t sign up for Part B (or

premium Part A) during their Initial Enrollment
Period
 January 1–March 31 annually
• Coverage starts July 1
 May have to pay a penalty
• 10% for twice the number of years you didn’t have
Part A
• 10% for each 12 months eligible, but not enrolled
in Part B for as long as you have Part B
June 2017 Understanding Medicare 11
 Premium Part A and Part B
Special Enrollment Period (SEP)
 Most people don't qualify for an SEP
 Must have employer group health plan
(EGHP) coverage based on active, current
employment of you or your spouse
 Can enroll
• Anytime still covered by EGHP, or
• Within 8 months of the loss of coverage or
current employment, whichever happens first

Retiree and COBRA coverage aren’t considered active
employment
June 2017 Understanding Medicare 12
When Employer or Union Coverage Ends

 When your employment ends

• You may get a chance to elect Consolidated
Omnibus Budget Reconciliation Act (COBRA)
• You may get a Special Enrollment Period

Sign up for Part B without a penalty
 Medigap Open Enrollment Period
• A 6-month period that begins on the first day of
the month in which you’re 65 or older and
enrolled in Part B
• Once started, it can’t be delayed or repeated
June 2017 Understanding Medicare 13
 Original Medicare
Part A—Hospital Insurance Coverage
 Part A– Hospital Insurance helps cover
• Inpatient hospital care
• Inpatient skilled nursing facility (SNF) care
• Blood (inpatient)
• Certain inpatient non-religious, nonmedical
health care in approved religious nonmedical
institutions (RNHCIs)
• Home health care
• Hospice care

June 2017 Understanding Medicare 14

 Paying for Medicare Part A
 Most people don’t pay a premium for Part A
• If you or your spouse paid Federal Insurance
Contributions Act (FICA) taxes at least 10 years
 If you paid FICA less than 10 years you can pay a
premium to get Part A
 May have a penalty if you don’t enroll when first
eligible for premium Part A
• Your monthly premium may go up 10%
• You'll have to pay the higher premium for twice the
number of years you could’ve had Part A, but didn't
sign up
June 2017 Understanding Medicare 15
 Inpatient Hospital Care

 Semi-private rooms
 Meals
 General nursing care
 Drugs that are part of your inpatient treatment
 Hospital services and supplies

June 2017 Understanding Medicare 16

 Benefit Periods

 Measures use of inpatient hospital and skilled

nursing facility (SNF) services
 Begins the day you first receive inpatient care
• In hospital or SNF
 Ends when not in hospital/SNF 60 days in a
row
 Pay Part A deductible for each benefit period
 No limit to the number of benefit periods you
can have
June 2017 Understanding Medicare 17
 Paying for Inpatient Hospital Stays

For Each Benefit

You Pay
Period in 2017

Days 1-60 $1,316 deductible

Days 61-90 $329 per day
$658 per day
Days 91-150
(60 lifetime reserve days)
All days after 150 All Costs

June 2017 Understanding Medicare 18

 Skilled Nursing Facility Covered Services

 Semi-private room
 Meals
 Skilled nursing care
 Physical, occupational, and speech-language
therapy
 Medical social services
 Medications, medical supplies/equipment
 Ambulance transportation (limited)
 Dietary counseling
June 2017 Understanding Medicare 19
 Skilled Nursing Facility (SNF) Care
Required Conditions for Coverage
 Require daily skilled services
• Not just long-term or custodial care
 Hospital inpatient 3 consecutive days or longer
 Admitted to SNF within specific time frame
• Generally 30 days after leaving hospital
 SNF care must be for a hospital-treated
condition
• Or condition that arose while receiving care in the
SNF for hospital-treated condition
 Must be a Medicare-participating SNF
June 2017 Understanding Medicare 20
 Paying for Skilled Nursing Facility Care

For Each Benefit

You Pay
Period in 2017

Days 1-20 $0

Days 21-100 $164.50 per day

All days after 100 All Costs

June 2017 Understanding Medicare 21

 5 Required Conditions for
Home Health Care Coverage
1. Must be homebound
2. Must need skilled care on part-time or
intermittent basis
3. Must be under the care of a doctor
• Receiving services under a plan of care
4. Have face-to-face encounter with doctor
• Prior to start of care or within 30 days
5. Home health agency must be Medicare-
approved
June 2017 Understanding Medicare 22
 Paying for Home Health Care

 In Original Medicare you pay

• Nothing for covered home health care services
• 20% of Medicare-approved amount

For durable medical equipment
–Covered by Part B
 Plan of care reviewed every 60 days
• Called episode of care

June 2017 Understanding Medicare 23

 Part A Hospice Care
 Interdisciplinary team for those with a life expectancy
of 6 months or less, and their family
 Sign election statement choosing hospice care instead
of routine Medicare-covered benefits to treat your
terminal illness
 Focus is on comfort and pain relief, not cure
 Doctor must certify each “election period”
• Two 90-day periods
• Then unlimited 60-day periods
• Face-to-face encounter
 Hospice provider must be Medicare-approved
June 2017 Understanding Medicare 24
 Covered Hospice Services
 Physician and nursing services
 Physical, occupational, and speech therapy
 Medical equipment and supplies
 Drugs for symptom control and pain relief
 Short-term hospital inpatient care for pain and symptom
management
 Respite care in a Medicare-certified facility
• Up to 5 days each time, no limit to number of times
 Hospice aide and homemaker services
 Social worker services
 Grief, dietary, and other counseling
June 2017 Understanding Medicare 25
 Paying for Hospice Care
 In Original Medicare you pay
• Nothing for hospice care
• Up to $5 per Rx to manage pain and symptoms

While at home
• 5% for inpatient respite care
 Room and board may be covered in certain cases
• Short-term respite care
• For pain/symptom management that can’t be
managed at home
• If you have Medicaid and live in a nursing facility
June 2017 Understanding Medicare 26
Medicare Part B—Medical Insurance Coverage

 Part B—Medical Insurance helps cover

• Doctors’ services
• Outpatient medical and surgical services, supplies
• Clinical lab tests
• Durable medical equipment
• Diabetic testing supplies
• Preventive services

June 2017 Understanding Medicare 27

What Are Medicare Part B—Covered Services?
Doctors’ Services that are medically necessary (includes
Services outpatient and some doctor services you get when
you’re a hospital inpatient) or covered preventive
services.
You pay 20% of the Medicare-approved amount (if the
doctor accepts assignment), and the Part B deductible
applies.

Outpatient For approved procedures like X-rays, casts, or stitches.

Medical and You pay the doctor 20% of the Medicare-approved
Surgical amount for the doctor’s services if the doctor accepts
Services and assignment. You also pay the hospital a copayment for
Supplies each service. The Part B deductible applies.

June 2017 Understanding Medicare 28

 Medicare Part B—Covered Services
Continued
Durable Items such as oxygen equipment and supplies,
Medical wheelchairs, walkers, and hospital beds for use in the
home. Some items must be rented.
Equipme
Medicare has a program called “competitive bidding.”
nt (DME)
If you live in a competitive bidding area, you must use
specific suppliers, or Medicare won’t pay for the item and
you’ll likely pay full price.
Includes national mail-order program for diabetic self-
testing supplies, and includes 9 local programs for infusion
pumps, including insulin pumps and pump supplies.
Visit [Link]/supplier to find Medicare-approved
suppliers in your area.
You pay 20% of the Medicare-approved amount, and the
Part B deductible applies.

June 2017 Understanding Medicare 29

 More Medicare Part B—Covered Services
Home Medically necessary part-time or intermittent skilled
Health nursing care, and/or physical therapy, speech-
language pathology services, and/or services for
Services people with a continuing need for occupational
therapy, some home health aide services, medical
social services, and medical supplies. You pay
nothing for covered services.
Other Medically necessary medical services and supplies,
(including such as clinical laboratory services, diabetes supplies,
kidney dialysis services and supplies, mental health
but not care, limited outpatient prescription drugs, diagnostic
limited to) X-rays, MRIs, CT scans, and EKGs, transplants and
other services are covered. Costs vary.

June 2017 Understanding Medicare 30

Medicare Part B–Covered Preventive Services
 "Welcome to Medicare" preventive visit  Depression screening
 Yearly “Wellness” visit  Diabetes screenings
 Abdominal aortic aneurysm screening  Diabetes self-management training
 Alcohol misuse screening and counseling  Flu shots (Vaccine)
 Bone mass measurement  Glaucoma tests
 Breast cancer screening (mammogram)  Hepatitis B shots (Vaccine)
 Cardiovascular disease (CVD) Risk  Hepatitis C screening test
Reduction Visit  HIV screening
 Cardiovascular disease screenings  Lung Cancer Screening
 Cervical and vaginal cancer screening  Medical nutrition therapy services
• Human Papillomavirus (HPV) Testing  Obesity screening and counseling
 Colorectal cancer screenings  Pneumococcal shots
• Screening fecal occult blood test
 Prostate cancer screening
• Screening flexible sigmoidoscopy
•
 Sexually-transmitted infections screening
Screening colonoscopy
• Screening barium enema and counseling
• Multi-target stool DNA test  Tobacco use cessation counseling
June 2017 Understanding Medicare 31
 Paying for Preventive Services

 In Original Medicare you

• Pay nothing for most preventive services if your
provider accepts “assignment”
• May pay more if provider doesn’t accept
assignment
• May have a copayment

If doctor performs other services that aren’t
part of covered preventive benefits, or

For certain preventive services

June 2017 Understanding Medicare 32

 NOT Covered By Part A and Part B

 Long-term care
 Routine dental care
 Dentures
 Cosmetic surgery
 Acupuncture
 Hearing aids and exams for fitting hearing
aids
 Other – check [Link]

June 2017 Understanding Medicare 33

 Medicare Part B
Costs for Most People
Yearly $183.00
Deductible

Coinsurance  20% coinsurance for most covered

for Part B services, like doctor’s services and
Services some preventive services, if provider
accepts assignment
 $0 for some preventive services
 20% coinsurance for outpatient mental
health services, and copayments for
hospital outpatient services

June 2017 Understanding Medicare 34

 What You Pay—Part B Premiums
 2017 Premiums
• Standard premium—$134 (or higher depending
on your income)
• Average premium—$109 (most people pay this)

Part B premium increased more than the cost-of-living
increase for 2017 Social Security benefits

Social Security will tell you the exact amount

June 2017 Understanding Medicare 35

 Monthly Part B Standard Premium—Income-
Related Monthly Adjustment Amount for 2017
Chart is based on your yearly income in 2015 (for what you pay in 2017)
File Individual Tax File Joint Tax Return
was File Married & In 2017
Return Separate Tax Return You
Pay
$85,000 or less $170,000 or less $85,000 or less $134.00
$85,000.01–$107,000 $170,000.01–$214,000 Not applicable $187.50
$107,000.01–$160,000 $214,000.01–$320,000 Not applicable $267.90
$160,000.01–$214,000 $320,000.01–$428,000 Above $85,00 and up to $348.30
$129,000
Above $214,000 Above $428,000 Above $129,000 $428.60

NOTE: You may pay more if you have a Part B late enrollment penalty.
June 2017 Understanding Medicare 36
 Paying the Part B Premium

 Deducted monthly from

• Social Security benefit payments
• Railroad retirement benefit payments
• Federal retirement benefit payments
 If not deducted
• Billed every 3 months
• Medicare Easy Pay to deduct from bank account
 Contact Social Security, the Railroad
Retirement Board, or the Office of Personnel
Management about premiums
June 2017 Understanding Medicare 37
 Part B Late Enrollment Penalty

 See how your insurance works with Medicare

• Contact your employer/union benefits
administrator
 Penalty for not signing up when first eligible
• 10% more for each full 12-month period
• May have a penalty as long as you have Part B
 Sign up during a Special Enrollment Period
 Usually no penalty if you sign up within 8
months of employer coverage ending

June 2017 Understanding Medicare 38

 Part B Late Enrollment Penalty Example

Mary’s Initial Enrollment Period ended September 30,

2009. She waited to sign up for Part B until the
General Enrollment Period in March 2012.
 Total time Mary delayed Part B: 30 months
 Mary’s Late Enrollment Penalty: 20% (30 months
includes 2 full 12-month periods)
 The penalty is added to the Part B monthly premium
 Mary will have the penalty for as long as she has
Part B

June 2017 Understanding Medicare 39

 When You Must Have Part B

 If you want to buy a Medigap policy

 If you want to join a Medicare Advantage Plan
 You're eligible for TRICARE for Life (TFL) or CHAMPVA
 Your employer coverage requires you have it when
you become eligible for Medicare (less than 20
employees)
• Talk to your employer’s or union benefits administrator
 Veterans Affairs (VA) benefits are separate from
Medicare
• You pay a penalty if you sign up late or if you don’t sign up
during your Medicare Initial Enrollment Period
June 2017 Understanding Medicare 40
 Check Your Knowledge—Question 1

In 2017, most people

will pay $109.00 for
their Part B premium.

a. True
b. False

June 2017 Understanding Medicare 41

 Check Your Knowledge—Question 2

What are the

elements of a “Benefit
Period”?
a. Measures the use of
some Part A services
b. The Part A deductible
applies for each
c. Ends when not in a
hospital/SNF for 60
days in a row
d. All of the above
June 2017 Understanding Medicare 42
 Lesson 2—Medicare Coverage Choices
 Your Medicare Coverage Choices
 Original Medicare (Part A and Part B)
• Assignment
• Private Contracts
 Medicare Supplement Insurance (Medigap)
Policies
 Medicare Prescription Drug Coverage (Part D)
 Medicare Advantage Plans (Part C)
 Other Medicare Health Plans

June 2017 Understanding Medicare 43

 Your Medicare Coverage Choices
Part A Part B Part A Part B
Hospital
and/ and Medical
Medical OR Hospital
Insurance or Insurance Insurance Insurance

Original Medicare Medicare Advantage Plan

Part C
Combines Part A and
Part B and usually
You can add one or both Part D
Medicare Part D Sometimes may add a Separate
Supplement Prescription Part D Plan
Insurance Drug Prescription Drug Coverage
(Medigap) Coverage. (Most Part C plans cover
Policy. Can have Part prescription drugs. You may be
Must have Part A and/or able to add drug coverage to some
A and B Part B plan types if not already included.)
June 2017 Understanding Medicare 44
 Original Medicare

 Health care option run by the federal government

 Provides your Part A and/or Part B coverage
 See any doctor or hospital that accepts Medicare
 You pay
• Part B premium (Part A is usually premium free)
• Deductibles, coinsurance, or copayments
 Get Medicare Summary Notice
 Can join a Part D plan to add drug coverage

June 2017 Understanding Medicare 45

 Assignment

 Doctor, provider, supplier accepts

assignment
• Signed an agreement with Medicare

Or is required to by law
• Accepts the Medicare-approved amount

As full payment for covered services

Only charges Medicare deductible/coinsurance
amount
 Most accept assignment
• They submit your claim to Medicare directly
June 2017 Understanding Medicare 46
 Don’t Accept/Must Accept
Assignment
 Providers and suppliers that don’t accept
assignment
• May charge you more

The limiting charge is 15% more

May have to pay entire charge at time of
service
 Providers sometimes must accept
assignment
• Medicare Part B–covered prescription drugs
• Ambulance suppliers
June 2017 Understanding Medicare 47
 Private Contracts

 Agreement between you and your doctor

• Doctor doesn’t furnish services through
Medicare
• Original Medicare and Medigap won’t pay
• Other Medicare plans won’t pay
• You’ll pay full amount for the services you get
• No claim should be submitted
• Can’t be asked to sign in an emergency
• The doctor can’t bill Medicare for 2 years for any
services provided to anyone with Medicare
June 2017 Understanding Medicare 48
 Medicare Supplement Insurance
(Medigap) Policies
 Medigap policies are private health insurance that
• Supplement Original Medicare

You must have both Medicare Part A and Part B to get a
Medigap policy

You pay a monthly premium to the insurer and also pay the
Part B monthly premium
• Help pay some health care costs that Original Medicare doesn’t
cover (coverage “gaps”)

Medicare will pay its share of the Medicare-approved
amounts for covered health care costs
–Then your Medigap policy pays its share

A Medigap policy covers one person
June 2017 Understanding Medicare 49
 Medigap Plans

 Standardized plans identified by a letter

• Plans A, B, C, D, F, G, K, L, M, and N are currently
sold
• Companies don’t have to sell all plans
• Plans E, H, I, and J exist but are no longer sold
• Plans with the same letter must offer the same
basic benefits

Only the policy cost will vary between companies
 Waiver states (Massachusetts, Minnesota, and
Wisconsin) standardize in a different way
June 2017 Understanding Medicare 50
 Medigap Policies

 You pay a monthly premium

 Costs vary by plan, company, your age, and location
 Follow federal/state laws that protect you
 Medigap Open Enrollment Period
• Starts when you're both 65 and signed up for Part B
• Once started, it can’t be delayed or repeated
• States may have longer period (check with your state)
 Doesn’t work with Medicare Advantage
 No networks except with a Medicare SELECT policy
June 2017 Understanding Medicare 51
 Delayed Medigap
Open Enrollment Period (OEP)
 If you delay enrolling in Medicare Part B
• Because you or your spouse is still working, and
• You have group health coverage
 Medigap OEP is delayed
• Until you’re 65 and enrolled in Part B
• No late enrollment penalty
 Notify Social Security to delay Part B

June 2017 Understanding Medicare 52

 Pre-existing Conditions and Medigap
 Health problem you had before the new
insurance policy starts
• Treated or diagnosed 6 months before coverage start
date
 Pre-existing Condition Waiting Period
• Insurance companies can refuse to cover out-of-pocket
costs for excluded condition for up to 6 months (“look-
back period”)

Without 6 months of prior creditable coverage and no
break in coverage
The Affordable more impact
Care Act doesn’t than 63
thedays
pre-existing condition
waiting period for Medigap coverage.
June 2017 Understanding Medicare 53
Medigap for People With a Disability or End-Stage
Renal Disease (ESRD)
 People with a disability or ESRD may not be
able to buy a policy until they turn 65
 Companies may voluntarily sell Medigap
policies
• May cost more than policies sold to people over 65
• Can use medical underwriting
 Get a Medigap Open Enrollment Period at 65

June 2017 Understanding Medicare 54

 Check Your Knowledge—Question 3
Which of the following is
NOT a possible Medicare
coverage choice?

a. Part A only
b. Part B only
c. Original Medicare and a
Medicare Advantage
Plan
d. Original Medicare and a
Medicare Prescription
Drug Plan
June 2017 Understanding Medicare 55
Medicare Prescription Drug Coverage (Part D)

 What’s Medicare Prescription Drug Coverage (Part D)?

 Medicare Prescription Drug Plans
 Medicare Drug Plan Costs
 Standard Structure
 Improved Coverage in the Coverage Gap
 Eligibility Requirements
 When to Join and Switch Plans
 Part D-covered Drugs
• Drugs Not Covered
 How Plans Manage Access To Covered Drugs
 Requirements for Prescribers
June 2017 Understanding Medicare 56
 What’s Medicare Prescription
Drug Coverage (Part D)?
 Medicare drug plans
• Approved by Medicare
• Run by private companies
• Available to everyone with Medicare
 You must join a plan to get coverage
 There are 2 ways to get Medicare drug
coverage
• Medicare Prescription Drug Plans
• Medicare health plans with prescription drug
coverage
June 2017 Understanding Medicare 57
 Medicare Part D Drug Coverage

 Can be flexible in benefit design

 Must offer at least a standard level of
coverage
 Vary in costs and drugs covered
• Different tier and/or copayment levels
• Deductible
• Coverage for drugs not typically covered by Part D
 Benefits and costs may change each year

June 2017 Understanding Medicare 58

 Medicare Part D Costs

 Most people will pay

• A monthly premium
• A yearly deductible (if applicable)
• Copayments or coinsurance
• Costs in the coverage gap
 Costs vary by
• Plan
• Late enrollment penalty
• Extra Help
June 2017 Understanding Medicare 59
 Part D Standard Benefit
Ms. Smith joins a Medicare Prescription Drug Plan. Her coverage begins on January 1. She doesn’t get Extra
Help and uses her Medicare drug plan membership card when she buys prescriptions. She pays a monthly
premium throughout the year.
1. Yearly 2. Copayment or 3. Coverage gap 4. Catastrophic
deductible coinsurance (what coverage
you pay at the
pharmacy)

Ms. Smith pays Ms. Smith pays a Once Ms. Smith and her plan have spent Once Ms. Smith
the first $400 copayment, and her $3,700 for covered drugs, she’s in the has spent $4,950
of her drug plan pays its share for coverage gap. In 2017, she gets a 50% out of pocket for
costs before each covered drug until discount from the drug manufacturer on the year, her
her plan starts their combined covered brand-name prescription drugs coverage gap ends.
to pay its amount (plus the that counts as out-of-pocket spending, and Now she only pays
share. deductible) reaches helps her get out of the coverage gap. For a small coinsurance
$3,700. 2017, she gets an additional 10% coverage or copayment for
from her plan on covered brand-name each covered drug
drugs and 49% coverage on covered until the end of the
generic drugs while in the coverage gap. year.

June 2017 Understanding Medicare 60

 Part D Eligibility Requirements

 You must
• Have Medicare Part A and/or Part B to join a Medicare Prescription
Drug Plan
• Have Medicare Part A and Part B to join a Medicare Advantage Plan
with drug coverage
• Have Medicare Part A and Part B or only Part B to join a Medicare
Cost Plan with Part D coverage
• Live in the plan’s service area
• Not be incarcerated
• Not be unlawfully present in the U.S.
• Not live outside the U.S.
 You must join a plan to get drug coverage
June 2017 Understanding Medicare 61
 Part D Initial Enrollment Period (IEP)

 When you first become eligible to get

Medicare
• 7-month IEP for Part D
If You Join Coverage Begins
During the 3 months Date eligible for Medicare
before you turn 65
During the month you First day of the following
turn 65 month
During the 3 months after First day of the month
you turn 65 after month you apply

June 2017 Understanding Medicare 62

 When You Can Join or Switch Plans

 Medicare’s annual Open Enrollment for Medicare

Advantage and Medicare Prescription Drug Plans is
October 15–December 7, coverage starts January 1
 You can leave a Medicare Advantage Plan and switch to
Original Medicare from January 1–February 14 each
year
• You have until February 14 to also join a Part D plan
 If you don’t have Medicare Part A coverage, and enroll
in Part B during the General Enrollment Period (January
1–March 31), you can sign up for a Medicare
Prescription Drug Plan from April 1–June 30 each year
June 2017 Understanding Medicare 63
 Special Enrollment Period (SEP)

 Life events that allow an SEP include if you

• Permanently move out of your plan’s service area
• Lose other creditable prescription coverage
• Weren’t properly told that your other coverage wasn’t
creditable, or your other coverage was reduced and is no
longer creditable
• Enter, live at, or leave a long-term care facility
• Have a continuous SEP if you qualify for Extra Help
• Belong to a State Pharmaceutical Assistance Program
• Join or switch to a plan that has a 5-star rating
• Have other exceptional circumstances
June 2017 Understanding Medicare 64
 5-Star Special Enrollment Period (SEP)

 Use the Medicare Plan Finder tool at [Link] to

see quality and performance ratings
 Star ratings are given once a year, assigned in October of
the past year
 Use 5-star SEP to switch to any 5-star plan 1 time each
year
• From December 8–November 30
• Coverage starts first day of month after enrolled
• Be careful not to switch from a Medicare Advantage (MA) Plan
with drug coverage to an MA Plan with no Part D coverage

June 2017 Understanding Medicare 65

 Part D Late Enrollment Penalty

 Higher premium if you wait to enroll

• Exceptions if you have

Creditable coverage

Extra Help
 Pay penalty for as long as you have coverage
• 1% of base beneficiary premium

For each full month eligible and not enrolled
• Amount changes every year, visit [Link]
for current figures

June 2017 Understanding Medicare 66

 Income-Related Monthly
Adjustment Amount (Part D-IRMAA)
Your Yearly Income Your Yearly Income In 2017 You Pay Monthly
in 2016 Filing an in 2016 Filing a Joint
Individual Tax Return Tax Return
$85,000 or less $170,000 or less Your Plan Premium (YPP)
Above $85,000 Above $170,000 YPP + $13.30*
Up to $107,000 Up to $214,000
Above $107,000 Above $214,000 YPP + $34.20*
Up to $160,000 Up to $320,000
Above $160,000 Above $320,000 YPP + $55.20*
Up to $214,000 Up to $428,000
Above $214,000 Above $428,000 YPP + $76.20*

*IRMAA is adjusted each year, as it’s calculated from the annual beneficiary base premium.
June 2017 Understanding Medicare 67
 Part D-Covered Drugs

 Prescription brand-name and generic drugs

• Approved by the U.S. Food and Drug Administration
• Used and sold in United States
• Used for medically-accepted indications
 Includes drugs, biological products, and insulin
• And supplies associated with injection of insulin
 Plans must cover a range of drugs in each
category
 Coverage and rules vary by plan

June 2017 Understanding Medicare 68

 Required Coverage

 All drugs in 6 protected categories

1. Cancer medications
2. HIV/AIDS treatments
3. Antidepressants
4. Antipsychotic medications
5. Anticonvulsive treatments
6. Immunosuppressants
 All commercially available vaccines
• Except those covered under Part B (e.g., flu shot)

June 2017 Understanding Medicare 69

 Requirement for Prescribers

 Enforcement date February 1, 2017

 Prescribers of Part D drugs must
• Be enrolled in an approved status, or
• Have a valid opt-out affidavit on file for their
prescriptions to be covered under Part D

Includes dentists, doctors, residents, psychiatrists,
nurse practitioners, and physician assistants

June 2017 Understanding Medicare 70

 Drugs Excluded by Law Under Part D

 Drugs for anorexia, weight loss, or weight gain

 Erectile dysfunction drugs when used for the
treatment of sexual or erectile dysfunction
 Fertility drugs
 Drugs for cosmetic or lifestyle purposes
 Drugs for symptomatic relief of coughs and colds
 Prescription vitamin and mineral products
 Non-prescription drugs

June 2017 Understanding Medicare 71

 How Plans Manage Access to Drugs
Prior Doctor must contact plan for prior approval and
Authorization show medical necessity for drug before drug will
be covered

Step Therapy  Must first try similar, less expensive drug

 Doctor may request an exception if
• Similar, less expensive drug didn’t work, or
• Step therapy drug is medically necessary

Quantity Limits  Plan may limit drug quantities over a period of

time for safety and/or cost
 Doctor may request an exception if additional
amount is medically necessary

June 2017 Understanding Medicare 72

 Formulary

 A list of prescription drugs covered by the plan

 May have tiers that cost different amounts
 Tier Structure Example

June 2017 Understanding Medicare 73

 Check Your Knowledge—Question 4

Effective February 1,
2017, will a dentist be
able to prescribe Part D
covered drugs?
a. Yes, if he or she opts
out of Medicare
b. Yes, if he or she is
enrolled in an
approved status
c. Both of the above
d. None of the above
June 2017 Understanding Medicare 74
Medicare Advantage (MA) Plans (Part C)

 What’s an MA Plan?
 How MA plans work
 MA Plan costs
 Who can join
 When to join and switch plans

June 2017 Understanding Medicare 75

 What’s a Medicare Advantage Plan?

 Health plan options

• Approved by Medicare
• Run by private companies
 Part of the Medicare program
 Sometimes called Part C
 Available across the country
 Provide Medicare-covered benefits
• May cover extra benefits

June 2017 Understanding Medicare 76

 How Medicare Advantage Plans Work

 Receive services through the plan

• All Part A- and Part B-covered services
• Some plans may provide additional benefits
 Most plans include prescription drug coverage
 You may have to use network doctors/hospitals
 May differ from Original Medicare in
• Benefits
• Cost sharing

June 2017 Understanding Medicare 77

 How Medicare Advantage (MA)
Plans Work (Continued)
 You’re still in the Medicare Program
• Medicare pays the plan every month for your care
 You still have Medicare rights and protections
 If the plan leaves Medicare you can
• Join another MA Plan, or
• Return to Original Medicare

June 2017 Understanding Medicare 78

 Medicare Advantage Costs

 You still pay the Part B premium

• A few plans may pay all or part for you
 State assistance for some people with limited
income and resources
 You may pay plan an additional monthly premium
 You pay deductibles, coinsurance, and copayments
• Different from Original Medicare
• Varies from plan to plan
• May be higher if out of network
June 2017 Understanding Medicare 79
Who Can Join a Medicare Advantage Plan?

 Eligibility requirements—you must

• Be enrolled in Medicare Part A (Hospital Insurance)
• Be enrolled in Medicare Part B (Medical Insurance)
• Live in the plan’s service area
• Be a United States (U.S.) citizen or lawfully present in
the U.S.
• Not be incarcerated
 To join you must also
• Provide necessary information to the plan
• Follow the plan’s rules
• Can only belong to one plan at a time
June 2017 Understanding Medicare 80
 When You Can Join or Switch
Medicare Advantage (MA) Plans

Initial  7-month period begins 3 months before the

month you turn 65
Enrollment  Includes the month you turn 65
Period  Ends 3 months after the month you turn 65
(Technically the Important: If you delay Part B enrollment (for
Initial Coverage example, due to active employer group
Enrollment coverage), your time to enroll in an MA Plan
may be more restricted.
Period)

 You can only join one MA Plan at a time, and enrollment is generally
for a calendar year.

June 2017 Understanding Medicare 81

 When You Can Join or Switch
Medicare Advantage Plans*

Fall Open Enrollment  October 15—December 7

 Coverage begins January 1

Medicare due to a  7-month period begins 3 months before

Disability the 25th month of disability.
 Ends 3 months after the 25th month of
disability.

June 2017 Understanding Medicare 82

 When You Can Join or Switch Plans

Special  Move out of your plan’s service area

Enrollment  You have Medicaid
Periods (SEPs) 
Plan leaves Medicare Program or reduces its
service area
 Leaving or losing employer or union coverage
 You enter, live at, or leave a long-term care facility
 You have a continuous SEP if you qualify for Extra
Help
 Losing your Extra Help status
 You join or switch to a plan that has a 5-star rating
 Retroactive notice of Medicare entitlement
 Other exceptional circumstances

June 2017 Understanding Medicare 83

When You Can Join or Switch Medicare Advantage
(MA) Plans
5-Star Special  Can enroll in 5-star MA Plan, Prescription Drug Plan
Enrollment (PDP), Medicare Advantage Plan with prescription
Period (SEP)
drug coverage (MA-PD), or Cost Plan
 Enroll once yearly from December 8–November 30
 New plan starts first day of month after enrolled
 Star ratings given once per year
• Ratings assigned in October and effective January
1
• Use Medicare Plan Finder to see star ratings
 Look at Overall Plan Rating to find eligible plans

June 2017 Understanding Medicare 84

 When You Can Leave
Medicare Advantage (MA) Plans
January 1 –  You can leave an MA Plan
February 14  Switch to Original Medicare
• Coverage begins first day of month after switch
• May join Part D Plan
 Drug coverage begins first day of month after

plan gets enrollment

 May not join another MA Plan during this period
 May be able to buy a Medicare Supplement
Insurance (Medigap) policy

June 2017 Understanding Medicare 85

 Types of Medicare Advantage Plans

 Health Maintenance Organization (HMO)

 HMO Point-of-Service
 Preferred Provider Organization
 Special Needs Plan
 Private Fee-for-Service
 Medicare Medical Savings Account

June 2017 Understanding Medicare 86

 Other Medicare Plans

 Some types of Medicare health plans that

provide health care coverage aren’t part of
Medicare Advantage
• But are still part of Medicare
• Some provide Part A and/or Part B coverage
• Some provide Medicare prescription drug coverage
• Examples include

Medicare Cost Plans

Innovation Projects and Pilot Programs

Medicare Program of All-inclusive Care for the
Elderly (PACE) Plans
June 2017 Understanding Medicare 87
 Compare Plans on Medicare Plan Finder

 Search for drug and health

plans
 Personalize your search
to find plans that meet
your needs
 Compare plans based on
star ratings, benefits, costs,
and more
 Visit [Link]/find-a-plan/
June 2017 Understanding Medicare 88
 Check Your Knowledge—Question 5

Most people enrolled in

a Medicare Advantage
Plan will continue to pay
a monthly Medicare
Part B premium.
a. True
b. False

June 2017 Understanding Medicare 89

 Lesson 3—Rights and the
Appeals Process
 Patient rights
 Appeals process
• Part A and Part B (Original Medicare)

Medigap Rights
• Part C (Medicare Advantage)
• Part D (Medicare Prescription Drug Coverage)

June 2017 Understanding Medicare 90

 Medicare Guaranteed Rights

 Specific rights in
• Original Medicare
• Medicare Advantage and other Medicare health
plans
• Medicare Prescription Drug Coverage
• In general, these rights protect

You when you get health care

You against unethical practices

Your ability to get medically necessary services

Your privacy
June 2017 Understanding Medicare 91
 Your Medicare Rights

 You have the right to be

• Treated with dignity and respect
• Protected from discrimination

Race, color, or national origin

Disability

Age

Religion

Sex
• If you think you haven’t been treated fairly, visit
[Link]/ocr

Call the Office for Civil Rights at 1-800-368-1019

TTY: 1-800-537-7697
June 2017 Understanding Medicare 92
“Notice of Privacy Practices for Original Medicare”

 Tells you how Medicare

• Must protect the privacy of your personal health
information
• Uses and discloses your personal medical information
 Describes your rights and how you can exercise them
 Published annually in the “Medicare
& You” handbook
 For more information
• Visit [Link]
• Call 1-800-MEDICARE (1-800-633-4227)
• TTY: 1-877-486-2048
June 2017 Understanding Medicare 93
 Who’s the Medicare
Beneficiary Ombudsman (MBO)?
 The Medicare Beneficiary Ombudsman
(MBO)
• Reviews concerns raised by people with
Medicare
• Helps make sure people have information about

Medicare coverage

How to file a complaint and get Medicare concerns
resolved

Medicare rights and protections, including appeals
processes
June 2017 Understanding Medicare 94
 Medicare Rights—Claims and Appeals

 You have the right to

• Have a claim for payment filed with Medicare
• Get decisions about

Health care payment

Coverage of services

Prescription drug coverage
• Get an appeal (review) of the decisions above

June 2017 Understanding Medicare 95

 Medicare Grievance Rights

You have the right to file complaints (also called

grievances) about
 Services you got
 Other concerns or problems getting health care and
quality of care
• In Original Medicare, call the Beneficiary and Family Centered
Care Quality Improvement Organization (BFCC-QIO)
• In Medicare Advantage or other Medicare health plan, call your
plan, the BFCC-QIO, or both
• If you have End-Stage Renal Disease (ESRD), call the ESRD
network in your state
June 2017 Understanding Medicare 96
 Medigap Rights in Original Medicare

 Buy a private Medicare Supplement Insurance

(Medigap) policy
• Guaranteed issue rights in your Medigap Open
Enrollment Period ensure insurance companies

Can’t deny you Medigap coverage

Can’t place conditions on coverage

Must cover pre-existing conditions

Can’t charge more because of past or present
health problems
• Some states give additional rights
June 2017 Understanding Medicare 97
 Coverage and Appeal Rights
in Medicare Health Plans
You have the right to
 Know how your doctors are paid
 Get a coverage decision or coverage
information
 A fair, efficient, and timely appeals process
• Five levels of appeal
• Decision letter sent explaining further appeal rights
• Automatic review of Part C plan reconsideration

By Independent Review Entity (IRE)
 File a grievance about concerns or problems
June 2017 Understanding Medicare 98
 Requesting Part D Appeals

 If your coverage determination or exception is

denied, you can appeal the plan’s decision
 In general, you must make your appeal requests in
writing
• Plans must accept verbal expedited (fast) requests
• Limited timeframe to file an appeal request (within 60
days or later with good cause)
 An appeal can be requested by
• You or your appointed representative
• Your doctor or other prescriber
 There are 5 levels of appeals
June 2017 Understanding Medicare 99
 Check Your Knowledge—Question 6

In a Medicare Health
Plan, the right to a
coverage decision lets
you find out if a
service or supply will
be covered after you
receive it.
a. True
b. False

June 2017 Understanding Medicare 100

 Lesson 4—Programs for People
With Limited Income and Resources
 Medicaid and the Children’s Health
Insurance Program (CHIP)
 Medicare Savings Programs
 Extra Help
 Programs in the United States territories

June 2017 Understanding Medicare 101

What Is Medicaid and the Children’s Health
Insurance Program (CHIP)?
 Medicaid is a federal-state health insurance program
• For people with limited income and resources
• Covers most health care costs if you have both Medicare and Medicaid
(dual eligible)
• Eligibility is determined by the state

Application processes and benefits vary

State office names vary

Apply if you MIGHT qualify
 Children’s Health Insurance Program (CHIP) is administered by
states, according to federal requirements
• Covers uninsured children up to 19
• May cover pregnant women when family income‘s too high for Medicaid

June 2017 Understanding Medicare 102

 Medicare Savings Programs

 Help from Medicaid paying Medicare costs

• For people with limited income and resources
• Often higher income and resources than full Medicaid
 Programs include
• Qualified Medicare Beneficiary (QMB)
• Specified Low-income Medicare Beneficiary (SLMB)
• Qualifying Individual (QI)
• Qualified Disabled & Working Individuals (QDWI)
NOTE: Federal law bars Medicare and MA providers
from balance billing a QMB beneficiary under any
circumstance.
June 2017 Understanding Medicare 103
 What Is Extra Help?

 Program to help people pay for Medicare

prescription drug costs (Part D)
• Also called the low-income subsidy
 If you have lowest income and resources
• Pay no premiums or deductible, and small or no
copayments
 If you have slightly higher income and resources
• Pay reduced deductible and a little more out of pocket
 No coverage gap or late enrollment penalty if you
qualify for Extra Help

June 2017 Understanding Medicare 104

 Qualifying for Extra Help

 You automatically qualify for Extra Help if you get

• Full Medicaid coverage
• Supplemental Security Income (SSI)
• Help from Medicaid paying your Medicare premiums
 All others must apply
• Online at [Link]
• Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778)

Ask for “Application for Help with Medicare Prescription
Drug Plan Costs” (SSA-1020)
• Contact your state Medicaid agency
June 2017 Understanding Medicare 105
 Steps to Take

 If you think you might qualify for any of these

programs
• Review the income and asset guidelines
• Collect your personal documents
 To get more information call your
• State Medical Assistance (Medicaid) Office
• Local State Health Insurance Assistance Program (SHIP)
• Local Area Agency on Aging
 Complete application with your State Medical
Assistance (Medicaid) Office

June 2017 Understanding Medicare 106

 Programs in U.S. Territories

 Help people pay their Medicare costs

 U.S. territories
• Puerto Rico
• Virgin Islands
• Guam
• Northern Mariana Islands
• American Samoa
 Programs vary
• Contact your local Medical Assistance office

June 2017 Understanding Medicare 107

 Check Your Knowledge—Question 7
If you think you might qualify
for a program that may help pay
some of your Medicare costs
you should
a. Check the income and asset
guidelines
b. Collect your personal
documents
c. Complete an application
with your state Medical
Assistance Office
d. All of the above
June 2017 Understanding Medicare 108
Lesson 5—Medicare and the Health Insurance
Marketplace
 Marketplace and People with Medicare
 Marketplace and Becoming Eligible for
Medicare
 Enrollment Considerations

June 2017 Understanding Medicare 109

Marketplace and People With Medicare

 Medicare isn’t part of the Marketplace

 If you have Medicare you don’t need to do anything related to
the Marketplace
• Your benefits don’t change because of the Marketplace
• No one can sell you a Marketplace plan

Even if you have only Medicare Part A and/or Part B

Except an employer through the Small Business Health Options
Program (SHOP) if you’re an active worker or dependent of an
active worker
–The SHOP employer coverage may pay first
–No late enrollment penalty if you delay Medicare
• Doesn’t include COBRA coverage
–The Marketplace doesn’t offer Medigap or Part D plans
June 2017 Understanding Medicare 110
 Marketplace and Becoming
Eligible for Medicare
 You can keep a Marketplace plan after your
Medicare coverage begins
• You may cancel the plan when Medicare coverage
starts

Once your Part A coverage starts you won’t be able
to get lower costs for your Marketplace plan
 Sign up for Medicare during your Initial
Enrollment Period
• Or, if you enroll later, you may have to pay a late
enrollment penalty for as long as you have Medicare
June 2017 Understanding Medicare 111
 If You Have a Marketplace Plan First
and Then Get Medicare Coverage
 You lose eligibility for any premium tax credits and/or reduced
cost sharing for your Marketplace plan
 If you drop your Marketplace plan, you must contact the plan
at least 14 days before you want to end that coverage. Time it
to avoid a gap in coverage.
• Depending on your income and resources, you may be eligible for
help paying your Medicare Part B and Part D premiums and for some
reduced cost sharing for Medicare Part D coinsurance/copayments
• You may also be able to buy a Medicare Supplement Insurance
(Medigap) Policy or join a Medicare Advantage Plan (like a Health
Maintenance Organization (HMO) or Preferred Provider Organization
(PPO))
June 2017 Understanding Medicare 112
Choosing Marketplace Instead of Medicare

 The Individual Marketplace isn't employer-sponsored coverage

 You can’t choose Marketplace coverage instead of Medicare
unless
• You pay or you’d have to pay a Part A premium

You can drop Part A and Part B and may be eligible to get a
Marketplace plan
• You have a medical condition that qualifies you for Medicare (like
ESRD) but haven’t applied for Medicare
• You’re not yet collecting Social Security retirement or disability
benefits and not yet eligible for Medicare based on age (or you’re in
the waiting period)

Medicare enrollment will be automatic once eligible and getting a
Social Security Cash benefit
June 2017 Understanding Medicare 113
 Medicare for People With Disabilities
and the Marketplace
 You may qualify for Medicare based on a disability
• You must be entitled to Social Security Disability
Insurance (SSDI) benefits for 24 months

On the 25th month, you’re automatically enrolled in
Medicare Part A and Part B
 If you’re getting SSDI, you can get a Marketplace
plan to cover you during your 24-month waiting
period
• You may qualify for premium tax credits and reduced
cost-sharing until your Medicare coverage starts
June 2017 Understanding Medicare 114
 Marketplace/Medicare
Enrollment Considerations
 If you don’t enroll in Medicare when you’re first eligible
(Initial Enrollment Period)
• A late enrollment penalty may apply (lifetime penalty for as long
as your have Part B)
• You generally can’t enroll until the Medicare General Enrollment
Period (January 1 to March 31) and coverage won’t start until
July 1
 If your Marketplace plan isn’t through your employer and
you must pay a premium for Part A, you would need to
drop Part A and Part B to be eligible to get a Marketplace
plan
• However, if you’re also getting Social Security benefits, you
would have to drop your Social Security if you drop Medicare
June 2017 Understanding Medicare 115
 Check Your Knowledge—Question 8

You can enroll in the

Individual Marketplace
instead of Part B and
get Part B later using a
Special Enrollment
Period.
a. True
b. False

June 2017 Understanding Medicare 116

 Introduction to Medicare Resources Guide
Resources
Centers for Medicare & Medicaid Services (CMS) Medicare Plan Finder
• 1-800-MEDICARE (1-800-633-4227). • [Link]/find-a-plan
TTY: 1-877-486-2048. State Health Insurance Assistance Programs and State
• [Link] Insurance Departments
• [Link]
• [Link]/
Social Security • [Link]/
• 1‑800‑772‑1213. TTY: 1‑800‑325‑0778 U.S. Department of Health and Human Services,
• [Link]/ Office for Civil Rights
Railroad Retirement Board • [Link]
• 1-877-772-5772. TTY: 1-312-751-4700 • [Link]/ocr/office/[Link]
• [Link]/ • 1-800-368-1019. TTY: 1-800-537-7697
Affordable Care Act Additional Resources
• [Link] • [Link]
• [Link]/healthcare/about-the-aca/[Link] • [Link]

June 2017 Understanding Medicare 117

 Introduction to Medicare Resources Guide
(continued)
Medicare Products
1. “Medicare & You Handbook” 9. “Medicare Hospice Benefits”
CMS Product No. 10050 CMS Product No. 02154
2. “Your Medicare Benefits” 10. “Who Pays First”
CMS Product No. 10116 CMS Product No. 02179
3. “Choosing a Medigap Policy: A Guide to Health 11. “Your Guide to Medicare Prescription Drug
Insurance for People with Medicare” Coverage”
CMS Product No. 02110 CMS Product No. 11109
4. “Medicare & the Health Insurance Marketplace” 12. “Getting Help with your Medicare Costs”
CMS Product No. 11694 CMS Product No. 10126
5. “Welcome to Medicare” 13. “Medicare & the Health Insurance Marketplace”
CMS Product No. 11095 CMS Product No. 11694 “
6. “Are You a Hospital Inpatient or Outpatient?” To access these products
CMS Product No. 11435
• View and order single copies at
7. “Medicare Coverage of Skilled Nursing Facility Care” [Link]/publications
CMS Product No. 10153
• Order multiple copies (partners only) at prod
8. “Medicare and Home Health Care” [Link].
CMS Product No. 10969 You must register your organization.

June 2017 Understanding Medicare 118

 Acronyms
 BPH Benign Prostatic Hyperplasia  FPL Federal Poverty Level
 BFCC-QIO Beneficiary and Family Centered  GEP General Enrollment Period
Care Quality Improvement Organization  HMO Health Maintenance Organization
 CHAMPVA Civilian Health and Medical  HMOPOS HMO Point-of-Service
Program of the Department of Veterans
 IEP Initial Enrollment Period
Affairs
 CHIP Children’s Health Insurance Program  IRMAA Income-Related Monthly
Adjustment Amount
 CMS Centers for Medicare & Medicaid
 IRS Internal Revenue Service
Services
 COBRA Consolidated Omnibus Budget  LIS Low-Income Subsidy
Reconciliation Act  MA Medicare Advantage
 DME Durable Medical Equipment  MA-PD Medicare Advantage Prescription
 EGHP Employer Group Health Plan Drug
 ESRD End-Stage Renal Disease  MRI Magnetic Resonance Imaging

 FDA Food and Drug Administration  MSA Medical Savings Account

 FICA Federal Insurance Contributions Act  MSN Medicare Summary Notice

 NTP National Training Program

June 2017 Understanding Medicare 119

 Acronyms (continued)
 NPI National Provider Identifier  SHIP State Health Insurance Assistance
 OEP Open Enrollment Period Program
  SHOP Small Business Health Options
PACE Programs of All-inclusive Care for the
Elderly Program
  SLMB Specified Low-income Medicare
PDP Prescription Drug Plan
Beneficiary
 PFFS Private Fee-for-Service
 SNF Skilled Nursing Facility
 PPO Preferred Provider Organization
 SNP Special Needs Plan
 QDWI Qualified Disabled & Working
 SPAP State Pharmaceutical Assistance
Individuals
Program
 QI Qualifying Individual
 SSA Social Security Administration
 QMB Qualified Medicare Beneficiary
 SSDI Social Security Disability Insurance
 QHP Qualified Health Plans
 SSI Supplemental Security Income
 RNHCI Religious Nonmedical Health Care
 TFL TRICARE for Life
Institution
  TTY Teletypewriter
RRB Railroad Retirement Board
 SEP Special Enrollment Period

June 2017 Understanding Medicare 120

 This Training is Provided by the

CMS National Training Program (NTP)

To view all available NTP training materials,
or to subscribe to our email list, visit
[Link]/outreach-and-education/training/CMSNational
TrainingProgram
.

Stay connected.
Contact us at training@[Link], or
follow us @CMSGov #CMSNTP
June 2017 Understanding Medicare 121