Medicare, Medicaid & the Marketplace

1. Medicare, Medicaid & the Marketplace Alaska Primary Care Association September 2014

2. Medicare • Health Insurance for people • 65 and over • on disability (SSDI) • End Stage Renal Disease, Lou Gehrig Disease

3. Medicare ++++ • Many people have Medicare only • Some have Medicare and a Medicare Supplement • Medicare works with Medicaid • Medicare works with IHS/tribal healthcare • Veterans can also have Medicare • It’s not “one or the other”

4. Medicare Part A • Part A – helps pay for inpatient hospital stays, skilled nursing facility care, home health care, hospice care and blood • Premium free – no monthly premium if you or your spouse paid Medicare taxes while working – 40 or more credits (FICA). • 30-39 work credits - $234/month • Less than 30 work credits - $426/month

5. Medicare Part B • Medicare Part B covers a variety of medically-necessary outpatient services and supplies: • Doctors’ Services • Outpatient Medical and Surgical Services • Laboratory, Diagnostic services • Durable Medical Equipment • Home Health Services • Part B premium is $104.90 - paid by state if on Medicaid or Medicare Savings (SLMB)

7. Medicaid Basics • Medicaid is the primary public program for financing basic health and long-term care services for low-income Alaskans. Focuses on coverage for low-income children, pregnant women, families, the elderly, blind and permanently disabled.

9. Medicare & Medicaid key points: • Help people re-certify for Medicaid • Medicare is primary; Medicaid pays last • Bring proof of both coverages to providers • Get/keep Part A and B – the state buys premiums • Medicaid stops covering prescriptions, so dual beneficiaries need to have Part D

10. The Marketplace • Must meet the ACA’s requirement to maintain Minimum Essential Coverage • For people who do not have insurance • If a person is 65+ they can have Medicare • Most have premium-free Part A

11. Frequently Asked Questions • Prohibition against the sale of duplicate coverage to an individual with Medicare • What if a person is eligible but not enrolled? • What if they have Part B only? • What if they don’t have free Part A?

12. Questions? Judith Bendersky, MPH Gerontologist 907-269-3669 judith.bendersky@alaska.gov PriyaHelweg, Office of External Affairs CMS 206-615-2598 priya.helweg@cms.hhs.gov