OPEN ENROLLMENT 2021 | 2022 - Michigan Drug Assistance Program & Premium Assistance Program
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
OPEN ENROLLMENT
2021 | 2022
Michigan Drug Assistance Program
& Premium Assistance Program
1
MEET THE PRESENTERS
Amber Smith Ellie Curriston Shelli Doll
Premium Assistance Premium Assistance MIDAP Coordinator
2
AGENDA
• MIDAP | Premium Assistance
Program Overview
• Open Enrollment 2021/ 2022
• Understanding Medicare – Parts
A, B, C, and D
• Extra Help | Low-Income
Subsidy (LIS)
• Marketplace Basics
• Temporary Coverage
• Tips for Open Enrollment
Success
3PROGRAM OVERVIEW
The Michigan Drug Assistance Program (MIDAP) is a federally funded program
that provides HIV (and other related) medications to eligible applicants who
have limited or no access to insurance coverage. Premium Assistance is a
program within MIDAP that will pay monthly health insurance premiums for
clients with MIDAP.
In order to be eligible for MIDAP, applicants must meet the
following criteria:
• Provide proof of HIV status
• Be a resident of the State of Michigan
• Have a gross income between 138% - 500% of the Federal
Poverty Level (FPL)
• Cannot be eligible for any other insurance program. MIDAP is
the payer of last resort.
4Michigan Drug Assistance Program Premium Assistance Program (PA) Insurance Assistance Program (IAP)
(MIDAP)
FEDERALLY FUNDED STATE FUNDED
FEDERALLY FUNDED
HIV Status Eligibility HIV Proof of Status is required one time at HIV Proof of Status is established during initial HIV + determined by a physician or nurse
Requirements MIDAP initial enrollment MIDAP enrollment practitioner
Disability Requirement No disability requirement No disability requirement Physician or Nurse Practitioner must determine
whether the client is too sick to work now or will
be too sick to work in the next 90 days
Income Eligibility Applicants’ gross income must fall between Applicants’ gross income must fall between Monthly gross income limit less than 200% of the
138%-500% of the FPL. $1,481.00-$5,370.00 138%-500% of the FPL. $1,481.00-$5,370.00 FPL. $2,147.00 per month (for a household size
Federal Poverty Level
per month (for a household size of 1) per month (for a household size of 1) of 1)
(FPL) Limits
Cash Asset Limits Does not apply Does not apply Cash asset limit is less than $10,000 (does not
include home or car) Must include verification
of assets.
Medicaid Applicants must not be eligible for Medicaid. Applicants must not be eligible for Medicaid. Applicants may be eligible or be receiving
Medicaid and/or Medicare.
However, applicants that have Medicaid However, applicants that have Medicaid Spend-
Spend-down, Emergency Services Only (ESO) down, Emergency Services Only (ESO) or MOMs
or MOMs are ELIGIBLE for MIDAP. are ELIGIBLE for MIDAP.
Prescription Coverage MIDAP pays the full cost of medications for MIDAP/PA pays copays for members who have Does not apply
members who have no insurance or who are Employer Sponsored Insurance, Private
pending Medicaid. Insurance, VA/Tricare, Indian Health Services,
Medicare Part C or D, COBRA, or a Qualified
Health Plan.
Insurance Coverage Members that are active on MIDAP and have MIDAP/PA pays premiums, medication related Clients must not be eligible for any other group
either a Medicare Part C or D Plan, COBRA or a coinsurance and deductibles for members who health insurance plan. Active IAP clients with
Qualified Health Plan could be eligible for have Medicare Part C or D, COBRA, or a Medicare Part D coverage may be eligible to
Premium Assistance. Qualified Health Plan. have the Medicare Part D paid for by IAP (only if
20XX Pitch deck title 5
the client is on Medicaid).HOW TO APPLY FOR MIDAP
For technical issues
related to the online
application contact
MIDAP Online MIDAP at (888) 826-
Application 6565
Premium Assistance
Application For MILogin
There are two ways to
assistance contact the
apply for MIDAP
client service center at
(517) 241-9700 or
1-800-968-2644
Paper Application
6WHAT DOES MIDAP COVER?
INSURANCE INCOME WHAT MIDAP COVERS
DHS/Medicaid Pending 0-138% Full cost of medications for 60 days while pending
Medicaid
ACA/Qualified Health Plans 139%-500% FPL Premiums, Medication-related Deductibles, Co-
insurances, Co-pays
Medicare Part C (Advantage Plan) 139%-500% FPL Premiums, Medication-related Deductibles, Co-
Medicare Part D (Prescription Plan) insurances, Co-pays
COBRAIMPORTANT DATES
15 Oct. – 7 Dec. 2021 1 Jan. 2022
Medicare Open Enrollment period Insurance Coverage for 2022 Begins for
all Medicare clients, and ACA clients IF
client was registered no later than
December 15th, 2021
Marketplace Open Enrollment Period 1 Feb. 2022
Insurance Coverage for 2022 Begins for
1 Nov. – 15 Jan. 2022 ACA clients registered between
December 16th and January 15th
8MEDICARE BASICS
ELIGIBILITY
REQUIREMENTS
• An Individual is eligible for Medicare if:
• They or their spouse working for at least 10 years in
Medicare-covered employment
• Are 65 years or older
• Are a citizen or permanents resident of the United
States
*If an individual is not yet 65, they might also qualify for coverage if
they have a disability or have End-Stage Renal Disease (permanent
kidney failure requiring dialysis or transplant)
9Medicare Part A Medicare Part B
(Hospital Insurance) (Medical Insurance)
MEDICARE • Covers inpatient care in hospitals
•
•
Covers doctor visits and outpatient care
Surgical services and supplies
COVERAGE •
•
Critical access hospitals
Inpatient rehabilitation facilities
•
•
Durable medical equipment
Outpatient medical services and supplies
TYPES
• Long-term care hospitals
• Outpatient mental health care
• Inpatient care in a Religious Non-Medical Health
• Outpatient physical therapy
Care Institution
• Occupational therapy
• Hospice care services
• Speech-language therapy
• Home health care services
• Home health services
• Some preventive services
Medicare Part C Medicare Part D
(Medicare Advantage Plan) (Prescription Drug Coverage)
• Plans are offered through private health plans • Helps cover the cost of prescription drugs
• Includes Medicare Part A, B & D and usually • Each Medicare drug plan has its own list of
additional services may be included depending on covered drugs
the plan that is chosen (vision, hearing, dental) • Many Medicare drug plans place drugs into
• Most plans also provide prescription drug different “tiers”
coverage • Drugs in each tier have a different cost
• Coverage may be limited to a network of providers o Lower tier = Lower cost; Higher tier =
Higher cost
10MIDAP MEDICARE COVERAGE
Medicare Part C Medicare Part D
(Medicare Advantage Plan) (Prescription Drug Coverage)
• Plans are offered through private health • Helps cover the cost of prescription
plans drugs
• Includes Medicare Part A, B & D and usually • Each Medicare drug plan has its own list
additional services may be included of covered drugs
depending on the plan that is chosen • Many Medicare drug plans place drugs
(vision, hearing, dental) into different “tiers”
• Most plans also provide prescription drug • Drugs in each tier have a different cost
coverage o Lower tier = Lower cost
• Coverage may be limited to a network of o Higher tier = Higher cost
providers
NOTE: Premium Assistance does not pay late enrollment penalties.
11The following documentation must be submitted to Premium
Assistance no later than:
Monday, December 20th, 2021
1. Open Enrollment Response Form and/or the January
PREMIUM invoice for their 2022 Medicare Part C or D Policy.
ASSISTANCE
2. LIS information, if applicable.
REQUIREMENTS
FOR MEDICARE
OPEN Premium Assistance Requirement for Medicare Open
ENROLLMENT Enrollment are separate from any MIDAP Recertifications or
Verifications.
If a client is due to recertify or verify with MIDAP, they will
need to do this in addition to submitting their required
Premium Assistance documentation.LOW-INCOME SUBSIDY (LIS) /
EXTRA HELP PROGRAM
This program is available to assist eligible
Applicants with Medicare recipients with the out-of-
Medicare Part D
coverage and whose pocket expenses associated with
income is under the Medicare Part D Prescription Plan.
150% FPL are Applicants can apply in any of the
required to apply for
the Low-Income following ways:
Subsidy (LIS) / Extra 1. Online at: www.socialsecurity.gov/extrahelp
Help Program. 2. Call Social Security at 1-800-772-1213 (TTY
1-800-325-0778) to apply over the phone
or request an application; or
3. Apply at their local Social Security Office
13LOW-INCOME SUBSIDY (LIS)
Once the Applicant receives notification whether they are
approved or denied for lis, a copy of the denial letter or an
updated copy of the invoice, if approved, must be sent to
premium assistance. If the applicant is:
Approved for full subsidy LIS/ Extra Help: The applicant may have no costs for
their out-of-pocket expenses such as reduced premiums, deductibles, and
coinsurance. An application who receives a 100% premium subsidy is not
necessarily “full subsidy eligible”. A person who fails to meet the lower resource
standards may receive a 100% premium subsidy but may pay an annual
deductible and higher copayments than a “full subsidy eligible” individual.
Approved for partial subsidy LIS/Extra Help: The applicant will have reduced out-
of-pocket expenses. MIDAP will assist with the remaining out-of-pocket expenses
(reduced premiums, deductibles, and coinsurance could be reduced).
Denied for LIS/Extra Help: The applicant will have no costs for their out-of-pocket
expenses. MIDAP will be assisting with all remaining out-of-pocket expenses (
reduced premiums, deductibles, and coinsurance).
14PREMIUM ASSISTANCE
REQUIREMENTS FOR LIS
Premium Assistance will reference the client’s invoice and household income to address the
Low-Income Subsidy.
A client meets the
The subsidy is
Premium Assistance
reflected on the
requirements of LIS if
Medicare Part D
any ONE of the
invoice.
following are met:
They provide proof
Their household that they were
income is above previously denied for
150% FPL. the Low-Income
Subsidy.
15PREMIUM ASSISTANCE
REQUIREMENTS FOR LIS
A client does not meet
the Premium Assistance The subsidy is not
requirements for LIS if reflected on the
ALL the following are Medicare Part D invoice.
met:
They have not provided
proof that they were
Their household income
previously denied for
is below 150% FPL
the Low-Income
Subsidy.
16MARKETPLACE / AFFORDABLE
CARE ACT (ACA) BASICS:
Open Enrollment is November 1, 2021 – January 15, 2022
Apply or update plan through www.healthcare.gov – It is highly recommended that clients review
their plan on an annual basis, even if they want to keep the same plan.
If your client has a 2021 ACA Plan, they can renew, change, or update their plan.
If the client choose not to renew, update, or enroll in a different plan by the deadline, the
Marketplace may auto-enroll them in their same plan OR in a similar plan.
It is highly recommended that your client update their marketplace application with their most recent
2021 income and household size by November 1st in order to receive the best benefits and savings.
17MARKETPLACE / AFFORDABLE
CARE ACT (ACA) BASICS:
All metal levels covered by Premium Assistance (Platinum, Gold, Silver, Bronze)
Catastrophic Plans are NOT covered by Premium Assistance.
Marketplace Cost Assessment will determine if any plans do not meet
Federal Program requirements.
Notification will be sent out if any specific plans do not meet the Federal
requirements.
MIDAP and Premium Assistance do not cover any costs related to doctor
visits.
18MARKETPLACE METAL TIERS
BRONZE SILVER GOLD / PLATINUM
Cheapest monthly costs but Middle-of-the-road plans that Most expensive but have strong
generally have high deductibles or balance coverage with monthly cost-sharing benefits and low
costs. deductibles.
fewer cost-sharing benefits.
Best for: Most people, including Best for: Those who expect to need
Best for: Those who are young and significant medical care.
healthy or who don’t expect to need those who expect to have typical
significant medical care. medical needs.
19SPECIAL ENROLLMENT
PERIOD (SEP)
WHAT IS A SPECIAL ENROLLMENT PERIOD?
This is a time outside of the yearly Open Enrollment Period when an individual can sign up
for health insurance if they’ve experienced one or more of the following:
• Loss of Health Insurance Coverage
• Moving
• Getting Married
• Having a baby or adopting a child
NOTE: You cannot change or enroll in a plan until the next Open Enrollment Period
unless the client qualifies for a Special Enrollment Period.
20NEW LOW-INCOME SEP
• Unlike existing SEPs, the low-income SEP would not be time-limited based on a
qualifying event. Instead, an individual could enroll at any time during the year
based on income.
• Monthly SEP for individuals who are eligible for advance premium tax credits and
whose household income is under 150 percent of the federal poverty level (FPL) (
That’s a maximum income of $19,230 per year for individuals).
• This includes people who already had an income in the subsidy-eligible range, as
well as people who were previously ineligible due to the subsidy cliff (ie, their
income was over 400% of the poverty level).
• This includes lawfully present immigrants who otherwise qualify for advance
premium tax credits.
• Individuals who qualify can enroll in any metal level of coverage. But those who are
already enrolled and want to use the SEP to switch marketplace plans during the
year would be limited to switching to a silver plan. Individuals could not, say, switch
to a gold plan mid-year and then back to a silver plan. But individuals could move
from their current silver plan to a silver plan with a more generous (or simply
different) provider network or drug formulary.
21The following documentation must be submitted to
Premium Assistance no later than:
Monday, December 20th, 2021
PREMIUM 1. Open Enrollment Response Form and/or the
January invoice for the 2022 Marketplace policy
ASSISTANCE
REQUIREMENTS 2. Marketplace Eligibility Letter
FOR ACA OPEN
ENROLLMENT
Premium Assistance Requirement for Marketplace Open
Enrollment are separate from any MIDAP Recertifications
or Verifications. If a client is due to recertify or verify with
MIDAP, they will need to do this in addition to submitting
their required Premium Assistance documentation.PREMIUM ASSISTANCE REQUIREMENTS FOR ACA OPEN ENROLLMENT All members on the insurance policy must be active on MIDAP. If someone on the policy is not active on MIDAP, Premium Assistance will not pay for that individual. PA only pays the portion of the premium that includes active MIDAP members. Premium Assistance does not cover Vision and/or Dental insurance unless they are all bundled into one policy.
MARKETPLACE FEDERAL POVERTY LEVELS
(FPL) & PREMIUM TAX CREDIT
ELIGIBILITY ELIGIBILITY:
LETTER • INCOME ELIGIBILITY BETWEEN
100% AND 400% FPL: IF YOUR
INCOME IS IN THIS RANGE, IN
ALL STATES YOU QUALIFY FOR
• MUST BE SUBMITTED DURING
PREMIUM TAX CREDITS THAT
THE OPEN ENROLLMENT
LOWER YOUR MONTHLY
PERIOD
PREMIUM FOR A MARKETPLACE
• THE DOCUMENT MUST SHOW HEALTH INSURANCE PLAN.
THE ADVANCED PREMIUM
• INCOME ABOVE 400% FPL: IF
TAX CREDIT (APTC) AND THE
YOUR INCOME IS ABOVE 400%
AMOUNT THE CLIENT
FPL, YOU MAY NOW QUALIFY
QUALIFIES FOR
FOR PREMIUM TAX CREDITS
• CLIENT MUST APPLY THE THAT LOWER YOUR MONTHLY
ENTIRE APTC TO THE PREMIUM FOR A 2022
MONTHLY HEALTH INSURANCE MARKETPLACE HEALTH
PREMIUM INSURANCE PLAN.
24OPEN ENROLLMENT RESPONSE
FORM
• Can be used for temporary coverage if a client has
not received their January 2022 invoice from their
insurance company.
• To complete the form, the client will need to call
their insurance company directly (not the Social
Security Office) and ask for the required information
on the form.
• Will still be expected to send the Marketplace
Eligibility Letter with the form, if applicable.
THE CLIENT WILL STILL BE EXPECTED TO SUBMIT
THE JANUARY 2022 INVOICE NO LATER THAN
JANUARY 31, 2022.
25OPEN ENROLLMENT
RESPONSE FORM
WHERE TO SUBMIT:
• Case Managers will be REQUIRED to submit all
Open Enrollment documentation via MIDAP Online.
• The Response Forms will be mailed to each Premium
Assistance eligible client with a letter detailing the
requirements and a pre-paid envelope. If needed,
the client can also mail or fax the documents to:
MDHHS
P.O. BOX 30727
LANSING, MI 48909
FAX (517) 335-7723
26OPEN ENROLLMENT RESPONSE FORM
HOW TO SUBMIT ONLINE:
• “Complete Open Enrollment
Required Action” button
located on the Assist Applicant
page for existing Premium
Assistance clients.
• “Change of Status” for
existing MIDAP clients that are
new to Premium Assistance.
• “New Application” for clients
that are new to MIDAP and
Premium Assistance. Select
“yes” to the question on the
application asking if you
would like to be reviewed for
Premium Assistance.
27OPEN ENROLLMENT RESPONSE FORM
WHERE TO FIND THE FORM
• A copy of the letter and a blank copy of the form will be attached to
this presentation
• The form can also be located on the Premium Assistance website at
www.michigan.gov/dap and on the resources tab within the MIDAP
Online system at www.milogin.michigan.gov
• Open Enrollment Response forms were also mailed to all active
premium assistance clients, and all active MIDAP client that were
eligible for either Medicare or a Marketplace insurance plan
28TEMPORARY COVERAGE
Clients that are approved for temporary coverage will receive a letter that lists the documentation
required to make their application complete and the deadline for returning all paperwork.
Required documentation is not received by the Premium Assistance Program by the due date, the
client’s monthly premium payments could be jeopardized.
PREMIUM PAYMENTS WILL BE MADE FOR TWO CONSECUTIVE MONTHS, AND CLIENT WILL BE GIVEN
60 DAYS TO SUBMIT MISSING DOCUMENTATION IF:
• A LIS eligible client has provided proof of LIS application and is awaiting a determination.
ONE TIME PREMIUM PAYMENT WILL BE MADE, AND CLIENT WILL BE GIVEN 30 DAYS TO SUBMIT
DOCUMENTATION IF:
• A LIS eligible client has not submitted proof of LIS application and is requested to submit proof.
• A client submitted an Open Enrollment Response form without an invoice, the client must submit
the invoice no later than January 31, 2022.
29TIPS FOR SUCCESS
Clients applying for Premium Assistance must be active on MIDAP.
Clients will receive the Open Enrollment Response Form and a prepaid return
envelope, along with a letter explaining the process of Open Enrollment in detail.
Any recertifications due during Open Enrollment must be completed separately.
Check MIDAP Online to verify application status and any other notes from MIDAP staff.
Complete applications are CRUCIAL for the payment to be submitted correctly and on
time.
Number of calls/voicemails increase during open enrollment. Please allow at least 48
hours for return calls.
20XX 30QUESTIONS?
31Elise Curriston
THANK
Premium Assistance
Phone: (517) 335-5055
Email: Curristone1@michigan.gov
YOU Amber Smith
Premium Assistance
Phone: 517-335-5061
Email: SmithA112@michigan.gov
Shelli Doll
MIDAP Coordinator
Phone: (517) 897-6400
Email: Dolls@michigan.gov
MIDAP Mainline
(888) 826-6565You can also read
