Make Medicare Work Coalition (MMW)

Bulletin Newsletter

February 25, 2016
To view other MMW materials and resources, including past MMW Bulletin newsletters, fact sheets, and recorded webinars, visit our MMW Coalition webpage at

Medicare Updates
CMS Fact Sheet: 2016 Medicare Amounts
CMS has released a tip sheet that lists Medicare's 2016 cost sharing amounts, which include Medicare Part A and Part B premiums, deductibles, and co-insurance amounts. The tip sheet also details the different Part B monthly premium amounts for beneficiaries who are not "held harmless," as well as the Part B and Part D Income Related Monthly Adjustment Amounts (IRMAA) for beneficiaries with higher incomes.
New Tip Sheet on How to get Your Medicare Summary Notice in Spanish
The Illinois Senior Medicare Patrol (SMP) has created a tip sheet in Spanish on how a beneficiary can request a Medicare Summary Notice (MSN) in Spanish by calling 1-800-MEDICARE. The tip sheet explains the steps a Spanish-speaking beneficiary can take to contact Medicare and request the MSN. It also explains what a MSN is, why it is important to review them on a regular basis, and what types of information an individual will need to have on hand when contacting Medicare. The tip sheet also provides an overview about the Illinois SMP program and why it is important to detect and report fraud. Click here to view the tip sheet.
The Illinois SMP has also created additional MSN resources, including a useful guide in English and Spanish on "How to Read Your Medicare Summary Notice" that is available here.
CMS Discontinues Initial Enrollment Questionnaire
Beginning January 1, 2016, the Centers for Medicare and Medicaid Services (CMS) will discontinue mailing the Initial Enrollment Questionnaire that was included in the enrollment package mailed to newly eligible Medicare beneficiaries. The IEQ was previously used to collect information about whether a beneficiary has other health insurance that pays primary to Medicare. The information obtained from the IEQ was maintained by the Medicare Benefits Coordination and Recovery Center (BCRC), which also gathers information about other insurance payers besides Medicare. Medicare will continue to collect information from other insurers on a regular basis from sources that are more accurate than the information reported on the IEQ.
Individuals who received an IEQ prior to January 1st should still complete it via by July 1st. Beneficiaries who have other insurance besides Medicare will still be able to self-report it to the BCRC by calling 1-855-798-2627.
Extra Help Updates
New 2016 Extra Help Income and Asset Limits
The U.S. Department of Health and Human Services (HHS) recently announced the 2016 Federal Poverty Levels (FPLs). These levels are updated every year and used to determine the income limits for many federal benefit programs, including Extra Help. (Please see the "Other Resources" section below for the most current AgeOptions Chart of Benefits, which lists the income limits for other federal programs, such as Medicaid and Medicare Savings Programs).
The new Extra Help program (also referred to as the Low-Income Subsidy or LIS) income and asset limits for 2016 are as follows:
2016 Annual LIS Income Limits*
2016 LIS Resource Limits*
Full LIS
Single         $1,336/month
Single           $8,780
Married       $1,802/month
Married         $13,930
Partial LIS
Single         $1,485/month
Single           $13,640
Married       $2,002/month
Married         $27,250
*Resource limits include $1,500 per person for burial expenses.  
Whether individuals qualify for full or partial LIS depends on their income and assets.
Full LIS provides the following benefits to a beneficiary who is enrolled in a Part D plan:
    • The entire monthly Part D plan premium is covered if the plan is at or below the Part D LIS benchmark and a basic plan. The benchmark amount is calculated by the Center for Medicare and Medicaid Services (CMS) and changes every year. LIS beneficiaries in plans with premiums that are above the benchmark or in an enhanced plan will be responsible for the premium amount that is over the benchmark or the portion of the plan that makes it enhanced. The LIS benchmark for Illinois in 2016 is $28.23.
    • The entire Part D plan drug deductible is covered (up to $360 in 2016).
    • Help with their drug co-pays: consumers pay $1.20/$3.60 (generic/brand name) or $2.95/$7.40 (generic/brand name)
    • Eliminates the donut hole - beneficiaries pay low co-pays throughout the year for formulary drugs
    • Individuals with full LIS who reach their True Out-of-Pocket (TrOOP) limit ($4,850 in 2016), will not have any drug co-pays for the remainder of the calendar year.
    • People on any level of LIS have a continuous Special Enrollment Period (SEP) to change Part D plans anytime during the year (up to once per month, although it is not recommended to switch that often).
    • The Part D late enrollment penalty is waived
    Partial LIS provides the following benefits:
    • CMS will pay either the entire amount or a portion of the Part D plan premium, depending on the person's LIS subsidy level. If the person is at the higher end of the income limit for LIS, they will be responsible for part of their premium regardless of whether it is at or below the benchmark.
    • Pays part of the drug plan deductible. People with partial LIS will have an annual $74 drug deductible in 2016 (if the plan has a deductible) that must be met before they receive assistance paying for their drugs.
    • Helps pay for prescription co-pays: individuals with partial LIS pay $2.95/generics and $7.40/brand names or 15% coinsurance for covered drugs. The amount they pay will depend on their income and asset levels.
    • Reduced cost in the donut hole. Once beneficiaries with partial LIS reach the TrOOP amount, they have a co-pay of $2.95 for generics/$7.40 for brand names for the remainder of the calendar year
    • People on any level of LIS have a continuous Special Enrollment Period (SEP) to change Part D plan anytime during the year.
    • The Part D late enrollment penalty is waived for as long as they have LIS.
    Note: Individuals with Medicare and Medicaid who live in a long-term care facility or receive home and community based services through a Medicaid waiver program) automatically qualify for full LIS and receive assistance paying for their entire monthly premium, annual drug deductible and do not have any drug co-pays.
Marketplace Updates
Marketplace Open Enrollment Period Ends: What Now?
The Marketplace Open Enrollment Period ended on January 31, 2016. This means that individuals will no longer be able to enroll in a plan for coverage in 2016 unless they qualify for a special enrollment period.
Marketplace plans may have changed in 2016. Individuals who had Marketplace plans in 2015 but did not take action to compare or renew their health plan will automatically be rolled over in 2016 to the same plan they had in 2015 (if it is still offered - they may be automatically put into a similar plan if it is not). If a person did not review their plan benefits during the past open enrollment period, they may be surprised to learn about premium, benefit and network changes.
An individual's Marketplace premium tax credit may also be different in 2016. . (Premium tax credits are a form of assistance provided to eligible individuals to help pay for Marketplace plans. An individual who receives a tax credit to help with their health insurance premiums can request to receive the full credit on their taxes, or they can apply a portion of it each month directly to their health plan's premium. Most people do the latter.) Individuals who did not update their expected 2016 income and household information may not receive the appropriate premium tax credit in 2016. This may result individuals having to pay back part of the premium tax credits they receive (if their income on file was under-reported) or not receiving enough of a premium tax credit (if income was over-reported). If an individual receives a higher premium tax credit in 2016 than they were eligible to receive, they will have to pay it back when they file their 2016 taxes. It is important to remember that individuals may report a change in income or household size at any time during their year by contacting the Marketplace.
Be aware of the penalty. Individuals who did not have minimum essential coverage in 2015 will be assessed a penalty for the months they did not have coverage when they file their taxes this year (unless they qualify for a hardship exemption). A hardship exemption is an exception that allows individuals to avoid paying the penalty for not having coverage. A list of qualifying exemptions can be found on the website here.
The penalty for not having coverage in 2015 is the higher of the following:
  • 2% of household income (with a maximum penalty of the national average premium for a Bronze plan sold through the Marketplace. In 2015, this national average premium amount was $2,484 for an individual and $12,240 for a family with five or more members.)
  • $325 per adult and $162.50 per child (with a maximum penalty of $975)
  Individuals who do not have minimum essential coverage in 2016, do not qualify for a hardship exemption, and did not enroll in a Marketplace plan during the open enrollment period for the 2016 coverage year will also have to pay a penalty next year when they file their 2016 federal tax returns. The penalty for not having coverage in 2016 will be greater and amount to an individual paying the higher of the following:
  • 2.5% of the household income (with the maximum being the total yearly premium for the national average price of a Bronze plan sold through the Marketplace)
  • $695 per adult and $347.50 per child (with the maximum being $2,085)
  To learn more about the individual mandate penalty, click here and visit CMS's blog about the penalty for not having health coverage here.
Marketplace Special Enrollment Periods
Just a reminder that individuals who experience a qualifying event or major life change, such as a loss of health coverage, a permanent move, a marriage, a birth, or a divorce, may qualify for a special enrollment period to enroll in health coverage through the Marketplace outside of the typical open enrollment period. The website has created a screening tool individuals can fill out to determine if they are eligible for a SEP. To apply for this SEP, individuals must call the Marketplace call center. Once they qualify, they have 60 days to select and enroll in a Marketplace plan. The Center of Budget and Policy Priorities has also created useful chart of Marketplace SEPs that lists each available SEP, what triggers it, who can use it and the timing of when the SEP goes into effect. Click here to view the chart.
CMS Eliminates Some Marketplace Special Enrollment Periods
Last month, CMS announced the elimination of some Health Insurance Marketplace special enrollment periods. Special enrollment periods (SEP) allow eligible individuals to enroll in a Marketplace insurance plan at times during the year that are outside of the standard open enrollment period. (For 2016 health coverage, the open enrollment period took place from November 1, 2015 - January 31, 2016.) CMS has eliminated six SEPs that were used in the past but are no longer considered necessary. These eliminated SEP's are listed on the CMS website and include:
    • Consumers who enrolled with too much in advance payments of the premium tax credit because of a redundant or duplicate policy
    • Consumers who were affected by an error in the treatment of Social Security Income for tax dependents
    • Lawfully present non-citizens that were affected by a system error in determination of their advance payments of the premium tax credit
    • Lawfully present non-citizens with incomes below 100% FPL who experienced certain processing delays
    • Consumers who were eligible for or enrolled in COBRA and not sufficiently informed about their coverage options
    • Consumers who were previously enrolled in the Pre-Existing Condition Health Insurance Program
CMS is also taking steps to clarify the guidelines for a SEP available to individuals who permanently move and have access to new health plans. CMS is clearly defining that this SEP cannot be used by individuals who plan a temporary or short-term move in which the individual does not plan to stay in their new location. CMS will continue to look at certain SEPs used by consumers to determine if additional guidance is required to guarantee that they are being used properly in qualifying circumstances.
Affordable Care Act Updates 
1095-B Forms from Medicare and Medicaid
CMS and the Illinois Department of Healthcare and Family Services (HFS) are mailing out notices to consumers. Each notice includes an IRS form labeled 1095-B. These notices are being mailed to individuals to notify them that the coverage they had through either Medicare Part A or Medicaid in 2015 meets the minimum essential coverage requirement under the Affordable Care Act. These forms serve as proof that individuals do not have to pay a penalty on their 2015 taxes. What action an individual must take if they receive either or both of these forms depends on whether they are required to file federal taxes.
If an individual is NOT required to file federal taxes and receives a notice from CMS and/or HFS, they can file the form away for safe keeping with other important tax documents. If an individual IS required to file taxes, they should carefully review the instructions mailed to them either by CMS or HFS along with each 1095-B form. This form is intended to be used as a reference for filing a tax return and does not need to be submitted along with their taxes. The form will indicate which months in 2015 they had coverage. Once their taxes are completed, the form can be filed away and kept as proof that they had minimum essential coverage in 2015.
Who will receive a notice and 1095-B form from CMS?
CMS is sending a letter along with IRS form 1095-B to Medicare beneficiaries with Medicare Part A who are under 65, those who enrolled in Part A for the first time in 2015, or those who had Part A for only a portion of 2015. Beneficiaries who are 65 or older or have had Part A for 12 months or more and are required to file federal taxes will not receive form 1095-B. These individuals will only have to check a box on their tax return indicating that they had minimum essential coverage for the entire year. Click here for more information and for a copy of the letter and form.
Who will receive a notice and 1095-B form from HFS?
HFS will mail out the notice and 1095-B form to people on Medicaid or Medicaid Spenddown to notify them that being on Medicaid meets minimum essential coverage. In addition, if an individual is on Medicaid Spenddown, the form will indicate which months they had coverage through Spenddown. A sample of the form can be found here. HFS has also released information and guidance about form 1095-B here.
Other Resources
Updated Chart of Benefits
AgeOptions has released an updated Chart of Benefits to reflect the recently announced Federal Poverty Levels. This chart is meant a resource tool for professionals to use when screening clients for benefit programs. The chart lists income, asset and eligibility requirements for various public programs in Illinois including Medicaid, Medicare Savings Program, Extra Help, the Benefits Access Program, Supplemental Security Income (SSI), LIHEAP, SNAP (Food Stamps), Access to Care, Community Spousal Impoverishment and other programs. 
Please note that this chart is designed for professionals, should not be altered, and should not be distributed to consumers. The chart is meant as a quick reference tool (a "cheat sheet") for counselors and does not provide detailed explanations for consumers about how each program works. The chart is updated whenever income, asset or eligibility requirements for programs change. Click here to view the chart.
Social Security Compassionate Allowances
The Social Security Administration (SSA) recently published a blog explaining their Compassionate Allowances program. Compassionate Allowances are a list of medical conditions meant to quickly identify individuals for disability status through SSA and allows SSA to quickly provide Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits to individuals who have a condition on the list. Click here to view a list of Compassionate Allowances. The newer allowances are listed in red.
MMAI and Health Insurance Marketplace Videos in American Sign Language
The MMW Coalition recently collaborated with the Chicago Hearing Society and created two educational videos in American Sign Language (ASL) explaining the Medicare-Medicaid Alignment Initiative (MMAI) and the Health Insurance Marketplace. Each video is filmed in segments to allow the viewer to watch at their own pace.
The MMAI videos explain the purpose of the program, who can enroll, covered health services, how to enroll in or get out of MMAI, and where to go for help. The Marketplace videos include information about what the Marketplace is, who is eligible to enroll in a Marketplace plan, plan costs, what health services are covered, enrolling in a plan and other helpful tips.
Both videos include closed captioning and voice-over narration; therefore, they are appropriate for individuals who are deaf or hard-of-hearing and use ASL, as well as for individuals who may prefer video format, have low vision or are limited English speakers. Visit our MMW webpage here to view the videos.

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