MEDICARE CORNER
BY FELICE HANNAH, AFSA/CSARC
OUTREACH LIAISON
Social Security Number Removal Initiative
(SSNRI)
The Social Security Administration is replacing
current the Health Insurance Claim Number
(HICN) with a Medicare Beneficiary Identifier
(MBI).
• 11-digits unique to each individual
• Numbers and letters upper- and lowercase
• Excluding S, L, O, I, B and Z (could be
mistaken for numbers)
• Will not include combinations of numbers
and/or letters which may be offensive
• Husband and wife will have their own MBI
• Identifiers, such as gender and signature will
not appear on the new Medicare Cards
• Beginning April 2018, people new to
Medicare will receive a card with MBI.
• Medicare Beneficiaries with current HICN
will receive their new card with MBI between
• April 2018–April 2019.
2018 Medicare Part B Income Related
Monthly Adjustment Amount (IRMAA)
A 2.2% COLA increase is predicted in 2018.
IRMAA is based on your Modified Adjusted
Gross income (MAGI) two years prior.
For example, if you filed taxes on 2015 income
in 2016, your Medicare Part B Premium payment
in 2017 is based on 2015 Income
The threshold for IRMAA remains at income
above $85,000 single and $170,000 couple.
Note Lower Thresholds for the following:
• Above $160,000/$320,000 in 2018 will be
Above $133,500/267,000
• Above $214,00/$428,000 in 2018 will be
Above $160,000/$320,000
• Part B Deductible, Premium and Therapy
Limits, Physical, Occupational and Speech
Therapy, will be are not available at this time
Higher Income Part D Premiums
MAGI:
$107,000/$214,000 = $13.00 + Plan Premium
$133,500/$267,000 = $33.60 + Plan Premium
$160,000/$320,000 = $54.20 + Plan Premium
Above $160,000/$320,000 = $74.80 + Plan
Premium
MEDICARE PART D 2018
• Initial Coverage Limit (3,750)
• After the deductible has been met (if
applicable) by the Beneficiary, the Plan pays
a percentage of the cost of the prescribed on
formulary drug
• The Beneficiary reaches the GAP (“Donut
Hole”) when the cost paid by the Beneficiary
and Part D Plan reaches $3,750
• Out of Pocket Threshold Limit (5,000)
• When the Maximum Out of Pocket (MOOP)
cost of the prescribed on formulary drug (paid
by the Beneficiary) reaches the Threshold
Limit, the Beneficiary reaches the Catastrophic
Coverage Level
o Beneficiary pays Greater of 5% or
$3.35/$8.35
o Beneficiary will continue to pay the
above amount for the remainder of the year
PART D Tiering Exceptions:
• Can request to be covered by a lesser
Preferred Generic or Brand Tier co-pay when
lower tier drugs may be ineffective or harmful
• Prescribing Doctor should complete standard
Coverage Determination Request Form
• Plan will make a decision within 24 hours
(if an emergency) or 72 hours
o Can appeal decision if denied
• Note: Brand Drugs cannot be appealed to
be covered at Generic Drug Tier Copay
• Tiering Exception cannot be made for
Specialty Tier Drugs
REMINDER! REMINDER!
Are You Out?
• As of March 8,2017 hospitals must give the
Beneficiary a Medicare Outpatient Observation
Notice (MOON), if Observation Service is
beyond 36 hours
• When covered by Original Medicare, under
observation Out-Patient hospital stay is covered
by Medicare Part B
o You may have out of pocket costs for
fixed copays, some procedures and/or drugs
administered by the hospital
• In-Patient hospital stay is covered by
Medicare Part A
• If transferred to a Skilled Nursing Facility,
Medicare will pay for the first 20 days of Skilled
Nursing Care, following a qualifying stay of three
full consecutive days as an In-Patient in the
hospital
o IMPORTANT to know if you are an
In-Patient or Out-Patient. Your out-of-pocket
cost could be exorbitant if transferred to a Skill
Nursing facility without a qualifying stay as
an In-Patient
MEDICARE: 2018 REVEALED
24 NORTH SHORE TOWERS COURIER ¢ November 2017